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PubMed2002

Validation study of two-microphone acoustic reflectometry for determination of breathing tube placement in 200 adult patients.

BACKGROUND: Acoustic reflectometry allows the construction of a one-dimensional image of a cavity, such as the airway or the esophagus. The reflectometric area-distance profile consists of a constant cross-sectional area segment (length of endotracheal tube), followed either by a rapid increase in the area beyond the carina (tracheal intubation) or by an immediate decrease in the area (esophageal intubation). METHODS: Two hundred adult patients were induced and intubated, without restrictions on anesthetic agents or airway adjunct devices. A two-microphone acoustic reflectometer was used to determine whether the breathing tube was placed in the trachea or esophagus. A blinded reflectometer operator, seated a distance away from the patient, interpreted the acoustic area-distance profile alone to decide where the tube was placed. Capnography was used as the gold standard. RESULTS: Of 200 tracheal intubations confirmed by capnography, the reflectometer operator correctly identified 198 (99% correct tracheal intubation identification rate). In two patients there were false-negative results, patients with a tracheal intubation were interpreted as having an esophageal intubation. A total of 14 esophageal intubations resulted, all correctly identified by reflectometry, for a 100% esophageal intubation identification rate. CONCLUSIONS: Acoustic reflectometry is a rapid, noninvasive method by which to determine whether breathing tube placement is correct (tracheal) or incorrect (esophageal). Reflectometry determination of tube placement may be useful in airway emergencies, particularly in cases where visualization of the glottic area is not possible and capnography may fail, as in patients with cardiac arrest.

Acoustics↗
PubMed1997

Evaluation of noninvasive monitoring techniques in domestic ferrets (Mustela putorius furo).

OBJECTIVE: To evaluate instrument placement and accuracy of indirect physiologic monitoring techniques in anesthetized domestic ferrets. ANIMALS: 10 healthy adult female ferrets (Mustela putorius furo). PROCEDURE: Direct arterial blood pressure measurement and arterial blood sample collection were performed in ferrets. A pulse oximeter probe was clipped to a forefoot or hind foot; an airway adaptor for capnography was attached to the endotracheal tube; and a sphygmomanometer cuff and Doppler flow probe were positioned on the tail. Isoflurane and nitrous oxide concentrations were varied to induce episodes of hypotension or hypoxia, respectively. Aforementioned noninvasive techniques were compared with direct methods of arterial blood gas analysis, hemoximetry, and arterial blood pressure measurement. Simultaneously obtained direct and indirect measurements were statistically evaluated for mean and SD of the differences, and SEM, and subjectively, for ease of use and relevance to the clinical situation. RESULTS: Values obtained from pulse oximetry were closely related to oxygen saturation measured by blood gas analysis (O2sat). The mean (+/- SD) difference for all results was -0.49 (+/- -4.09)%. The most precise measurements were obtained when O2sat was between 90 and 100%. Capnography measurements varied between ranges. The most accurate measurements were obtained when PaCO2 was < 25 mm of Hg, when the mean difference was 1.6 (+/- -3.01) mm of Hg. Indirect blood pressure measurement consistently underestimated the direct blood pressure value. CONCLUSIONS AND CLINICAL RELEVANCE: Pulse oximetry is a convenient and accurate method for monitoring oxygen saturation in domestic ferrets. Capnography is useful for monitoring respiratory rate and pattern, but may present difficulties in interpretation of actual PaCO2. Indirect blood pressure monitoring is not accurate by use of current methods in ferrets.

Anesthetics, Inhalation↗
PubMed2004

Extended/advanced monitoring techniques in gastrointestinal endoscopy.

