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Anesthesia Monitoring and Management
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
The capnograph is a non-invasive device with an adaptor that connects between the endotracheal tube and the Y-piece, or samples directly from the endotracheal tube. Sidestream sampling: exhaled gas is aspirated from the adapter between the endotracheal tube and the Y-piece and delivered to the capnometer (Figure 7.13).Mainstream sampling: the measuring device itself is placed between the endotracheal tube and the Y-piece (Figure 7.14).
Chronic respiratory failure – pathophysiology
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Mafalda Vanzeller, Marta Drummond, João Carlos Winck
Capnography refers to the noninvasive measurement of the partial pressure of carbon dioxide (PCO2) in exhaled breath expressed as the CO2 concentration during time (11). The relationship of CO2 concentration to time is graphically represented by the CO2 waveform, or capnogram. Changes in its shape are diagnostic of disease conditions, while changes in end-tidal CO2 (EtCO2 − the maximum CO2 concentration at the end of each tidal breath) can be used to assess disease severity and treatment response (11). EtCO2 measurement is accomplished by placement of an infrared sensor in the arm or ear of the patient. A beam of infrared light is passed across the gas sample to fall on a sensor. The presence of CO2 in the gas leads to a reduction in the amount of light falling on the sensor, which changes the voltage in a circuit. The analysis is rapid and accurate and is the result of the human breath infrared absorptive power. Capnography became a routine part of anaesthesia, and EtCO2 is now being routinely used to titrate pressures in noninvasive ventilation laboratories and to monitor treatment efficacy. Capnography or EtCO2 provides instantaneous information about ventilation, perfusion and metabolism (how CO2 is eliminated, transported and produced) and complements the information given by pulse oximetry (11).
Nursing care of the cardiac catheterisation patient
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Julie Parkinson, Jo-Anne M. Vidal, Eva Kline-Rogers
If procedural sedation is used, nurses should continuously monitor pulmonary ventilation and oxygen using pulse oximetry, combined with clinical observation of respiration to detect hypopneic hypoventilation, bradypnea, apnea or partial airway obstruction.1 Furthermore, adequacy of ventilation and oxygenation should be recorded at least every 10 minutes, with any indication of respiratory compromise promptly reported to the proceduralist and corrective interventions implemented immediately. End-tidal carbon dioxide monitoring (capnography) and respiratory rate monitoring are better indicators of respiration than SpO2 monitoring, especially in the CCL environment where the patient is almost completely covered in sterile drapes and direct visual assessment of ventilation is difficult. Capnography should be used for all patients at higher risk of impaired respiratory function, including patients with COPD, STEMI, haemodynamically unstable patients, and patients requiring higher doses of procedural sedation or any anaesthesia-supported procedure.
Optimizing Physiology During Prehospital Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Daniel P. Davis, Nichole Bosson, Francis X. Guyette, Allen Wolfe, Bentley J. Bobrow, David Olvera, Robert G. Walker, Michael Levy
In addition to confirming initial advanced airway placement, capnography is the best method for ongoing monitoring of airway position. EMS clinicians should use continuous capnography during transport and movement of patients in order to monitor the position of the advanced airway and to rapidly detect dislodgement. While colorimetric devices can initially detect exhaled carbon dioxide, their effectiveness declines with exposure to air and liquids. Thus, these devices are not reliable for ongoing monitoring of advanced airway placement to detect dislodgement and cannot guide ventilation. Pulse oximetry is routinely used by EMS to monitor oxygenation status but is an unreliable strategy to confirm initial advanced airway placement and provides only delayed detection of airway dislodgement (49–51). Revisualization by direct or video laryngoscopy may be used for confirming ETT placement but cannot be used for continuous monitoring of advanced airway position. While some EMS systems allow SGA insertion by basic life support clinicians, the lack of capnography at this level must be recognized as a limitation; in which case colorimetric end-tidal CO2 detectors along with clinical signs of proper ventilation (chest rise, auscultation of lungs sounds) are the best alternative to confirm SGA placement. In these cases, waveform capnography should be placed as soon as practicable by advanced life support or hospital personnel.
Brief Research Report: Prehospital Rapid Sequence Airway
Published in Prehospital Emergency Care, 2021
Darren Braude, Douglas Dixon, Michael Torres, John P. Martinez, Sean O’Brien, Timothy Bajema
This is a retrospective quality assurance analysis in two low-volume EMS systems dating back to 2005, both with a low total number of RSA cases. Indications to choose RSA over RSI was left to the discretion of prehospital providers as was the decision to make a second attempt with an EGD versus moving on to intubation or alternative airway strategies. It can be challenging to determine true clinical success retrospectively. Capnography reports were not consistently available but we believe the high threshold of 95% saturation on turnover precludes any clinically significant device misplacement. We did not have enough of any one EGD to make meaningful comparisons between devices nor could we determine the benefit of gastric tube placement. Given advances in EGD from the original Combitube and King airways to the current products that allow for passive oxygenation (iGel) and the ability to exchange via endotracheal intubation (iGel, LMA Supreme, AuraGainTM, etc.) further study may give more heterogeneous results.
Emerging approaches in pediatric mechanical ventilation
Published in Expert Review of Respiratory Medicine, 2019
Duane C Williams, Ira M Cheifetz
After setting the ventilator parameters, providers utilize non-invasive monitoring to gain insight into adequate gas exchange. Measuring ETCO2 and VCO2 possess the capability to non-invasively assist in the care of critically ill patients without the need for frequent blood gas analysis. The measurement of ETCO2 is dependent on an adequate pulmonary capillary flow of CO2 rich blood to the alveoli. The normal ETCO2 in a healthy subject generally differs by 4–6 mmHg from the corresponding PaCO2 (representing normal anatomic dead space of the upper airway). Although capnography is routinely utilized as a standard of care to confirm endotracheal tube placement, its use is less consistent in those mechanically ventilated for respiratory failure. A widening ETCO2- PaCO2 gradient can alert providers to an increase in alveolar dead space seen in states such as low cardiac output, pulmonary embolism, and worsening V/Q mismatch [63,64]. This is of central importance as an increase in alveolar dead space has been linked to an increased mortality in ARDS [65].