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Dr Ajmal Eusuf
ICU Monitoring Standards and Capnography
Current Monitoring
• Personnel
• Patient monitoring
• Equipment monitoring
Current Monitoring-patient
• Saturations and gases
• ECG
• Blood pressure
• Respirations
• Heart and lungs should have clinical monitoring intermittently
Current monitoring-equipment
• Ventilator failures and supply
• Oxygen analysis
• Disconnection alarms
• Volume and pressure alarms
• Temperature
Rational for capnography
• Would you put a patient to sleep in theatre without capnography being present?
• Would you keep them asleep without capnography?
• Must of our theatre patients are fit and well• ICU patients are sicker • One set of equipment for all the unit which
takes a few minutes to set up
Capnographic analysis
• Primarily used for correct intubation
• Can also be used for 1)tidal volume
• 2) dead space
• 3) partial obstruction
• 4) breath stacking
• 5) analysis of chronic airway disease
• Examples:
• Normal
• Capnograph breating around tube
• CPR capnograph
• Disconnection
• Oesophageal intubation
• Hyperventilation
• Hypoventilation
• Rising baseline
• ROSC
• Sharkfin
• Phase 1- anatomical and apparatus dead space
• Phase 2- mixing of dead space and alveolar CO2
• Phase 3- alveolar plateau
• Phase 4- start of inspiration
Critical incidents
• In theatre! Australian study showed endobronchial intubation was most common incident at 42%
• Oesophageal intubation was 18%
• 58% of these incidents were picked up via CO2 and SpO2, 25% picked up clinically
• Was calculated that 93% of all incidents should be picked up via CO2, SpO2 and BP.
Comparisons
• Anaesthetic and recovery guidelines are roughly the same
• American ICS specifies capnography as mandatory monitoring
• UK ICS still debating this
• Most units now have capnography as mandatory for intubation purposes, but only 50% use this!
• Comparisons of theatre and ICU patients
Conclusion
• Capnography has a wide range of uses
• For better compliance of UK unit protocols, probably need it as bedside monitoring
• Lagging behind other world-wide practises
• Probably needed more by ICU than theatres?
Any Questions?
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