The practice of sedation and analgesia is under increasing scrutiny by numerous regulatory agencies, with the aim of making these procedures safer and reducing the incidence of cardiopulmonary complications during GI endoscopy. As we move toward more evidence-based medicine, new technologies will have to be assessed in a manner that demonstrates their efficacy and utility in clinical practice. Although there have been no controlled studies examining whether more intensive monitoring during endoscopy improves outcomes, extended monitoring with capnography seems to offer an advantage over conventional monitoring in that, by providing a real-time indication of any change in adequate ventilation before oxygen desaturation occurs, it can detect early phases of respiratory depression, which can allow a more precise and safer titration of medications. There is a close agreement among experts that capnography may reduce the risk of adverse outcomes during deep sedation; therefore, its use should be required for patients undergoing advanced endoscopic procedures with the potential for deep sedation. Extended monitoring with capnography should also be endorsed whenever propofol is considered as an alternative to standard sedation with a benzodiazepine or narcotic. Our understanding of the clinical application of techniques for monitoring of depth of sedation is in its infancy, and its full contribution to the practice of endoscopy has yet to be determined. Their potential role in improving sedation practice during endoscopy needs to be confirmed by controlled trials. If we consider the lack of proven efficacy of these emerging monitoring techniques in reducing the adverse outcomes associated with sedation and analgesia, the importance of appropriate monitoring cannot be overemphasized. However, it is vital for the endoscopist to be thoroughly familiar with the type of sedation chosen, to be able to recognize the various levels of sedation, and, above all, to rescue patients should they unintentionally progress to a deeper level of sedation than intended.

Procedural Sedation↗
PubMed1993

Arterial to end-tidal CO2 tension difference after bilateral lung transplantation.

OBJECTIVES: To assess ventilation/perfusion mismatch with high ventilation/perfusion ratios (i.e., alveolar deadspace) and to assess capnography as a noninvasive method of monitoring ventilation after bilateral lung transplantation. DESIGN: Clinical, prospective study. Repeated-measures analysis of variance was done to assess the time course of the arterial to end-tidal CO2 tension difference. SETTING: University hospital operating theater and intensive care unit. PATIENTS: Seven consecutive patients aged 25 to 64 yrs who underwent bilateral lung transplantation for end-stage lung disease. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The arterial to end-tidal CO2 tension difference was determined using infrared absorption capnography during postoperative day 1. Measurements were done at 10 mins, and at 1, 3, 12, and 24 hrs after bilateral lung transplantation (timing of measurements determined from the time when both lungs were perfused and mechanically ventilated). An arterial to end-tidal CO2 tension difference, ranging from 6 to 21 torr (0.8 to 2.8 kPa), mean 16 +/- 5 torr (2.2 +/- 0.7 kPa), was observed immediately after the transplantation. This difference rapidly decreased to 9 +/- 4 torr (1.2 +/- 0.6 kPa; p < .01) after 3 hrs and to 5 +/- 3 torr (0.6 +/- 0.4 kPa; p < .01) after 24 hrs. CONCLUSIONS: Our data suggest marked alveolar deadspace ventilation immediately after bilateral lung transplantation. The presence and rapid improvement of this ventilation/perfusion mismatch may reflect the presence of ischemia-reperfusion lung injury and its improvement in the first hours of reperfusion. In five of seven patients, capnography was not a good measure of PaCO2 during the first hours after bilateral lung transplantation.

Adult↗
PubMed1993

The Australian Incident Monitoring Study. Which monitor? An analysis of 2000 incident reports.

