Capnography - Revision history

Parkerw02: /* Airway Monitoring */

2023-07-03T12:54:25Z

Airway Monitoring

← Older revision		Revision as of 12:54, 3 July 2023
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	==Airway Monitoring==		==Airway Monitoring==
	*Ensure adequate [[BVM]] ventilation		*Ensure adequate [[BVM]] ventilation
	*Assess for [[intubation\|ETT]] placement using ~~presents~~ of measurable ETCO2 and waveform		*Assess for [[intubation\|ETT]] placement using presence of measurable ETCO2 and waveform
	**In out of hospital use, this had SN 1.0 and SP 1.0 in detected good placement<ref>Silvestri, S, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005; 45(5):497-503.</ref>		**In out of hospital use, this had SN 1.0 and SP 1.0 in detected good placement<ref>Silvestri, S, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005; 45(5):497-503.</ref>

ClaireLewis at 14:58, 12 October 2019

2019-10-12T14:58:31Z

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	*ETCO2 of 35-45mmHg is considered normal		*ETCO2 of 35-45mmHg is considered normal
	**<35mmHg = Hypocapnia or Hyperventilation		**<35mmHg = Hypocapnia or Hyperventilation
	**>45mmHg = Hypercapnia or Hypoventilation		**>45mmHg = [[Hypercapnia]] or Hypoventilation
	*Directly measure the function of ventilation (not oxygenation)		*Directly measure the function of ventilation (not oxygenation)
	**ETCO2 ≥ PCO2		**ETCO2 ≥ PCO2
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	==Airway Monitoring==		==Airway Monitoring==
	*Ensure adequate BVM ventilation		*Ensure adequate [[BVM]] ventilation
	*Assess for ETT placement using presents of measurable ETCO2 and waveform		*Assess for [[intubation\|ETT]] placement using presents of measurable ETCO2 and waveform
	**In out of hospital use, this had SN 1.0 and SP 1.0 in detected good placement<ref>Silvestri, S, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005; 45(5):497-503.</ref>		**In out of hospital use, this had SN 1.0 and SP 1.0 in detected good placement<ref>Silvestri, S, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005; 45(5):497-503.</ref>

	==Cardiac Arrest Monitoring==		==[[Cardiac Arrest]] Monitoring==
	===Ensure adequate chest compressions===		===Ensure adequate chest compressions===
	*ETCO2 10-20mmHg signifies high quality chest compressions<ref>Kodali, BS, et al. Capnography during cardiopulmonary resuscitation: Current evidence and future directions. J Emerg Trauma Shock. 2014; 7(4):332–340.</ref>		*ETCO2 10-20mmHg signifies high quality chest compressions<ref>Kodali, BS, et al. Capnography during cardiopulmonary resuscitation: Current evidence and future directions. J Emerg Trauma Shock. 2014; 7(4):332–340.</ref>
	===ROSC===		===[[ROSC]]===
	*Attaining ROSC is associated with an ETCO2 jump 10mmHg with ROSC (13.5 on average)<ref>Grmec, S, et al.Utstein style analysis of out-of-hospital cardiac arrest--bystander CPR and end expired carbon dioxide. Resuscitation. 2007; 72(3):404-14.</ref>		*Attaining ROSC is associated with an ETCO2 jump 10mmHg with ROSC (13.5 on average)<ref>Grmec, S, et al.Utstein style analysis of out-of-hospital cardiac arrest--bystander CPR and end expired carbon dioxide. Resuscitation. 2007; 72(3):404-14.</ref>
	**10mHg has a sensitivity of 33% and a specificity of 97% for ROSC<ref>Tat LC, Ming PK, Leung TK. Abrupt rise of end tidal carbon dioxide level was a specific but non sensitive marker of return of spontaneous circulation in patient with out-of-hospital cardiac arrest. Resuscitation. 2016; 104:53–58.</ref>		**10mHg has a sensitivity of 33% and a specificity of 97% for ROSC<ref>Tat LC, Ming PK, Leung TK. Abrupt rise of end tidal carbon dioxide level was a specific but non sensitive marker of return of spontaneous circulation in patient with out-of-hospital cardiac arrest. Resuscitation. 2016; 104:53–58.</ref>
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	*ETCO2 level of 10mmHg or less after 20 min of CPR predicts death<ref>Eckstein, M, et al. End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest. Prehospital and Disaster Medicine. 2011; 26(3):148-150.</ref><ref>Levine, R, End-tidal Carbon Dioxide and Outcome of Out-of-Hospital Cardiac Arrest. NEJM.1997. 337(5):301-6.</ref>		*ETCO2 level of 10mmHg or less after 20 min of CPR predicts death<ref>Eckstein, M, et al. End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest. Prehospital and Disaster Medicine. 2011; 26(3):148-150.</ref><ref>Levine, R, End-tidal Carbon Dioxide and Outcome of Out-of-Hospital Cardiac Arrest. NEJM.1997. 337(5):301-6.</ref>

