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ICU_one_pager_end_tidal_co2.pptx

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Jagannath Hansda

Capnography measures exhaled carbon dioxide (CO2) through either colorimetric or waveform methods. It can be used to confirm endotracheal tube placement, monitor cardiac and pulmonary physiology, guide resuscitation, and detect hypoventilation earlier than pulse oximetry alone. Specific capnography waveforms and values provide information about cardiac output, airway obstruction, lung disease, and response to CPR.

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EXHALATION INHALATION SpO2 98 PI 0.8 by Nick Mark MD CAPNOGRAPHY onepageric u.com @nickmma rk Link to the most current version ONE COLORIMETRIC CAPNOGRAPH CC BY-SA 3.0 v1.1 (2020-11-18) Measurement of exhaled carbon dioxide can be used to confirm ETT placement, for safer procedural sedation, to guide resuscitation, and to monitor cardiac & pulmonary physiology. 揃 PETCO2 End-tidal CO2 (whats measured by capnography) 揃 PACO2 Alveolar CO2 揃 PvCO2 Mixed venous CO2 揃 PaCO2 Arterial CO2 (whats measured on an ABG) PETCO2 is usually less than PaCO2 because of dead space. If physiological dead space increases the difference between PETCO2 and PaCO2 will also rise. Examples include: 揃 Low cardiac output reduced delivery of CO2 to lungs 揃 Blockage of Pulmonary arteries (pulmonary embolus) PRINCIPLE: PaCO2 PvCO2 PACO2 PETCO2 45 35 40 40 ETCO2 IN CARDIAC ARREST ETT CONFIRMATION Litmus paper changes color based on pH; exhaled CO2 lowers the pH and causes the the paper to transiently turn from PURPLE to YELLOW (MELLOW YELLOW); acidic vomitus can cause a false permanent color change. A B C Provides an approximate PETCO2 reading as each area is sensitive to different ETCO2 values: A <4 MMHG B 4-15 MMHG C 15-38 MMHG 39 14 ETCO2 RR PORTABLE ELECTRONIC CAPNOGRAPH WAVEFORM CAPNOGRAPH ETCO2 (mmHg) 0 10 20 30 40 50 etCO2 39 RR 14 Side-stream detector (LONGER LATENCY) I II III IV The waveform is composed of 4 phases 揃 Phase I anatomical dead space ventilation 揃 Phase II dead space mixed with alveolar ventilation 揃 Phase III alveolar ventilation (where ETCO2 measured) 揃 Phase IV end of exhalation CAPNOGRAPH WAVEFORM : ETCO2 IN PROCEDURAL SEDATION Measured PETCO2 IR spectroscopy precisely measures exhaled CO2 content IR spectroscopy measures exhaled CO2 content and displays results graphically; can also be used with special nasal cannula to monitor non-intubated pts. PROLONGED PHASE II/III 揃 Bronchospasm 揃 Airway obstruction 揃 COPD CARDIAC OSCILLATIONS 揃 Hypovolemia 揃 Hypoventilation CURARE CLEFT 揃 Patient dysynchrony during mechanical ventilation breath DIMORPHIC PHASE II/II 揃 Right mainstem intubation 揃 Differential lung emptying (Single lung transplant, severe kyphoscoliosis, etc) PROMINENT PHASE IV 揃 Obesity 揃 Pregnancy 揃 Poor compliance SUDDEN DROP IN ETCO2 揃 Displaced ETT 揃 Decreased CO (arrythmia, PE, etc) Adequacy of CPR 揃 Achieving an PETCO2 > 20mmHg is associated with adequate CPR. If not achieving this goal consider rotating the person performing compressions. Detection of ROSC 揃 Sudden increase in PETCO2 during CPR is a marker for ROSC. Determination of futility 揃 Persistent PETCO2 < 10 for > 20 min is associated with futility, and even 5 min with ETCO2 < 10 is associated with poor outcomes. Confirmation of exhaled CO2 can be used for ETT placement confirmation. Colorimetric capnograph is only appropriate in well perfusing patients; waveform capnograph is more accurate, particularly in low CO states. SPECIFIC CAPNOGRAPH PATTERNS: shark fin Waveform capnography can be used to monitor for hypoventilation in non-intubated patients during procedural sedation (using an ETCO2 sensor nasal cannula). Waveform capnography is more sensitive than just SpO2 monitoring, and can detect hypoventilation up to 60 seconds before desaturation occurs. 揃 Poor gas exchange due to overdistension of alveoli high TV, excessive PEEP, COPD ETCO2 waveform Peak ETCO2 value Each heartbeat ejects a small amount of CO2 Terminal upswing DOWNSLOPING PHASE III 揃 Severe emphysema (alveoli destruction can cause rapid initial emptying of CO2) Mainstream (in-line) detector (SHORTER LATENCY)
