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At least 145 records · Page 8Linked to original sources
PubMed2006

Do all mechanically ventilated pediatric patients require continuous capnography?

With most patients in modern ICUs requiring mechanical ventilation, any technology that may lead to more optimal ventilatory strategies would be invaluable in the management of critically ill patients. The focus of most ventilator strategies is protecting the lung from the deleterious effects of mechanical ventilation. Every effort is made to minimize the duration of mechanical ventilation while optimizing the potential for successful extubation. A concise organized plan based on objective criteria that is adjusted to meet changes in patient status is clearly recommended. Continuous capnographic monitoring provides clinicians with clear, precise, objective data that may prove beneficial in the design and implementation of mechanical ventilatory strategies. There are no clear-cut methods for achieving the optimal ventilator strategy for a specific patient. Although guidelines and management theories exist throughout the medical literature, in practice, they often merely serve as loose guidelines. The dynamic properties of an acutely ill patient make the management of mechanical ventilation an ongoing process requiring clinical assessment and planning by multidisciplinary members of the patient care team. Comprehensive evaluation of ventilatory management strategies and patient responses must be made by a collaborative effort of physicians, respiratory care practitioners, and nurses. An objective, consistent approach to the overall management is essential. Although still controversial, it is the authors' opinion that volumetric capnograph provides the data necessary to establish adequate gas delivery, optimal PEEP, and effective ventilation with the least amount of mechanical assistance, regardless of clinician or institutional preferences.

Capnography↗
PubMed1997

Removal of retained air during cardiac surgery with transesophageal echocardiography and capnography.

STUDY OBJECTIVE: To evaluate a new method for removal of retained air at the end of cardiopulmonary bypass (CPB) by end-tidal CO2 pressure (PETCO2) and pulmonary arterial pressure (PAP) monitoring, and transesophageal two-dimensional echocardiography (TEE). DESIGN: Prospective study. SETTING: Cardiac surgery unit at a university hospital. PATIENTS: 36 ASA physical status I, II, III patients for open heart surgery. INTERVENTIONS: The CPB reservoir was gradually raised to decrease venous drainage. Accordingly, the right heart began to receive the venous blood and eject it to the pulmonary artery. The vent existing in the left ventricle or the left atrium then collected any whole blood containing air bubbles that came from the pulmonary circulation. The air bubbles were confirmed by TEE to be removed and not to eject from the left ventricle to te systemic circulation. MEASUREMENTS AND MAIN RESULTS: Levels of PETCO2, PaCO2, PAP, and the duration of the removal procedure were measured when a sufficient pulmonary circulation was established and the removal of retained air was considered to be satisfactorily accomplished by the absence of air bubbles, confirmed by TEE for more than 30 seconds. PETCO2 reached 28 +/- 4 mmHg during the removal of air, while PaCO2 reached 35 +/- 6 mmHg (p < 0.05). Mean PAP during removal of air reached 18 +/- 4 mmHg, which was approximately 90% of that before CPB. The duration time of removal of air was 9 +/- 2 min. CONCLUSIONS: PETCO2 and PAP are useful indicators of pulmonary circulation during this procedure for removal of air. PETCO2 of 25 to 30 mmHg and PAP of 90% of the prebypass level have been found to be necessary for the removal of air. Our technique for removal of air using PETCO2, PAP, and TEE enables us to satisfactorily eliminate residual air.

Adolescent↗
PubMed2003

Clinical test to confirm tracheal intubation: a new method to confirm endotracheal intubation in the absence of capnography.

BACKGROUND AND OBJECTIVE: Advancing an uncut endotracheal tube into the right main bronchus produces unilateral breath sounds. We wanted to test the validity of using this method to distinguish oesophageal from tracheal intubation. METHODS: Forty-two patients were randomized into two groups. The first group was randomized to receive an endotracheal tube that was advanced into the right main bronchus. The second group of patients had their tracheas intubated as normal and then a second endotracheal tube was placed in the oesophagus. Blinded observers were then asked to decide by auscultation if the patients had unilateral breath sounds or not and if they were bronchial and therefore to decide if endotracheal intubation had occurred. RESULTS: Ninety-one per cent of patients (95% CI 0.71-0.99) intubated in the right main bronchus were correctly identified by unilateral breath sounds confirming the usefulness of this test. CONCLUSIONS: Advancing an endotracheal tube into the right main bronchus and auscultation of unilateral breath sounds is a useful way of confirming tracheal intubation.

Adolescent↗
PubMed1998

Can capnography detect bronchial flap-valve expiratory obstruction?

OBJECTIVE: We have previously shown in a mechanical lung model [1] that bronchial flap-valve expiratory obstruction results in sequential lung expiration, best detected by prolonged and low magnitude tracheal expired flow (V) from the obstructed lung. However, the normal expiratory resistance of clinical ventilation circuits might also generate prolonged, low value exhaled V, that could be confused with bronchial flap-valve obstruction. We reasoned that bronchial flap-valve obstruction would also cause sequential CO2 unloading from each lung and result in a biphasic tracheal capnogram. METHODS: To test this hypothesis, we ventilated (VT, 650 ml; f, 10 br/min) a dual mechanical test lung, with each side connected to a separate alcohol-burning chamber. An airway adapter-monitor system measured airway V, P, PCO2, and FO2. The circumference of the diaphragm in a respiratory one-way valve was trimmed to generate unidirectional resistance to expiratory V. Measurement sequences were repeated after this flap-valve was interposed in the left "main-stem bronchus." RESULTS AND DISCUSSION: During moderate or severe left bronchial flap-valve obstruction, left bronchial V was delayed so that the left lung anatomical dead space (devoid of CO2) mixed with normal right exhalate to depress the expiratory upstroke or early plateau of the tracheal capnogram. During severe obstruction, decreased perfusion of the left lung caused lower alveolar PCO2. Then, prolonged low V from the left bronchus also resulted in depression of the end of the tracheal alveolar plateau. In general, the low magnitude of bronchial V from the obstructed lung limited its effect on the tracheal capnogram and the best marker of sequential lung emptying during bronchial flap-valve obstruction may be late exhaled V without reduction in total tidal volume.

Airway Obstruction↗