The role of monitors in patients undergoing general anaesthesia was studied by analysing the first 2000 incidents reported to the Australian Incident Monitoring Study; 1256 (63%) were considered applicable to this study. In 52% of these a monitor detected the incident first; oximetry (27%) and capnography (24%) detected over half of the monitor detected incidents, the electrocardiograph 19%, blood pressure monitors 12%, a low pressure (circuit) alarm 8%, and the oxygen analyser 4%. Of the other monitors used, 5 first detected 1-2% of incidents, and the remaining 8 less than 0.5% each. The oximeter would have detected over 40% of the monitor detected incidents had its more informative modulated pulse tone always been relied upon instead of the "bleep" of the ECG. A theoretical analysis was then carried out to determine which of an array of 17 monitors would reliably have detected each incident had each monitor been used on its own and had the incident been allowed to evolve. To facilitate "scoring" of monitors, the incidents were categorized empirically into 60 clinical situations; 40% of applicable incidents were accounted for by only 5 clinical situations, 60% by 10 and nearly 80% by 20. 98% were accounted for by the 60 situations. A pulse oximeter, used on its own, would theoretically have detected 82% of applicable incidents (nearly 60% before any potential for organ damage). These figures for capnography are 55% and 43% and for oximetry and capnography combined are 88% and 65%, respectively. With the addition of blood pressure monitoring these become 93% and 65%, and of an oxygen analyser, 95 and 67%. Other monitors, including the ECG, each increase the yield by by less than 0.5%. The international monitoring recommendations and those of the Australian and New Zealand College of Anaesthetists are thoroughly vindicated by the patterns revealed in this study. The priority sequence of monitor acquisition for those with limited resources should be stethoscope, sphygmomanometer, oxygen analyser if nitrous oxide is to be used, pulse oximeter, capnograph, high pressure alarm, and, if patients are to be mechanically ventilated, a low pressure alarm (or spirometer with alarm); an ECG, a defibrillator, a spirometer and a thermometer should be available.

Accidents↗
PubMed1993

The Australian Incident Monitoring Study. Oesophageal intubation: an analysis of 2000 incident reports.

There were 35 oesophageal intubations in the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS). These reports confirm existing impressions that misplacement of the endotracheal tube can occur in trained as well as untrained hands, and that auscultation is an unreliable test. On the other hand, the value of capnography is emphasised, with no false positives in the 16 cases in which the instrument was used. There was one false negative. Over the 4 years of the AIMS study, reports have declined in frequency. It is possible that the early detection of oesophageal intubation by capnography has altered its status to the extent that anaesthetists no longer regard it as a "critical" incident. It is highly recommended that the presence of the expected concentration of carbon dioxide in expired air be confirmed by capnography immediately after any endotracheal intubation.

Accidents↗
PubMed1994

Ventilation monitoring during monitored anesthesia care: a review.

The use of capnography during general anesthesia has become not only state of the art but also a recommended standard of care. In intubated patients, measurements of partial pressure of carbon dioxide in exhaled pulmonary gases approximate partial pressure of carbon dioxide in arterial blood under stable conditions. End-tidal carbon dioxide measurement has allowed anesthetists to continuously follow carbon dioxide concentration in exhaled gases; indirectly, it has enabled them to continuously monitor carbon dioxide concentration in arterial blood. This information has proven indispensable in the care of patients receiving general anesthesia, with its accompanying respiratory depressant effects. Recently, attention has focused on the utilization of capnography in sedated, nonintubated patients to follow carbon dioxide concentrations and access respiratory system function. This review of the current body of literature outlines development in capnography monitoring for sedated, nonintubated patients. Emphasis is placed on current techniques of measurement, the degree of correlation, and ramifications for clinical practice.

Anesthesia↗
PubMed2003

Good estimation of arterial carbon dioxide by end-tidal carbon dioxide monitoring in the neonatal intensive care unit.

End-tidal carbon dioxide pressure (PetCO(2)) was measured in the neonatal intensive care unit (NICU) to assess its reliability and accuracy in predicting arterial partial pressure of carbon dioxide (PaCO(2)). Arterial blood was drawn for gas analysis and compared with exhaled CO(2) measured by mainstream capnography. In total, 130 PetCO(2)/PaCO(2) comparisons were obtained from 61 patients (20 term and 41 preterm infants). PetCO(2) was significantly different from PaCO(2) (PetCO(2) = 42.3 +/- 10.5 mmHg vs. PaCO(2) = 45.8 +/- 12.3 mmHg, P < 0.001, mean +/- SD). The overall PetCO(2) bias (mean +/- SD) was 3.5 +/- 7.1 mmHg. There was a positive correlation between PetCO(2) and PaCO(2) (n = 130, r = 0.818, P < 0.001) in both term (n = 44, r = 0.779, P < 0.001) and preterm infants (n = 86, r = 0.849, P < 0.001). The PetCO(2) biases (95% CI) were 3.5 +/- 9.0 mmHg (0.8-6.2) in the term group and 3.4 +/- 6.0 mmHg (2.2-4.7) in the preterm group. Therefore, PetCO(2) was a valid and reliable method for monitoring PaCO(2) in neonates, especially preterm infants. This method decreases blood loss and prevents complications associated with arterial catheters. In conclusion, we recommend using mainstream capnography to monitor PetCO(2) instead of measuring PaCO(2) in the NICU.

