Waveform capnography should be monitored in all intubated patients and displayed on the monitor (as above).etCO2 is a measurement of the partial pressure of CO2 in gas expired at the end of exhalation (when exhaled gas will most closely resemble the alveolar CO2 concentration).Understanding how to interpret etCO2 waveforms.Understanding changes in etCO2 within the context of other data (especially trends in minute ventilation).Paying attention to etCO2 values (e.g., noting them daily in reviews of the patient, along with other vital signs).Within the next decade, continuous waveform capnography will likely become a universal standard of care across all well-resourced intensive care units.Īs the use of waveform capnography expands, we need to be thoughtful about integrating this into our practice. Capnography is increasingly recommended both to confirm endotracheal tube insertion and to subsequently monitor the patency and effectiveness of ventilation throughout the duration of intubation. Capnography was pioneered in the operating room, but the safety implications for all critically ill patients are clear (the standard of safety monitoring in the ICU shouldn't be lower than in the operating room). Failure to use waveform capnography contributed to >70% of ICU-related airway deaths in the NAP4 audit. Waveform capnography is emerging as a standard monitoring tool to improve safety among intubated patients. Capnography Reference Handbook.Introduction – an emerging standard of care Abnormal capnography waveforms and their interpretation. Another option is colorific devices which use a pH detector for presence of CO 2, no number or waveform is generated.ĭeranged Physiology. Other methods to monitor Carbon dioxide ( CO 2) for confirmation of ETT position in the trachea during intubation: There are emergency tracheal intubation monitors, which use infrared technology and provide digital recording only, no waveform. Terminology Reminder: arterial blood gas analysis provides partial pressure of carbon dioxide in arterial blood (PaCO 2). Capnography ‘window’ adaptor in ventilator tubing has condensation, water drops or sputum effecting the reading: Action is to change the adaptor.Calibration error during set up: Action is to recalibrate.Tips & Tricks: Baseline (Phase 1) should be 0, any deviation from this should warrant further checks: A leak in the sampling system or around the ET tube.ARDS (causing a ventilation-perfusion mismatch).COAD (causing incomplete alveolar emptying).Mind The Gap: Arterial to End-Tidal CO 2 Gradient which under normal physiologic conditions, the difference between arterial Pa CO 2(from ABG) and alveolar end-tidal carbon dioxide (ET CO 2 from capnograph) is 2-5 mmHg. Use the data trend for ET CO 2, along with SP O 2 and ventilator information. During cardiac arrest for quality of compressions and return of spontaneous circulationīenefits: rather than taking endless blood samples, if the patient has an ETT or trache then capnography will provide end-tidal carbon dioxide (ET CO 2).Procedural ventilation monitoring (non intubated).What are ‘ normal’ ranges‘ for end-tidal carbon dioxide (ET CO 2)?: 35-45 mmHg. This is actually phase 0, reflecting the inspiratory downstroke and the beginning of inspiration. If rebreathing occurs, the angle is greater than 90 degrees. The beta angle can be used to assess rebreathing. The transition from phase III to 0 is the beta angle.ī. This is normally the PET CO 2 (also known as End Expiration measured ET CO 2).Ī.
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