Capnography d. Gihan Tarabih

8/10/2019 Capnography d. Gihan Tarabih

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CAPNOGRAPHY-

and PULSE OXIMETRY: The Standard of

RESPIRATORY Care

Dr.Gehan A Tarrabih , MD ,

Ass. Prof .Anesthesia and SICU ,

Mansoura Faculty Of Medicine.


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CAPNOGRAPHY-OXIMETRY

Why use them?


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Capnography &

Pulse Oximetry

CO2:

Relects ventilation

Detects apnea and

hypoventilation

immediately

Should be used withpulse oximetry

O2 Saturation:

Reflects oxygenation

30 to 60 second lag

in detecting apnea or

hypoventilation

Should be used withcapnography


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Indications for Use -

End-Tidal CO2Monitoring Validation of proper endotracheal tube

placement

Detection and Monitoring of Respiratorydepression

Hypoventilation

Obstructive sleep apnea

Procedural sedation

Adjustment of parameter settings in

mechanically ventilated patients


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ETCO2& Cardiac Resuscitation

If patient is intubated and pulmonary

ventilation is consistent with bagging,ETCO2 will directly reflect cardiac output

Flat waveform can establish PEA Increasing ETCO2can alert to return of

spontaneous circulation

Configuration of waveform will change

with obstruction


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Capnography

What are we measuring?


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RespirationThe BIG Picture


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Capnography Depicts

Respiration


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Physiological Factors

Affecting ETCO2 Levels


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Normal Arterial &

ETCO2 Values


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Deadspace


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CAPNOGRAPHY

Theory of Operation


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Infrared Absorption

A beam of infrared light energy is passed

through a gas sample containing CO2

CO2 molecules absorb specific wavelengths

of infrared light energy.

Light emerging from sample is analyzed.

A ration of the CO2affected wavelengths tothe non-affected wavelengths is re[ported as

ETCO2


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Capnography vs.

Capnometry

Capnography:

Measurement and

display of both ETCO2

value and capnogram

(CO2waveform)

Measured by a

capnograph

Capnometry:

Measurment and

display of ETCO2

value

(no waveform)

Measured by a

capnometer


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Mainstream vs. Sidestream


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Quantitative vs. Qualitative

ETCO2

Quantitative ETCO2:

Provides an actual numericvalue

Found in capnographs and

capnometers

Qualitative ETCO2:

Only provides a range of values

Termed CO2Detectors


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Colorimetric CO2Detectors

A detector not a

monitor

Uses chemically treatedpaper that changes color

when exposed to CO2

Must match color to a

range of values

Requires six breaths

before determination

can be made


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CAPNOGRAPHY

The Capnogram


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Elements of a Waveform

Dead Space

Beginning of

exhalation

Alveolar

gas mixeswith dead

space

Alveolar

Gas

End

of

exhalation

Inspiration


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Value of the CO2Waveform

The Capnogram:

Provides validation of the ETCO2valueVisual assessment of patient airway integrity

Verification of proper ETT placement

Assessment of ventilator/breathing circuit integrity


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The Normal CO2Waveform

AB Baseline

BC Expiratory UpstrokeCD Expiratory Plateau

D ETCO2value

DE Inspiration begins


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Esophageal Tube

A normal capnogram is the best evidence that

the ETT is correctly positioned

With an esophageal tube little or no CO2 is

present


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Inadequate Seal Around ETT

Possible causes:

Leaky or deflated endotracheal ortracheostomy cuff

Artificial airway too small for the patient


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Hypoventilation

(increase in ETCO2)

Possible causes:

Decrease in respiratory rate

Decrease in tidal volume

Increase in metabolic rate

Rapid rise in body temperature (hypothermia)


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Hyperventilation

(decrease in ETCO2)

Possible causes:

Increase in respiratory rate

Increase in tidal volume

Decrease in metabolic rate

Fall in body temperature (hyperthermia)


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Rebreathing

Possible causes:

Faulty expiratory valve

Inadequate inspiratory flow

Insufficient expiratory flow

Malfunction of CO2absorber system


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Muscle Relaxants

Curare Cleft:

Appears when muscle relaxants begin to subside

Depth of cleft is inversely proportional to degree of

drug activity


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Faulty Ventilator

Circuit Valve

Baseline elevated

Abnormal descending limb of capnogram

Allows patient to rebreath exhaled gas


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Sudden Loss of Waveform

Apnea

Airway Obstruction

Dislodged airway (esophageal)

Airway disconnection

Ventilator malfunction

Cardiac Arrest


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QUIZ TIME


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#1

Normal capnogram

controlled ventilations

spontaneous respirations


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#2

Muscle relaxants

General anesthesiaThe cleft on the alveolar plateau is due to

spontaneous respiratory effort


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#3

Normal capnogram

Spontaneous ventilation in children

Sampling from nasal cannula or O2mask in adults


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#5

Bronchospasm


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#7

Esophageal intubation


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#8

Contamination of CO2sensor


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#9

Rebreathing


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#10

Flat line


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Waveform:

Regular Shape, Plateau BelowNormal

Indicates CO2deficiency

Hyperventilation

Decreased pulmonary perfusion

Hypothermia

Decreased metabolism

Interventions

Adjust ventilation rate

Evaluate for adequate sedation

Evaluate anxiety

Conserve

body heat


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Waveform:

Regular Shape, PlateauAboveNormal

Indicates increase in ETCO2

Hypoventilation

Respiratory depressant drugs

Increased metabolism

Fever, pain, shivering

Interventions

Adjust ventilation rate

Decrease respiratory depressant drug dosages

Assess pain management

Conserve body heat


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Questions


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Documents

Capnography d. Gihan Tarabih