EXHALATION INHALATION SpO2 98 PI 0.8 by Nick Mark MD CAPNOGRAPHY onepageric u.com @nickmma rk Link to the most current version ONE COLORIMETRIC CAPNOGRAPH Measurement of exhaled carbon dioxide can be used to confirm ETT placement, for safer procedural sedation, to guide resuscitation, and to monitor cardiac & pulmonary physiology. 揃 PETCO2 End-tidal CO2 (whats measured by capnography) 揃 PACO2 Alveolar CO2 揃 PvCO2 Mixed venous CO2 揃 PaCO2 Arterial CO2 (whats measured on an ABG) PETCO2 is usually less than PaCO2 because of dead space. If physiological dead space increases the difference between PETCO2 and PaCO2 will also rise. Examples include: 揃 Low cardiac output reduced delivery of CO2 to lungs 揃 Blockage of Pulmonary arteries (pulmonary embolus) PRINCIPLE: PaCO2 PvCO2 PACO2 PETCO2 45 35 40 40 ETCO2 IN CARDIAC ARREST ETT CONFIRMATION Litmus paper changes color based on pH; exhaled CO2 lowers the pH and causes the the paper to transiently turn from PURPLE to YELLOW (MELLOW YELLOW); acidic vomitus can cause a false permanent color change. A B C Provides an approximate PETCO2 reading as each area is sensitive to different ETCO2 values: A <4 MMHG B 4-15 MMHG C 15-38 MMHG 39 14 ETCO2 RR PORTABLE ELECTRONIC CAPNOGRAPH WAVEFORM CAPNOGRAPH ETCO2 (mmHg) 0 10 20 30 40 50 etCO2 39 RR 14 Side-stream detector (LONGER LATENCY) I II III IV The waveform is composed of 4 phases 揃 Phase I anatomical dead space ventilation 揃 Phase II dead space mixed with alveolar ventilation 揃 Phase III alveolar ventilation (where ETCO2 measured) 揃 Phase IV end of exhalation CAPNOGRAPH WAVEFORM : ETCO2 IN PROCEDURAL SEDATION Measured PETCO2 IR spectroscopy precisely measures exhaled CO2 content IR spectroscopy measures exhaled CO2 content and displays results graphically; can also be used with special nasal cannula to monitor non-intubated pts. PROLONGED PHASE II/III 揃 Bronchospasm 揃 Airway obstruction 揃 COPD CARDIAC OSCILLATIONS 揃 Hypovolemia 揃 Hypoventilation CURARE CLEFT 揃 Patient dysynchrony during mechanical ventilation breath DIMORPHIC PHASE II/II 揃 Right mainstem intubation 揃 Differential lung emptying (Single lung transplant, severe kyphoscoliosis, etc) PROMINENT PHASE IV 揃 Obesity 揃 Pregnancy 揃 Poor compliance SUDDEN DROP IN ETCO2 揃 Displaced ETT 揃 Decreased CO (arrythmia, PE, etc) Adequacy of CPR 揃 Achieving an PETCO2 > 20mmHg is associated with adequate CPR. If not achieving this goal consider rotating the person performing compressions. Detection of ROSC 揃 Sudden increase in PETCO2 during CPR is a marker for ROSC. Determination of futility 揃 Persistent PETCO2 < 10 for > 20 min is associated with futility, and even 5 min with ETCO2 < 10 is associated with poor outcomes. Confirmation of exhaled CO2 can be used for ETT placement confirmation. Colorimetric capnograph is only appropriate in well perfusing patients; waveform capnograph is more accurate, particularly in low CO states. SPECIFIC CAPNOGRAPH PATTERNS: shark fin Waveform capnography can be used to monitor for hypoventilation in non-intubated patients during procedural sedation (using an ETCO2 sensor nasal cannula). Waveform capnography is more sensitive than just SpO2 monitoring, and can detect hypoventilation up to 60 seconds before desaturation occurs. 揃 Poor gas exchange due to overdistension of alveoli high TV, excessive PEEP, COPD ETCO2 waveform Peak ETCO2 value Each heartbeat ejects a small amount of CO2 Terminal upswing DOWNSLOPING PHASE III 揃 Severe emphysema (alveoli destruction can cause rapid initial emptying of CO2) Mainstream (in-line) detector (SHORTER LATENCY) CC BY-SA 3.0 v1.1 (2020-11-18)