Capnography↗
PubMed2001

Quantitative analysis of end-tidal carbon dioxide during mechanical and spontaneous ventilation in infants and young children.

Capnography provides a substitute for monitoring of arterial carbon dioxide tension (PCO(2)). We performed a prospective study to evaluate a new application of capnography, using quantitative curve analysis in the pediatric ICU. Twenty-five infants and children admitted to the pediatric ICU after cardiovascular surgery for congenital heart diseases were included in the study. Capnographic curves were recorded during 3 phases of mechanical and spontaneous ventilation: phase 1, immediate postoperative period; phase 3, preextubation period; and phase 2, period between phases 1 and 3. Each recording included 17 sec of capnographic tracings from consecutive spontaneous and/or ventilator-driven breaths. Quantitative curve analysis was made to define parameters including peak value of exhaled PCO(2) (P), mean rate of rise of PCO(2) (R), and area under each capnographic curve (A). Qualitative inspection of the wave contour showed no obvious difference in phase 3 during spontaneous and mechanically assisted ventilator breaths. However, an obvious difference existed between spontaneous and mechanically assisted breaths in phase 2. For each parameter (P, R, and A), there was a significant difference in phases 2 and 3 from spontaneous breaths. However, there was no significant difference in phases 2 and 3 from ventilator-assisted breaths. We further calculated the ratio of parameters of spontaneous breaths (S) and ventilator-assisted breaths (V) in phase 2 and phase 3. The ratio of S/V for P, R, and A showed significant differences between phase 2 and phase 3. We conclude that quantitative analysis of exhaled end-tidal PCO(2) curves revealed significant changes of specific parameters during the transition from the ventilator-dependent state to the spontaneously breathing ventilator-independent state. This new approach provides a new way to estimate respiratory status in infants and children receiving ventilator therapy. Through quantitative capnographic curve analysis, if P, R, and A from spontaneous breaths approached those of ventilator-assisted breaths, patients have resumed reasonable pulmonary mechanics, and extubation may then be considered.

Capnography↗
PubMed2001

[Fiberoptic intubation during remifentanil propofol sedation].

OBJECTIVE: Fiberoptic intubation for the management of the difficult airway is usually achieved with the patient under light sedation. The goal of the present study was to evaluate the combination of propofol and remifentanil for sedation during fiberoptic intubation. METHODS: Plans were made to use fiberoptic intubation in 40 patients with predictably difficult airways. After topical anaesthesia of the pharynx with lidocaine, oxygen was administered via nasal cannula. A capnograph was attached to determine the adequacy of ventilation and an infusion of remifentanil (0.05 microgram/kg/min) and propofol (2 mg/kg/h) was started. After the first signs of sedation, nasal fiberoptic intubation was carried out. The depth of sedation was guided by clinical observation and capnographic data and the remifentanil dose was adjusted as necessary. RESULTS: All patients, including some with very severe airway anomalies, were uneventfully intubated using the regimen we have described. Nasal capnography made it possible to monitor ventilation in all patients during bronchoscopy and intubation. The onset of hypoventilation was recognized in patients and appropriately treated by adjusting the narcotic dose. No subject became hypoxic or hypercarbic during the procedure. The changes of blood pressure and heart rate exceeded the 30% range in only one patient (a 37% blood pressure increase). Sedation was rated as good to very good in 35 patients. Coughing occurred only in 5 patients and 37 out of 40 patients had no recall that intubation had occurred. CONCLUSION: Our combination of remifentanil and propofol was shown to be a safe sedation regimen for fiberoptic intubation. Monitoring ventilation via nasal capnography and arterial oxygen saturation via pulse oximetry provided sufficient patient safety.

