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  • Print publication year: 2011
  • Online publication date: August 2011

15 - Capnography in non-invasive positive pressure ventilation

from 1 - Ventilation

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.

References

1. HillNS. Noninvasive Positive Pressure Ventilation: Principles and Applications. Armonk, NY:Futura Publishing, 2001.
2. BrochardL, IsabeyD, PiquetJ, et al. Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 1990; 323: 1523–30.
3. MeduriGU, Abou-ShalaN, FoxRC, et al. Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 1991; 100: 445–54.
4. KramerN, MeyerTJ, MehargJ, CeceRD, HillNS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995; 151: 1799–806.
5. ScalaR, NaldiM. Ventilators for noninvasive ventilation to treat acute respiratory failure. Respir Care 2008; 53: 1054–80.
6. MehtaS. Noninvasive ventilation. Am J Respir Crit Care Med 2001; 163: 540–77.
7. HillNS, BrennanJ, GarpestadE, NavaS. Noninvasive ventilation in acute respiratory failure. Crit Care Med 2007; 35: 2402–7.
8. American Association for Respiratory Care. Clinical practice guideline: Capnography/capnometry during mechanical ventilation–2003 revision and update. Respir Care 2003; 48: 534–9.
9. HoffmanRA, KriegerBP, KramerMR, et al. End-tidal carbon dioxide in critically ill patients during changes in mechanical ventilation. Am Rev Respir Dis 1989; 140: 1265–8.
10. AntónA, GüellR, GómezJ, et al. Predicting the result of noninvasive ventilation in severe acute exacerbation of patients with chronic airflow limitation. Chest 2000; 117: 828–33.
11. SchönhoferB, Sortor-LegerS. Equipment needs for noninvasive mechanical ventilation. Eur Respir J 2002; 20: 1029–36.
12. SaatciE, MillerDM, StellIM, LeeKC, MoxhamJ. Dynamic deadspace in face masks used with non-invasive ventilators: a lung model study. Eur Respir J 2004; 23: 129–35.
13. FraticelliA, LelloucheF, TailleS, QaderS, Brochard, L. Comparison of different interface during NIV in patients with acute respiratory failure. Am J Respir Crit Care Med 2003; 167: A389.
14. SandersMH, KernNB, CostantinoJP, et al. Accuracy of end-tidal and transcutaneous PCO2 monitoring during sleep. Chest 1994; 106: 472–83.
15. WoolleyA, HicklingK. Errors in measuring blood gases in the intensive care unit: effect of delay in estimation. J Crit Care 2003; 18: 31–7.
16. OrrJA, BrewerLM, PinkstonJ. Limitations of capnometry for noninvasive ventilation using under-mask gas sampling. Crit Care Med 2007; 35 (Suppl): A234.
17. NuccioPF, JacksonMR. End tidal CO2 measurements with noninvasive ventilation. Society for Technology in Anesthesia (STA), January 13–14, 2009, San Antonio, TX.
18. FergusonGT, GilmartinM. CO2 rebreathing during BiPAP ventilatory assistance. Am J Respir Crit Care Med 1995; 151: 1126–35.
19. LofasoF, BrochardL, TouchardD, et al. Evaluation of carbon dioxide rebreathing during pressure support ventilation with airway management system (BiPAP) devices. Chest 1995; 108: 772–8.
20. Renaghan, D. Capnometric analysis of carbon dioxide rebreathing during noninvasive positive pressure ventilation with BiPAP. Crit Care Med 2000; 28: A177.
21. SchettinoGP, ChatmongkolchartS, HessDR, KacmarekRM. Position of exhalation port and mask design affect CO2 rebreathing during noninvasive positive pressure ventilation. Crit Care Med 2003; 31: 2178–82.
22. HillN. What mask for noninvasive ventilation: is deadspace an issue? Crit Care Med 2003; 31: 2247–8.
23. SamolskiD, CalafN, GüellR, CasanP, AntónA. Carbon dioxide rebreathing in non-invasive ventilation: analysis of masks, expiratory ports and ventilatory modes. Monaldi Arch Chest Dis 2008; 69: 114–18.
24. LieschingTN, CromierK, NelsonD, et al. Total face mask vs standard full face mask for noninvasive therapy of acute respiratory failure. Am J Respir Crit Care Med 2003; 167: A996.
25. CrinerGJ, TravalineJM, BrennanKJ, KreimerDT. Efficacy of a new full face mask for noninvasive positive pressure ventilation. Chest 1994; 106: 1109–15.
26. FerreiraJC, ChipmanDW, HillNS, KacmarekRM. Bilevel vs ICU ventilators providing noninvasive ventilation: effect of system leaks: a COPD lung model comparison. Chest 2009; 136: 448–56.
27. KacmarekR. Noninvasive positive-pressure ventilation: the little things do make the difference!Respir Care 2003; 48: 919–21.
28. PlantP, OwenJ, ElliottM. A multicentre randomized controlled trial of the early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. Lancet 2000; 355: 1931–5.
29. ChhajedPN, HeussLT, TammM. Cutaneous carbon dioxide monitoring in adults. Curr Opin Anaesthesiol 2004; 17: 521–5.