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Sleep research recording methods
Published in Philip N. Murphy, The Routledge International Handbook of Psychobiology, 2018
The pediatric respiratory montage also includes capnometry (cannula for exhaled carbon) to capture end-tidal expiration dysfunction unique to children. Note that home-based clinical polysomnography is not currently used, due in part to the risk of entanglement during an unattended study, though some innovative investigators have been successful using attended nap polysomnography in children’s homes (Gribbin, Watamura, Cairns, Harsh, & Lebourgeois, 2012).
End-tidal carbon dioxide
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
Ryan J. Vealey, Laura B. Hemmer
The analysis of expired respiratory and anesthetic gases has become a vital component of modern anesthetic practice. Current ASA standard monitoring guidelines include continuous monitoring of CO2 when possible, stating “Continual monitoring for the presence of expired carbon dioxide shall be performed unless invalidated by the nature of the patient, procedure or equipment.”2 Assuming a normal alveolar/arterial gradient (5 mmHg in healthy, supine patients), ET-CO2 obtained via capnometry provides a real-time, continuous assessment of ventilation.1 Determination of this gradient has a particular relevance in neurosurgical procedures. To enhance brain relaxation, mild-to-moderate intraoperative hyperventilation is often requested and knowledge of each individual's alveolar/arterial gradient is necessary to provide this without inadvertently raising or lowering the CO2 excessively. This is accomplished by sending a baseline arterial blood gas at the beginning of the procedure and noting the ET-CO2 value at that time. A patient-specific gradient is then generated.
Pediatric ICU management
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Jason O. Robertson, Adam M. Vogel
End-tidal carbon dioxide (EtCO2) monitoring, known as capnometry, is a noninvasive method for measuring the PaCO2 in expired gas. The principle is similar to pulse oximetry in that a sampling chamber contains a light source on one side and a photodetector on the other measures the carbon dioxide (CO2) content of exhaled gas that passes through it. Since CO2 absorbs light at the infrared wavelength (940 nm), the CO2 present in the gas may be calculated from the amount of infrared light that reaches the photodetector. EtCO2 is a reflection of alveolar ventilation, metabolic rate, and the pulmonary circulation. It is also useful for confirmation of endotracheal tube placement and may be helpful for early detection of endotracheal tube dislodgement.
Characteristics and feasibility of ambulatory respiratory assessment of paediatric neuromuscular disease: an observational retrospective study
Published in International Journal of Neuroscience, 2023
Cheng Zhang, Cui-jie Wei, Zhe Jin, Jing Ma, Yan-e Shen, Qing Yu, Yan-bin Fan, Hui Xiong, Cheng-li Que
NMD progression leads to respiratory muscle weakness. Timely provision of non-invasive ventilation (NIV) is important to improve the survival and quality of life of the affected children [10, 11]. Although there is a lack of validated and uniform criteria [12], generally speaking, hypercapnia hypoventilation during sleep stage is an important indicator for initiation of NIV. For example, peak nocturnal transcutaneous carbon dioxide (TcCO2) ≥49 mmHg should be considered as a criterion to start home mechanical ventilation (HMV) in patients with NMDs, who have symptoms of hypoventilation, daytime hypercapnia, abnormal nocturnal oximetry results, and a diminished forced vital capacity [13]. Therefore, carbon dioxide (CO2) monitoring (nocturnal capnometry) is also an important aspect of respiratory assessment in NMDs. However, limited availability of equipment and expansive disposable consumables made TcCO2 impractical, especially in developing countries and underdeveloped regions. SDB have a gradual progression in NMD children and can broadly include SDB at its onset, nocturnal hypoventilation, and diurnal respiratory failure [14].
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
Waveform capnography is the most reliable method for confirming initial and ongoing placement and function of an advanced airway and is considered standard of care for in-hospital advanced airway management (44). Given the availability of waveform capnography, unrecognized misplacement of an advanced airway should never occur. Although colorimetric devices and capnometry can confirm initial advanced airway placement, they are less sensitive and specific in low-flow states such as cardiac arrest (45–47). Conversely, Silvestri et al. reported 100% sensitivity and 100% specificity of waveform capnography for proper ETT placement in a simulated low-flow state (47). The use of capnography to confirm ETT placement in cardiac arrest is now a Class I recommendation from the American Heart Association (48).
Prehospital Cardiac Arrest Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Jestin N. Carlson, M. Riccardo Colella, Mohamud R. Daya, Valerie J. De Maio, Philip Nawrocki, Dhimitri A. Nikolla, Nichole Bosson
The monitoring of the flow of carbon dioxide through the airway has many potential applications in cardiac arrest patients. More than just a measure of ventilatory status or alveolar gas-exchange at the lungs, end-tidal carbon dioxide (ETCO2) correlates with cardiac output and provides an indication of tissue perfusion, including both pulmonary and cerebral perfusion (81). In addition to ETCO2 level (capnometry), continuous wave-form capnography may guide resuscitation, specifically for the continuous assessment of advanced airway placement, ventilation and compressions quality, and for the detection of ROSC or re-arrest. EMS clinicians should be aware that ETCO2 can be influenced by many factors, such as compressions (82), ventilations (83), etiology of arrest, medications administered (84), and acid contaminants in the airway (e.g., gastric contents) (85), making it challenging to interpret isolated values without incorporating other information and trends. Colorimetric devices are inferior given that they are limited in use to initial confirmation of advanced airway placement and cannot provide continuous monitoring required to guide resuscitation and ventilations.