Adjuvants, Anesthesia↗
PubMed1999

Microstream capnograpy technology: a new approach to an old problem.

Significant technical limitations inherent in black-body infrared technology used in conventional sidestream and mainstream capnography have hindered the acceptance and growth of capnography as a monitoring tool outside the operating room environment. We describe a new technology (Microstream) for CO2 monitoring, based on molecular correlation spectroscopy, which results in a highly efficient and selective emission of a spectrum of discrete wavelengths exactly matching those for CO2 absorption. The CO2 specific emissions allow for an extremely small sample cell (15 microl), which in turn, permits the use of a very low sample flow rate (50 ml/min) without compromising waveform integrity or end-tidal CO2 accuracy. Design and technology features of the CO2 emission source, sample cell, and breath sampling circuits are described.

Absorption↗
PubMed2002

Rapid detection of oesophageal intubation: take care when using colorimetric capnometry.

BACKGROUND: Rapid detection of a misplaced endotracheal tube in the esophagus is crucial, especially in emergency situations. Hence, we have compared the ability of a colorimetric CO2 indicator (Colibri technology, CO2ntrol 1) and a capnography to differentiate oesophageal and tracheal intubation, with and without CO2 air in the esophagus. METHODS: Fourteen otherwise healthy patients were intubated with an endotracheal tube in the trachea under general anesthesia. After a positive verification of this endotracheal tube and established mechanical ventilation a second endotracheal tube was placed in the esophagus. Both were initially ventilated four times, and expired CO2 was measured with a mainstream capnograph and a colorimetric indicator. In the remaining five patients CO2 containing air was inserted into the esophagus first and then ventilated four times. RESULTS: Both the colorimetric indicator and mainstream capnograph verified correct placement of the endotracheal tube from the first ventilation. When the tube was placed in the esophagus, both methods correctly showed that no CO2 was present. However, in patients (n=5) with CO2 installed in their esophagus, the colorimetric indicator, but not the capnograph, had readings showing that CO2 was present. This may cause a misinterpretation of correct tracheal placement. CONCLUSIONS: We found that in emergency situations where CO2 containing air may be present in the esophagus, capnography should be the preferred method of verifying endotracheal and not oesophageal intubation. The tested colorimetric CO2 indicator (Colibri technology, CO2ntrol 1) is very sensitive to low CO2 values. It may therefore falsely indicate correct endotracheal intubation, even when the tube is in the oesophageus.

Anesthesia↗
PubMed2003

Comparison of transcutaneous and endtidal CO2-monitoring for rigid bronchoscopy during high-frequency jet ventilation.

OBJECTIVE: To compare endtidal and transcutaneous respiratory monitoring of high-frequency jet ventilation (HFJV) in rigid bronchoscopy. Both techniques provide a noninvasive measurement of pCO2. METHODS: High-frequency jet ventilation was applied via a rigid bronchoscope. Driving pressure (DP) was initially adapted to ensure normal ventilation. It was then changed twice by +/- 30% from the initial value. Endtidal and transcutaneous data were compared with arterial blood gas monitoring (ABG). RESULTS: Results were analyzed separately for the time just after changing the driving pressure (10 min) and the remaining time until the next change of the driving pressure (4 min). The first part was called the dynamic phase, and the second part the steady-state phase. Correlation coefficient between endtidal capnography and ABG was 0.96 for the steady state and 0.94 for the dynamic phase, respectively. Bland-Altman analysis revealed a bias of -0.21 kPa with limits of agreement (LOA) 1.63 kPa for the steady state and -0.25 kPa, 2.08 kPa for the dynamic phase, respectively. Correlation coefficient between transcutaneous monitoring and ABG for the steady state phase was 0.83, and was 0.72 for the dynamic phase. Bland-Altman analysis resulted in a bias of -0.89 kPa with LOA - 3.84 kPa during steady state and 0.92 kPa, 4.06 kPa for the dynamic phase, respectively. CONCLUSION: Endtidal capnography offers accurate respiratory monitoring of HFJV. Transcutaneous monitoring showed a good correlation to ABG only during steady-state conditions. For the dynamic phase the accuracy was significantly lower. Thus, we cannot recommend transcutaneous respiratory monitoring for the specific indication of rigid bronchoscopy using HFJV.

