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Capnography
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  • Cited by 9

Book description

In recent years capnography has gained a foothold in the medical field and is fast becoming a standard of care in anaesthesiology and critical care medicine. In addition, newer applications have emerged which have expanded the utility of capnographs in a number of medical disciplines. This new edition of the definitive text on capnography reviews every aspect of this valuable diagnostic technique. An introductory section summarises the basic physiology of carbon dioxide generation and transport in the body. A technical section describes how the instruments work, and a comprehensive clinical section reviews the use of capnography to diagnose a wide range of clinical disorders. Edited by the world experts in the technique, and with over 40 specialist contributors, Capnography, second edition, is the most comprehensive review available on the application of capnography in health care.

Reviews

Review of the first edition: ‘… addresses the physiologic and technological considerations that need to be understood to make capnography a clinically useful tool and should be standard reading for those who depend on it as an anesthetic monitor.'

Source: Anesthesiology Journal

Review of the first edition: ‘… a good addition to the reference library of departments of anesthesiology, critical care and emergency medicine.'

Source: Canadian Journal of Anesthesiology

'The inclusion of informative chapters on neonatal monitoring, sleep medicine, sedation, and veterinary medicine usefully widens the appeal of the book … [It] should be seen as an essential specialist reference book for the departmental library that those interested and/or needing to gain knowledge in capnography … can dip in and out of when required.'

Source: British Journal of Anaesthesia

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Contents


Page 1 of 2


  • 10 - Neonatal monitoring
    pp 80-95
  • View abstract

    Summary

    This chapter examines different time- and volume-based capnograms, and analyzes them from a clinical perspective, with a special focus on problems related to ventilation, by far the most common clinical application of capnography. A water trap with a large internal volume can introduce artifacts when high airway pressures during inspiration compress gas in the trap. The capnogram provides evidence of acutely reduced pulmonary perfusion coincident with a drop in cardiac output. The most important use of capnography in the field, in the intensive care unit, and in the operating room comes with the establishment of an artificial airway. An individual tracing of the time-based capnogram left a number of questions unanswered, which the single breath volume-based capnogram provides. The data offered by the volume-based capnogram refine the information offered by time-based capnography.
  • 12 - Conscious sedation
    pp 102-114
  • View abstract

    Summary

    Since gas exchange is a primordial function of the lungs and the conductive airways, respiratory assessment is of paramount importance. Capnography has been utilized in surgical patients for over three decades to confirm tracheal intubation and assess ventilation. Nitrogen washout provides an estimate of functional residual capacity, total lung volume, deadspace volume, and alveolar volume. Clinicians typically utilize exhaled CO2 concentration against time during a respiratory cycle. A number of applications are available in and out of the operating room. Capnography can be used as a continuous monitor of alveolar ventilation in patients with lung disease or hemodynamic instability. Mainstream capnometry appears to provide more accurate PETCO2 than conventional sidestream capnometry during spontaneous breathing in non-intubated patients. In the opinion of some investigators, the technology should be employed in all cases requiring sedation in or out of the operating room.
  • 13 - Capnometry monitoring in high- and low-pressure environments
    pp 115-126
  • View abstract

    Summary

    The ability to safely and effectively manage the airway is among the most fundamental and challenging aspects of out-of-hospital (OOH) emergency medical treatment. Commonly used devices to facilitate OOH airway management encompass a spectrum from basic means, such as the bag-valve mask (BVM), to more advanced and invasive means, such as the esophageal-tracheal combitube, laryngeal mask airway (LMA), laryngeal tube airway (LT), endotracheal tube (ET), and, ultimately, emergency surgical airways. End-tidal carbon dioxide (PetCO2) monitoring has emerged as the technology that can best confirm endotracheal or endobronchial location of an endotracheal tube. The threshold for detection of exhaled CO2 is significantly lower for capnometry and capnography as opposed to colorimetric devices. The use of capnography for OOH airway management enhances patient safety and can prevent the problem of unrecognized misplaced intubation (UMI) and should be a mandatory component of OOH airway management.
  • 14 - Biofeedback
    pp 127-134
  • View abstract

    Summary

    In the hospital setting, patients in the emergency room and intensive care units are at high risk for complications. This chapter reviews the specific role of capnography in the successful airway management of the hospitalized patient. Initiating airway intubation in the emergency room or in the intensive care unit allows significant opportunity for miscalculations that can take the form of esophageal intubations, delays in securing ventilation due to a difficult airway, and inadequate ventilation due to inappropriate settings. The most frequent cause of a false-positive result occurs when a large amount of expired gas is forced into the esophagus during bag-mask ventilation. As it relates to airway maintenance, continuous capnography provides graphical and numerical assurance of airway patency. During routine intensive care radiographic evaluations, inappropriate enteral tube placement has been identified as often as endotracheal tube malposition.
  • 15 - Capnography in non-invasive positive pressure ventilation
    pp 135-144
  • View abstract

    Summary

    The usually more controlled circumstances of airway management in the operating room (OR) often provide better conditions, better monitoring, and more experienced personnel, particularly when a problem occurs, than is available in other critical care environments or the emergency department. While the detection of CO2 by capnography after completion of a difficult intubation procedure may suggest success, it may more precisely indicate only that the tube tip is somewhere in the respiratory path, although perhaps not exactly where the intubationist desires. A capnography pattern indicating declining CO2 in each subsequent breath over several breaths will help identify esophageal intubation. Unilateral pathophysiologic conditions that cause unilateral hypoventilation or high airway resistances would result in a biphasic waveform. Many techniques to facilitate blind nasal tracheal intubation use the detection of significant exhaled gas flow from a spontaneously breathing patient to indicate the proximity of the tube tip to the glottic opening.