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ICU_one_pager_end_tidal_co2.pptx

  • 1. EXHALATION INHALATION SpO2 98 PI 0.8 by Nick Mark MD CAPNOGRAPHY onepageric u.com @nickmma rk Link to the most current version ONE COLORIMETRIC CAPNOGRAPH CC BY-SA 3.0 v1.1 (2020-11-18) Measurement of exhaled carbon dioxide can be used to confirm ETT placement, for safer procedural sedation, to guide resuscitation, and to monitor cardiac & pulmonary physiology. 揃 PETCO2 End-tidal CO2 (whats measured by capnography) 揃 PACO2 Alveolar CO2 揃 PvCO2 Mixed venous CO2 揃 PaCO2 Arterial CO2 (whats measured on an ABG) PETCO2 is usually less than PaCO2 because of dead space. If physiological dead space increases the difference between PETCO2 and PaCO2 will also rise. Examples include: 揃 Low cardiac output reduced delivery of CO2 to lungs 揃 Blockage of Pulmonary arteries (pulmonary embolus) PRINCIPLE: PaCO2 PvCO2 PACO2 PETCO2 45 35 40 40 ETCO2 IN CARDIAC ARREST ETT CONFIRMATION Litmus paper changes color based on pH; exhaled CO2 lowers the pH and causes the the paper to transiently turn from PURPLE to YELLOW (MELLOW YELLOW); acidic vomitus can cause a false permanent color change. A B C Provides an approximate PETCO2 reading as each area is sensitive to different ETCO2 values: A <4 MMHG B 4-15 MMHG C 15-38 MMHG 39 14 ETCO2 RR PORTABLE ELECTRONIC CAPNOGRAPH WAVEFORM CAPNOGRAPH ETCO2 (mmHg) 0 10 20 30 40 50 etCO2 39 RR 14 Side-stream detector (LONGER LATENCY) I II III IV The waveform is composed of 4 phases 揃 Phase I anatomical dead space ventilation 揃 Phase II dead space mixed with alveolar ventilation 揃 Phase III alveolar ventilation (where ETCO2 measured) 揃 Phase IV end of exhalation CAPNOGRAPH WAVEFORM : ETCO2 IN PROCEDURAL SEDATION Measured PETCO2 IR spectroscopy precisely measures exhaled CO2 content IR spectroscopy measures exhaled CO2 content and displays results graphically; can also be used with special nasal cannula to monitor non-intubated pts. PROLONGED PHASE II/III 揃 Bronchospasm 揃 Airway obstruction 揃 COPD CARDIAC OSCILLATIONS 揃 Hypovolemia 揃 Hypoventilation CURARE CLEFT 揃 Patient dysynchrony during mechanical ventilation breath DIMORPHIC PHASE II/II 揃 Right mainstem intubation 揃 Differential lung emptying (Single lung transplant, severe kyphoscoliosis, etc) PROMINENT PHASE IV 揃 Obesity 揃 Pregnancy 揃 Poor compliance SUDDEN DROP IN ETCO2 揃 Displaced ETT 揃 Decreased CO (arrythmia, PE, etc) Adequacy of CPR 揃 Achieving an PETCO2 > 20mmHg is associated with adequate CPR. If not achieving this goal consider rotating the person performing compressions. Detection of ROSC 揃 Sudden increase in PETCO2 during CPR is a marker for ROSC. Determination of futility 揃 Persistent PETCO2 < 10 for > 20 min is associated with futility, and even 5 min with ETCO2 < 10 is associated with poor outcomes. Confirmation of exhaled CO2 can be used for ETT placement confirmation. Colorimetric capnograph is only appropriate in well perfusing patients; waveform capnograph is more accurate, particularly in low CO states. SPECIFIC CAPNOGRAPH PATTERNS: shark fin Waveform capnography can be used to monitor for hypoventilation in non-intubated patients during procedural sedation (using an ETCO2 sensor nasal cannula). Waveform capnography is more sensitive than just SpO2 monitoring, and can detect hypoventilation up to 60 seconds before desaturation occurs. 揃 Poor gas exchange due to overdistension of alveoli high TV, excessive PEEP, COPD ETCO2 waveform Peak ETCO2 value Each heartbeat ejects a small amount of CO2 Terminal upswing DOWNSLOPING PHASE III 揃 Severe emphysema (alveoli destruction can cause rapid initial emptying of CO2) Mainstream (in-line) detector (SHORTER LATENCY)