Adult↗
PubMed1999

The assessment of four different methods to verify tracheal tube placement in the critical care setting.

UNLABELLED: One of the most serious complications of conventional endotracheal intubation is unidentified placement of the tube in the esophagus. The aim of our study was to evaluate four different methods for immediate detection of the tube position: auscultation, capnographic determination of ETCO2, esophageal detection method (EDM) using a self-inflating bulb, and the transillumination method using a lighted stylet (Trachlight; Laerdal, Armonk, NY). Thirty-eight endotracheally intubated patients admitted to our medical intensive care unit were enrolled in the study. A second identical tube was inserted into the esophagus under laryngoscopic control. The endotracheal tube was then disconnected from the ventilator. Two blinded examiners, one experienced, the other inexperienced, determined the tube position within 30 s using one of the four methods. The order of the tubes tested and the methods used were randomized. In 130 of 152 examinations, both examiners correctly diagnosed the position of the tube. The wrong result was obtained by both examiners 4 times; only the experienced examiner was wrong 4 times, and only the inexperienced examiner was wrong 14 times. Using ETCO2, both examiners were correct in all cases. Auscultation showed an obvious relation to the examiner's experience: the experienced examiner was correct in all cases, the inexperienced examiner was correct in only 68% of cases. Using the self-inflating bulb, there were two wrong results of the experienced examiner and one wrong result of the inexperienced examiner. The transillumination technique was associated with a high error rate by both examiners (16% and 13%, respectively). Comparing all four methods showed that capnography is superior to auscultation (P = 0.0005) and to the Trachlight detection method (P = 0.0078). EDM was not statistically superior to auscultation and transillumination. Capnography was the most reliable method for rapid evaluation of tube position, followed by EDM, whereas auscultation and Trachlight did not seem to be of comparable value. Experience was a determining factor for auscultation. IMPLICATIONS: To prevent unidentified esophageal intubation, a serious complication in the critical care setting, four methods for detecting tube position were tested by two examiners (one experienced, the other inexperienced) in endotracheally intubated patients after insertion of a second tube into the esophagus.

Adult↗
PubMed1997

Prolonged "phantom" square wave capnograph tracing after patient disconnection or extubation. Potential hazard associated with the Siemens Servo 900c ventilator.

BACKGROUND: The authors report on the appearance of misleading square wave "phantom" capnograph tracings for approximately 3 min after disconnection from the Siemens Servo 900c ventilator. A series of experiments are described to examine the mechanism of this phenomenon. METHODS: Patients were ventilated using the Siemens Servo 900c ventilator with the following settings: minute volume, 5 1/min; respiratory rate, 8 breaths/min; PEEP, 0 cm H2O; trigger sensitivity, 20 cm H2O. The ventilator was connected to the Siemens Servo Evac 180 evacuation system (25 1/min on evacuation flowmeter). Airway pressure and capnography were recorded at the Y piece during ventilation and after disconnection. A back-up ventilator was used to support the patient during disconnection of the ventilator being studied. RESULTS: Initially, the "phantom" capnograph tracing closely resembled the square wave capnograph tracing before disconnection, but the amplitude and shape of the waveform gradually decayed. Based on experiments described in this article, the authors show that the carbon dioxide for the "phantom" capnograph tracing comes from the gas exhaled by the patient in the last breaths before disconnection and which is present in both the expiratory tubing and in the evacuation system. The small pressure gradient between the exhaust reservoir and the atmosphere causes reverse flow of expired gas after disconnection, when both the nonreturn flap valve at the exhaust outlet is open (due to minimal valve incompetence) and when the expiratory servo valve is open (in the absence of positive end-expiratory pressure). This continuous reverse flow is detected by the capnograph but is interrupted intermittently by each attempted positive pressure ventilation, thereby creating a "phantom" capnograph. CONCLUSIONS: After accidental disconnection of the patient from the breathing system, or after accidental extubation of the trachea, the "phantom" capnograph is likely to confuse even an experienced anesthesiologist into the mistaken belief that his rapidly deteriorating patient is being ventilated adequately. Several potential mechanisms to eliminate this phenomenon are outlined, including the avoidance of zero positive end-expiratory pressure. "Phantom" capnography provides an illustration of the dangers of using monitoring techniques, however reliable, as a substitute for vigilant clinical observation.

