Scribd
Upload
122 views10 pages

Capnography Monitoring in PICU

Capnography is the analysis of exhaled carbon dioxide levels through numeric and graphical trends. It can be measured transcutaneously or through end tidal carbon dioxide monitoring. When using capnography, it is important to initially correlate the capnography readings with arterial blood gas measurements to establish that they change in direct relation. Once a consistent correlation is established, capnography can help reduce the need for frequent arterial blood draws. Capnography provides useful clinical information and can help assess ventilation and perfusion matching as well as the effectiveness of CPR.

Uploaded by

jcrubino
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
122 views10 pages

Capnography Monitoring in PICU

Capnography is the analysis of exhaled carbon dioxide levels through numeric and graphical trends. It can be measured transcutaneously or through end tidal carbon dioxide monitoring. When using capnography, it is important to initially correlate the capnography readings with arterial blood gas measurements to establish that they change in direct relation. Once a consistent correlation is established, capnography can help reduce the need for frequent arterial blood draws. Capnography provides useful clinical information and can help assess ventilation and perfusion matching as well as the effectiveness of CPR.

Uploaded by

jcrubino
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

CAPNOGRAPHY

MONITORING
A10 Slide Production by
James Rubino USAF RT
CAPNOGRAPHY –
WHAT IS THAT?
 The analysis of exhaled carbon dioxide via
numeric and graphical trends.
 Helpful in reducing ABG draws in stable
patients.
HOW IS THAT DONE IN THE PICU
 Transcutaneous - TcCO2
 More Accurate and Precise
 CO2 measured through the Skin via heated electrode
 Used often in neonates
 Must change every few hours to avoid skin burns
 End Tidal CO2 – EtCO2
 Measured between the end of the ETT and the
Ventilator Circuit
 Based on IR light Absorption of CO2 at 4.3 μm
 Mainstream – gas measured at end of ETT
 Slipstream – sampling line carries gas from ETT to
machine for analysis
 Some of the exhaled Vt and Ve can be lost to sampling line
WHAT MUST I ABSOLUTELY
KNOW?
 Often need calibration to room air & known
control sample
 When Capnography begins it is always
tracked along with an initial set (2-4) ABGs
to see how they correlate.
 Exact number matches not important
 Direct Correlation VERY IMPORTANT!
 Capnography and ABG should consistently change
in direct relation with one another.
 Capnography is an approximation of PaCO2 – not
the same
WHAT ELSE?
 Can be used to assess CPR effectiveness
 IfCO2 = 0 then metabolism has stopped and
death has occurred. CPR should cease.
 Sepis
 Can double CO and slightly decrease CO2
 Cardiogenic Shock
 Reduced CO and slightly increases CO2
 ALVEOLAR VENTILATION
 Inversely effects CO2
 Double Alveolar Ventilation – Halve CO2
 Halve Alveolar Ventilation – Double CO2
INTERESTING INFORMATION
 Average adult creates 200ml CO2 per minute
 Fever and Exorcise Increase CO2 output
 Hypothermia, Sleep, Sedation Decrease CO2 output
 PetCO2 – Partial Pressure Endtidal CO2
 Usually 1-5 mmHg less then PaCO2 in an upright well
ventilated and perfused adult
 Capnography works best when:
 There is a V/Q match
NORMAL BLOOD GAS &
CAPNOGRAPHY

PaCO2 ~40 mmHg


PvCO2 ~46 mmHg
PACO2 (actual exhaled) 35 – 43 mmHg
PetCO2 (end tidal) 35 – 43 mmHg
FACO2 (Exhaled %) 5% - 6%
FACO2 (end tidal %) 5% - 6%

FYI: Dead Space Ratio


Quantifies inactive respiration using an ABG and Capnography.

Vd/Vt = (PaCO2 – PetCO2) / PaCO2  This is the “Dead Space Ratio”

Multiply the Vd/Vt by the Vt to find the “Dead Space” volume in


the respiratory system.
HOW TO MAKE ABG’S LESS
NECESSARY
 Arterial End-tidal CO2 Gradient
 [P(a-et)CO2]
 Whenreliably determined (repeatable) can use
Capnography alone
 Steps
 Draw ABG and Record PetCO2
 PaCO2 – PetCO2 = [P(a-et)CO2]
 If [P(a-et)CO2] is similar over 2-4 ABG draws then
considered reliable
 You can accurately approximate the PaCO2 and
make ventilation changed as necessary
CASE STUDY
 Stabilized patient on ventilator ABG 1
 SIMVPC 24/5 Rate 10 RR 18
 PaCO2 40 & PetCO2 36
 What is the [P(a-et)CO2]?
 Same Stable Patient Same Settings ABG 2
 PaCO2 44 & PetCO2 39
 What is the [P(a-et)CO2]?
 Same Stable Patient on Ventilator
 PetCO2 44
 What changes if any could be made?
 The patients PaCO2 = 48 mmHg & Vt = 700. What is the
Dead Space volume for this patient at this time?
THE END

You might also like