  • 2. EXHALATION INHALATION SpO2 98 PI 0.8 by Nick Mark MD CAPNOGRAPHY onepageric u.com @nickmma rk Link to the most current version ONE COLORIMETRIC CAPNOGRAPH Measurement of exhaled carbon dioxide can be used to confirm ETT placement, for safer procedural sedation, to guide resuscitation, and to monitor cardiac & pulmonary physiology. 揃 PETCO2 End-tidal CO2 (whats measured by capnography) 揃 PACO2 Alveolar CO2 揃 PvCO2 Mixed venous CO2 揃 PaCO2 Arterial CO2 (whats measured on an ABG) PETCO2 is usually less than PaCO2 because of dead space. If physiological dead space increases the difference between PETCO2 and PaCO2 will also rise. Examples include: 揃 Low cardiac output reduced delivery of CO2 to lungs 揃 Blockage of Pulmonary arteries (pulmonary embolus) PRINCIPLE: PaCO2 PvCO2 PACO2 PETCO2 45 35 40 40 ETCO2 IN CARDIAC ARREST ETT CONFIRMATION Litmus paper changes color based on pH; exhaled CO2 lowers the pH and causes the the paper to transiently turn from PURPLE to YELLOW (MELLOW YELLOW); acidic vomitus can cause a false permanent color change. A B C Provides an approximate PETCO2 reading as each area is sensitive to different ETCO2 values: A <4 MMHG B 4-15 MMHG C 15-38 MMHG 39 14 ETCO2 RR PORTABLE ELECTRONIC CAPNOGRAPH WAVEFORM CAPNOGRAPH ETCO2 (mmHg) 0 10 20 30 40 50 etCO2 39 RR 14 Side-stream detector (LONGER LATENCY) I II III IV The waveform is composed of 4 phases 揃 Phase I anatomical dead space ventilation 揃 Phase II dead space mixed with alveolar ventilation 揃 Phase III alveolar ventilation (where ETCO2 measured) 揃 Phase IV end of exhalation CAPNOGRAPH WAVEFORM : ETCO2 IN PROCEDURAL SEDATION Measured PETCO2 IR spectroscopy precisely measures exhaled CO2 content IR spectroscopy measures exhaled CO2 content and displays results graphically; can also be used with special nasal cannula to monitor non-intubated pts. PROLONGED PHASE II/III 揃 Bronchospasm 揃 Airway obstruction 揃 COPD CARDIAC OSCILLATIONS 揃 Hypovolemia 揃 Hypoventilation CURARE CLEFT 揃 Patient dysynchrony during mechanical ventilation breath DIMORPHIC PHASE II/II 揃 Right mainstem intubation 揃 Differential lung emptying (Single lung transplant, severe kyphoscoliosis, etc) PROMINENT PHASE IV 揃 Obesity 揃 Pregnancy 揃 Poor compliance SUDDEN DROP IN ETCO2 揃 Displaced ETT 揃 Decreased CO (arrythmia, PE, etc) Adequacy of CPR 揃 Achieving an PETCO2 > 20mmHg is associated with adequate CPR. If not achieving this goal consider rotating the person performing compressions. Detection of ROSC 揃 Sudden increase in PETCO2 during CPR is a marker for ROSC. Determination of futility 揃 Persistent PETCO2 < 10 for > 20 min is associated with futility, and even 5 min with ETCO2 < 10 is associated with poor outcomes. Confirmation of exhaled CO2 can be used for ETT placement confirmation. Colorimetric capnograph is only appropriate in well perfusing patients; waveform capnograph is more accurate, particularly in low CO states. SPECIFIC CAPNOGRAPH PATTERNS: shark fin Waveform capnography can be used to monitor for hypoventilation in non-intubated patients during procedural sedation (using an ETCO2 sensor nasal cannula). Waveform capnography is more sensitive than just SpO2 monitoring, and can detect hypoventilation up to 60 seconds before desaturation occurs. 揃 Poor gas exchange due to overdistension of alveoli high TV, excessive PEEP, COPD ETCO2 waveform Peak ETCO2 value Each heartbeat ejects a small amount of CO2 Terminal upswing DOWNSLOPING PHASE III 揃 Severe emphysema (alveoli destruction can cause rapid initial emptying of CO2) Mainstream (in-line) detector (SHORTER LATENCY) CC BY-SA 3.0 v1.1 (2020-11-18)