Capnography↗
PubMed2000

Arterial to end-tidal carbon dioxide pressure difference during laparoscopic surgery in pregnancy.

BACKGROUND: There is controversy about whether capnography is adequate to monitor pulmonary ventilation to reduce the risk of significant respiratory acidosis in pregnant patients undergoing laparoscopic surgery. In this prospective study, changes in arterial to end-tidal carbon dioxide pressure difference (PaCO2--PetCO2), induced by carbon dioxide pneumoperitoneum, were determined in pregnant patients undergoing laparoscopic cholecystectomy. METHODS: Eight pregnant women underwent general anesthesia at 17-30 weeks of gestation. Carbon dioxide pnueumoperitoneum was initiated after obtaining arterial blood for gas analysis. Pulmonary ventilation was adjusted to maintain PetCO2 around 32 mmHg during the procedure. Arterial blood gas analysis was performed during insufflation, after the termination of insufflation, after extubation, and in the postoperative period. RESULTS: The mean +/- SD for PaCO2--PetCO2 was 2.4 +/- 1.5 before carbon dioxide pneumoperitoneum, 2.6 +/- 1.2 during, and 1.9 +/- 1.4 mmHg after termination of pneumoperitoneum. PaCO2 and pH during pneumoperitoneum were 35 +/- 1.7 mmHg and 7.41 +/- 0.02, respectively. There were no significant differences in either mean PaCO2--PetCO2 or PaCO2 and pH during various phases of laparoscopy. CONCLUSIONS: Capnography is adequate to guide ventilation during laparoscopic surgery in pregnant patients. Respiratory acidosis did not occur when PetCO2 was maintained at 32 mmHg during carbon dioxide pneumoperitoneum.

Analysis of Variance↗
PubMedDate not supplied

End-tidal carbon dioxide monitoring for weaning patients: a pilot study.

This research pilot study evaluates the usefulness of capnography for patients being weaned from mechanical ventilation in a medical intensive care unit (MICU). The hypothesis that capnography would allow for more rapid weaning from mechanical ventilation, and require fewer arterial blood gases (ABGs) during the process, was found to be untrue. Several implications for critical care nursing practices were derived from the literature review and findings of this study.

Adult↗
PubMed2003

Airway equipment in Scottish emergency departments.

Airway management is the cornerstone of resuscitation. Emergency endotracheal intubation is more likely to be difficult in the accident and emergency (A&E) department setting compared with the operating room. A&E departments must have an appropriate selection of equipment to deal with difficult airway problems. The aim of this study was to determine the type and range of equipment for airway management in A&E departments in Scotland, UK. A two-page postal survey was sent to consultants in charge of 24 A&E departments covering 98% of major trauma patients in Scotland. The response rate was 96% (23/24). Every department had equipment for basic airway management and all had laryngoscopes, stylets, gum elastic bougies and capnography. Ninety-six per cent (22/23) had equipment for performing a surgical airway and 74% (17/23) possessed laryngeal mask airways suitable for adults; only one department did not possess a suitable rescue device. Thirty per cent (7/23) of departments did not use capnography routinely to confirm correct placement of endotracheal tubes. It is concluded that airway equipment in Scottish A&E departments is adequate for basic airway care and endotracheal intubation. Nearly all departments have access to a suitable rescue device for the failed or difficult airway. Capnographic confirmation of tube placement should be mandatory in A&E.

Capnography↗