	==Procedural Sedation Monitoring==		==[[Procedural Sedation]] Monitoring==
	*Pulse-ox has a lag time of sec to mins		*Pulse-ox has a lag time of sec to mins
	*Capnography will show real-time respiratory changes and apnea		*Capnography will show real-time respiratory changes and apnea
	*ETCO2 monitoring detects clinically signifcant respiratory events before SPO2 or clinically noted apnea/hypoventilation<ref>Burton, JH, et al. Does End-Tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices. Academic Emergency Medicine. 2006; 13:500–504.</ref>		*ETCO2 monitoring detects clinically signifcant respiratory events before SPO2 or clinically noted apnea/hypoventilation<ref>Burton, JH, et al. Does End-Tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices. Academic Emergency Medicine. 2006; 13:500–504.</ref>

	==DKA==		==[[DKA]]==
	*Adults with BG>550<ref>Bou Chebl R, Madden B, Belsky J, Harmouche E, Yessayan L. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department. BMC Emerg Med. 2016 Jan 29;16:7.</ref>		*Adults with BG>550<ref>Bou Chebl R, Madden B, Belsky J, Harmouche E, Yessayan L. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department. BMC Emerg Med. 2016 Jan 29;16:7.</ref>
	**ETCO2>35 mmHg has a sensitivity 100%, ETCO2<26 mmHg has specificity of 96%		**ETCO2>35 mmHg has a sensitivity 100%, ETCO2<26 mmHg has specificity of 96%

Forrestcwells: /* Background */

2019-08-25T16:27:58Z

Background

← Older revision		Revision as of 16:27, 25 August 2019
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	==Background==		==Background==
	*End-tidal CO2 monitors can be qualitative or quantitative		*End-tidal CO2 monitors can be qualitative or quantitative
	**Qualitative ~~include calorimety~~ devices (CO2 ~~= blue, No~~ CO2 ~~= yellow~~)		**Qualitative devices indicate presence or absence of EtCO2
	**Quantitative ~~include~~ devices ~~that~~ give numeric values		***Colorimetric EtCO2 devices change color from purple (CO2 absent) to yellow (CO2 present)
			**Quantitative devices give numeric values
	***Mainstream (or inline) CO2 monitors are placed within the closed circuit of the ventilator (or BVM)		***Mainstream (or inline) CO2 monitors are placed within the closed circuit of the ventilator (or BVM)
	***Sidestream CO2 monitors use special NC to detect CO2		***Sidestream CO2 monitors use special NC to detect CO2

Kxl328: /* Background */

2018-11-09T14:57:41Z

Background

← Older revision		Revision as of 14:57, 9 November 2018
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	***Mainstream (or inline) CO2 monitors are placed within the closed circuit of the ventilator (or BVM)		***Mainstream (or inline) CO2 monitors are placed within the closed circuit of the ventilator (or BVM)
	***Sidestream CO2 monitors use special NC to detect CO2		***Sidestream CO2 monitors use special NC to detect CO2
	*EtCO2 is ~3-5 mmHg less than PaCO2		*EtCO2 is ~3-5 mmHg less than PaCO2 - see [[EBQ:End-Tidal CO2 PaCO2 correlation]]
	**Due to dilution of CO2 in alveolar dead space		**Due to dilution of CO2 in alveolar dead space
	**Processes that increase alveolar dead space:		**Processes that increase alveolar dead space:

Kxl328: /* Background */

2018-11-09T14:57:23Z

Background

← Older revision		Revision as of 14:57, 9 November 2018
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	***Mainstream (or inline) CO2 monitors are placed within the closed circuit of the ventilator (or BVM)		***Mainstream (or inline) CO2 monitors are placed within the closed circuit of the ventilator (or BVM)
	***Sidestream CO2 monitors use special NC to detect CO2		***Sidestream CO2 monitors use special NC to detect CO2
			*EtCO2 is ~3-5 mmHg less than PaCO2
			**Due to dilution of CO2 in alveolar dead space
			**Processes that increase alveolar dead space:
			***[[Pulmonary embolism]]
			***Decreased cardiac output

	==Basics==		==Basics==

Chungirv: /* See Also */

2017-08-07T15:31:47Z

Alvarez13 at 06:55, 26 November 2016

2016-11-26T06:55:40Z

← Older revision		Revision as of 06:55, 26 November 2016
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	*Capnography will show real-time respiratory changes and apnea		*Capnography will show real-time respiratory changes and apnea
	*ETCO2 monitoring detects clinically signifcant respiratory events before SPO2 or clinically noted apnea/hypoventilation<ref>Burton, JH, et al. Does End-Tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices. Academic Emergency Medicine. 2006; 13:500–504.</ref>		*ETCO2 monitoring detects clinically signifcant respiratory events before SPO2 or clinically noted apnea/hypoventilation<ref>Burton, JH, et al. Does End-Tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices. Academic Emergency Medicine. 2006; 13:500–504.</ref>

			==DKA==
			*Adults with BG>550<ref>Bou Chebl R, Madden B, Belsky J, Harmouche E, Yessayan L. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department. BMC Emerg Med. 2016 Jan 29;16:7.</ref>
			**ETCO2>35 mmHg has a sensitivity 100%, ETCO2<26 mmHg has specificity of 96%
			*Adults with BG>250<ref>Soleimanpour H, Taghizadieh A, Niafar M, Rahmani F, Golzari SE, Esfanjani RM. Predictive value of capnography for suspected diabetic ketoacidosis in the emergency department. West J Emerg Med. 2013 Nov;14(6):590-4. doi: 10.5811/westjem.2013.4.14296.</ref>
			**ETCO2>24.5 mmHg has sensitivity of 90%, ETCO2<24.5 mmHg has specificity of 90%

	==See Also==		==See Also==

Neil.m.young at 16:53, 4 August 2016

2016-08-04T16:53:53Z

← Older revision		Revision as of 16:53, 4 August 2016
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	*The curve peaks at the end of Phase III which is noted as the End-Tidal CO2 measurement		*The curve peaks at the end of Phase III which is noted as the End-Tidal CO2 measurement
	*Inhalation follows (Phase 0 or IV)		*Inhalation follows (Phase 0 or IV)


	==Airway Monitoring==		==Airway Monitoring==

Neil.m.young at 16:53, 4 August 2016

2016-08-04T16:53:16Z

← Older revision		Revision as of 16:53, 4 August 2016
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	==External Links==		==External Links==
	http://www.capnography.com/		*[http://www.capnography.com/ Capnography.com]

	==References==		==References==

Neil.m.young at 16:52, 4 August 2016

2016-08-04T16:52:52Z

← Older revision		Revision as of 16:52, 4 August 2016
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	*Capnography will show real-time respiratory changes and apnea		*Capnography will show real-time respiratory changes and apnea
	*ETCO2 monitoring detects clinically signifcant respiratory events before SPO2 or clinically noted apnea/hypoventilation<ref>Burton, JH, et al. Does End-Tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices. Academic Emergency Medicine. 2006; 13:500–504.</ref>		*ETCO2 monitoring detects clinically signifcant respiratory events before SPO2 or clinically noted apnea/hypoventilation<ref>Burton, JH, et al. Does End-Tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices. Academic Emergency Medicine. 2006; 13:500–504.</ref>



	==See Also==		==See Also==

← Older revision		Revision as of 15:31, 7 August 2017
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	*[[Intubation]]		*[[Intubation]]
	*[[Procedural sedation]]		*[[Procedural sedation]]
			*[[EBQ:End-Tidal CO2 PaCO2 correlation]]

	==External Links==		==External Links==