Application of Capnography in ED

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Application of Capnography in ED

• Chen, Kuo-Chih, MD
• Shin-Kong Wu Ho-Su Memorial Hospital
• 92-11-03

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www.capnography.com.

• An Educational and animated website
• Designed, produced and maintained by Bhavani
  Shankar Kodali MD
• Associate Professor, Harvard Medical School
  Brigham and Women's Hospital, Boston, MA

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Information from ACLS

• ETT primary confirmation
• Physical examination
• ETT secondary confirmation
• End-tidal CO2 detectors
• Qualitative
• Quantitative
• Esophageal Detector Device

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EDD
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End-Tidal CO2 detector
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Capnography Devices
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Colorimetry
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Monitor Consideration

• Invasiveness
• Ease of use
• Reproducibility of results
• Delayed v.s. Real-time data acquisition
• Risk-benefit ratio of the device

American Journal of Medicine. 95(2)221-228,
August 1993.
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Respiratory Monitor

• Standard ABG
• Noninvasive
• Oxygenation
• Pulse oximetry
• Ventilation
• End-tidal CO2

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PEtCO2

• Gas sampling
• Main-stream
• Side-stream
• Infrared spectroscopy
• Mass spectroscopy
• Raman spectroscopy

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Main- vs Side-Stream
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Infra-red Spectrography
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Cardiac arrest
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Capnogram vs Tidal Volume
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(a-ET)PCO2  reflects  Alveolar Dead Space
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(a-ET)PCO2
Hemorrhage
Air embolism
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PETCO2 increased
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PETCO2 decreased
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Clinical application of PEtCO2

• Confirming Endotracheal Intubation
• Monitoring Alveolar Ventilation
• Assessing Cardiopulmonary Resuscitation (CPR)
• Monitoring Changes in Dead Space

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ETT confirmation

• Under use in ICU (UK)
• Anaesthesia. 2003 May58(5)476-9
• ER setting
• ETCO(2) monitor (non-CA)
• Clinical methods (CA CPR)
• Resuscitation. 2003 Feb56(2)153-7

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Accidental esophageal intubation  
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Assess CPR

• IAC-CPR vs S-CPR
• Ann Emerg Med. 1989 Aug18(8)831-7
• Mechanical vs Manual CPR
• Ann Emerg Med. 1993 Apr22(4)669-74
• Am J Emerg Med. 1998 May16(3)289-92
• ACD-CPR vs S-CPR
• Ann Emerg Med. 1995 Jan25(1)48-51
• Immediate rise after ROSC
• JAMA. 1987 Jan 23-30257(4)512-5
• Predict survivor
• JAMA. 1989 Sep 8262(10)1347-51

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Prognostic value in CA

• 10-15 torr at 20min
• Eur J Emerg Med. 2001 Dec8(4)263-9
• Am J Crit Care. 2001 Nov10(6)391-8
• N Engl J Med. 1997 Jul 31337 (5)301-6
• Ann Emerg Med. 1994 Jan23(1)25-30
• Crit Care Med. 1990 Apr18(4)358-62

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Other application

• ETCO2 in pediatric DKA
• Acad Emerg Med. 2002 Dec9(12)1373-8
• ETCO2 in procedure sedation
• Acad Emerg Med. 2002 Apr9(4)275-80
• ETCO2 and sono for resus. prediction
• Acad Emerg Med. 2001 Jun8(6)610-5
• Feeding tube placement
• Anaesthesia. 2003 May58(5)476-9
• Crit Care Med. 2002 Oct30(10)2255-9
• Crit Care Med. 2001 May29(5)936-9

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Adequacy of spontaneous respiration
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ETCO2 in Shock

• Gas tonometry
• Crit Care Med. 1997 Mar25(3)533-7
• Sublingual capnometry
• Am J Respir Crit Care Med. 1998 Jun157(6 Pt
  1)1838-43
• Crit Care Med. 1999 Jul27(7)1225-9.
• Crit Care Med. 2000 Jul28(7)2415-9
• Chest. 2000 Oct118(4)1127-32
• Chest. 2001 Sep120(3)923-7
• Chest. 2001 Nov120(5)1633-8
• Crit Care Med. 2003 Mar31(3)818-22

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Summary
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Application in SKH
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THE END