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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.
Capnography can provide important clues concerning the acid-base status of patients. Arterial blood gas analysis is essential to properly evaluate the acid-base status, and diagnose and treat underlying disorders. Acids and bases are constantly formed in the body as by-products of metabolism, and are carefully regulated. Buffering mechanisms include intracellular and extracellular chemical buffers, regulation of CO2 by the respiratory and central nervous systems (CNS), and control of bicarbonate by the kidney. Capillary blood samples can be used, particularly in children, to measure arterial blood gases (ABGs). Loop and thiazide diuretics can incite a metabolic alkalosis, while carbonic anhydrase inhibitors can cause a metabolic acidosis. Overdoses of drugs can produce mixed acid-base disorders, such as the combined metabolic acidosis and respiratory alkalosis from a salicylate overdose. Simple acid-base disorders involve a primary abnormality in either metabolism or respiration that produces a secondary change, or compensatory response, in the other component.
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.