BM6711
HOSPITAL TRAINING
CAPNOGRAPHY
Presented to Presented by
The BME faculties [Link] priya
312213121050
12/8/2016
OBJECTIVES
• Understand why we use capnography
• Understand the physiology of respiration/
ventilation
• Define normal & abnormal EtCO2 values/
waveforms
• Understand the 4 major applications of EtCO 2
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CAPNOGRAPHY
Definition? What are we measuring?
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CAPNOGRAM
• During anesthesia, there is
interplay between two
components: the patient and
the anesthesia administration
device (which is a ventilator).
• The critical connection
between the two components
is either an endotracheal
tube or a mask, and CO2 is
typically monitored at this
junction.
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RESPIRATION-THE BIG PICTURE
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CAPNOGRAPHY DEPICTS RESPIRATION
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TERMINOLOGY
ETCO2-END TIDAL CO2
•End Tidal CO2 (ETCO2 or PetCO2): The level
of (partial pressure of)
Carbon Dioxide released at
end expiration.
•Normal range-35-45 mmHg
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ETCO2 DETECTOR TYPES
• Colorimetric: Positive color change in the
presence of CO2.
• Capnometer: The numeric measurement of
CO2.
• Capnogram: The expired wave form in
addition to a numeric value.
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CALORIMETRIC
• pH sensitive, chemically impregnated paper
encased in a plastic chamber that’s placed
between the ETT and ventilation device
• Color change is reversible
• On the spontaneous breathing
patient it will be purple on inhalation,
yellow on exhalation
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CAPNOMETRY
• Pros • Cons
• First generation of CO2 • Numeric value only
monitors • Outdated
• Portable • Bulky adapter
• Given at least a numeric • Treating the machine
value
• Cheaper than
capnography
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CAPNOGRAPHY
• Pros • Cons
• Numeric value plus • Expensive
expiratory waveform • Fragile
• Able to monitor a trend • Secretions
• Ability to assess • Temperature sensitive
perfusion
• Very accurate
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CAPNOGRAPHY VS CAPNOMETRY
CAPNOGRAPHY
• Measurement and display of CAPNOMETRY
ETCO2 value and capnogram • Meaurement and display of
ETCO2 value(no waveform)
(CO2 waveform) • Meaured by capnometer.
• Measured by a capnograph
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SUDDEN LOSS OF WAVEFORM
• Apnea
• Aiway obstruction
• Disloged airway(oesophageal)
• Airway disconnection
• Ventilator malfunction
• Cardiac arrest
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ESOPHAGEAL TUBE
• A normal capnogram is the best evidence that the
ETT is correctly positioned.
• With an esophageal tube little or no co2 is present.
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TYPES OF TECHNOLOGY
Infrared (IR) Spectroscopy
Side stream sampling
Main stream sampling
Microstream technology
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INFRARED SPECTROSCOPY
• A beam of infrared light energy is passed
through a gas sample containing CO 2
• CO2 molecules absorb specific wavelengths of
infrared light energy.
• Light emerging from sample is analyzed.
• A ration of the CO2 affected wavelengths to
the non-affected wavelengths is reported as
ETCO2.
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SIDESTREAM
• “First generation” devices
• Sample of exhaled gas is
aspirated From the patients
airway interface into the
monitor which houses the
sensor
• Can be used in non intubated
• patients
• Secretions/moisture
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MAINSTREAM
• “Second generation”
• Sensor attaches directly
to the airway
• During exhalation,
exhaled gas passes
directly
• over the sensor
• Primarily for intubated
patients
• Secretions
• FRAGILE!
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MICROSTREAM
• Samples 1/20th the volume
• Vapor permeable tubing
• Sub micron-multi-surface tubing
• Expensive parts are protected
• Microbeam IR sensor is CO2 specific
• Can be used for adult and pediatrics
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NORMAL WAVEFORM
WAVEFORM
End of
Alveolar
Beginning of exhalation
plateau
exhalation
Beginning of
new breath
End of
inspiration
Clearing of anatomic dead space
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WAVEFORMS
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TERMINATION OF RESUSCITATION
• EtCO2 measurements during a resuscitation
give you an accurate indicator of survivability
for patients under CPR
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FACTORS THAT AFFECT CO2 LEVELS
INCREASE IN ETCO2 DECREASE IN ETCO2
Increased muscular activity Decreased muscular activity
Increased Cardiac output Decreased Cardiac output
Effective drug therapy for bronchospasm
bronchospasm
Hypoventilation Hyperventilation
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USES OF CAPNOGRAPHY
4 MAIN USES OF CAPNOGRAPHY:
•Severity of asthma patients
•Monitoring of head injured patients
•Cardiac arrest
•Tube confirmation
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REFERENCES
• [Link]
waveform-interpretation
• [Link]
aveform_obstruction
• [Link]
• Diagnostic and therapeutic equipment slides.
• Wikipedia.
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Thank you
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