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Carbon Monoxide and Nonquantitative Carbon Dioxide Detection

Published online by Cambridge University Press:  28 June 2012

Georg Petroianu ,
Wolfgang Maleck ,
Wolfgang Bergler  and
Roderich Ruefer
Georg Petroianu*
Affiliation:
Department of Pharmacology, University of Heidelberg at Mannheim, Mannheim, Germany
Wolfgang Maleck
Affiliation:
Anaesthesiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
Wolfgang Bergler
Affiliation:
ENT Department, University of Heidelberg at Mannheim, Mannheim, Germany
*
Department of Pharmacology, University of Heidelberg at Mannheim, Mannheim, Germany
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Abstract

Introduction:

The capnometric demonstration of end-tidal carbon dioxide (CO2) is a reliable method of differentiating between a correct endotracheal tube position and an accidental misplacement of the tube into the esophagus. Recently, several CO2 detectors have been introduced for monitoring end-tidal CO2 in the “out-of-hospital” setting, where quantitative capnometry with capnography is not yet available.

Hypothesis:

These devices are not influenced by carbon monoxide (CO) present in lethal concentration.

Methods:

A heated (37°C) 2.3 L reservoir bag filled one-third full with water (representing the stomach in esophageal misintubation) was machine ventilated (tidal volume: 450 ml; frequency: 16/min) with the following mixtures for three minutes each: 1) 95% O2, 5% CO; 2) 45% O2 5% CO, 50% N2O; and 3) 44% O2 5% CO, 50% N2O, 1% halothane. The presence of end-tidal CO2 was monitored with each of the following devices: 1) MiniCAP™ III CO2 Detector; 2) StatCAP™ CO2 Detector; 3) EasyCAP™ CO2 Detector; PediCAP™ CO2 Detector; and 5) Colibri™ CO2 Detector.

Results:

In none of the cases was the presence of CO2 signaled by the detector.

Conclusion:

The presence of 5% CO does not interfere with infrared spectrometry detection (MiniCAP™ and StatCAP™) or chemical detection (EasyCAP™, PediCAP™, and Colibri™) of CO2. The devices can be used safely in patients with CO poisoning for monitoring of endotracheal tube position.

Keywords

capnometrycarbon dioxidecarbon monoxide
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 11 , Issue 4 , December 1996 , pp. 276 - 279
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1996

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References

1. Cobb, N, Etzel, RA: Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988. JAMA 1991;266:659–663.CrossRefGoogle ScholarPubMed
2. Buckley, RG, Aks, SE, Eshom, JL, et al. : The pulse oximetry gap in carbon monoxide intoxication. Ann Emerg Med 1994;24:252–255.CrossRefGoogle ScholarPubMed
3. Andersen, KH, Schultz-Lebahn, T: Oesophageal intubation can be undetected by auscultation of the chest. Acta Anaesthesiol Scand 1994;38:580–582.CrossRefGoogle ScholarPubMed
4. American Society of Anesthesiologists: Standards for basic intraoperative monitoring. In: American Society of Anesthesiologists 1993 Directory of Members. Park Ridge, IL: American Society of Anesthesiologists, 1993:709–710.Google Scholar
5. Holland, R, Webb, RK, Runciman, WB: Oesophageal intubation: an analysis of 2,000 incident reports. Anaesth Intensive Care 1993;21:608–610.CrossRefGoogle Scholar
6. Department of Health, Welsh Office, Scottish Office Home and Health Department, Department of Health and Social Security, Northern Ireland: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1988–1990. London, HMSO, 1994, p 94.Google Scholar
7. Waeckerle, JF: End-tidal CO2 detectors stir controversy. Ann Emerg Med 1994;24:320–321.CrossRefGoogle ScholarPubMed
8. Phillips, G: Checking for endotracheal placement. Anaesth Intensive Care 1994;22:498–499.Google Scholar
9. Rossi, R: Kapnographie im Notarztdienst. Notarzt 1994;10:S19–22.Google Scholar
10. Petroianu, GA, Maleck, WM: Detection of an oesophageal intubation: “state of the art.” Anaesth Intensive Care 1994;22:744–746.Google ScholarPubMed
11. Ginsburg, WH: When does a guideline become a standard? The new American Society of Anesthesiologists Guidelines give us a clue. Ann Emerg Med 1993;22:1891–1896.CrossRefGoogle Scholar
12. Bhende, MS, Thompson, AE, Orr, RA: Utility of an end-tidal carbon dioxide detector during stabilization and transport of critically ill children. Pediatrics 1992;89:1042–1044.CrossRefGoogle ScholarPubMed
13. Eitel, DR, Hess, DH, Drawbaugh, R, Ogden, C: Use of the Fenem end-tidal CO2 detector in patients in cardiac arrest. Respir Care 1991;36:1289.Google Scholar
14. Gerard, J, MacLeod, BA, Heller, MB, Yealy, DM: Verification of endotracheal intubation using a disposable end-tidal CO2 detector. Prehospital and Disaster Medicine 1989;4:74. Abstract.Google Scholar
15. Hayden, SR, Sciammarella, J, Viccellio, P: The reliability of disposable end-tidal CO2 detectors for certification of endotracheal tube placement in victims of cardiac arrest. Ann Emerg Med 1994;23:621.CrossRefGoogle Scholar
16. MacLeod, BA, Heller, MB, Gerard, J, et al. : Verification of endotracheal tube placement with colorimetric end-tidal CO2 detection. Ann Emerg Med 1991:267–270.CrossRefGoogle Scholar
17. Ornato, JP, Shipley, JB, Racht, EM, et al. : Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. Ann Emerg Med 1992;21:518–523.CrossRefGoogle ScholarPubMed
18. McCabe, L, Heller, MB: Confirmation of prehospital endotracheal intubation using an infrared end-tidal CO2 detector. Prehospital and Disaster Medicine 1991;6:379. Abstract.Google Scholar
19. Petroianu, G: Überprüfung der Tubuslage mit einem nichtquantitativen CO2 Detektor. Anaesthesist 1993;42:324–325.Google Scholar
20. Campbell, RC, Boyd, CR, Shields, RO, Odom, HW, Corse, KM: Evaluation of an end-tidal carbon dioxide detector in the aeromedical setting. Journal of Air Medical Transport 1990;11:13–15.CrossRefGoogle Scholar
21. Vukmir, RB, Heller, MB, Stein, KL: Confirmation of endotracheal tube placement: a miniaturized infrared qualitative CO2 detector. Ann Emerg Med 1991;20:726–729.CrossRefGoogle ScholarPubMed
22. White, RD, Asplin, BR: Out-of-hospital quantitative monitoring of end-tidal carbon dioxide pressure during CPR. Ann Emerg Med 1994;23:25–30.CrossRefGoogle ScholarPubMed
23. Gedeon, A, Krill, P, Mebius, C: A new colorimetric breath indicator (Colibri). Anaesthesia 1994;49:798–803.CrossRefGoogle ScholarPubMed
24. Anton, WR, Gordon, RW, Jordan, TM, et al. : A disposable end-tidal CO2 detector to verify endotracheal intubation. Ann Emerg Med 1991;20:271–275.CrossRefGoogle ScholarPubMed
25. Bhende, MS, Thompson, AE, Cook, DR, Saville, AL: Validity of a disposable end-tidal CO2 detector in verifying endotracheal tube placement in infants and children. Ann Emerg Med 1992;21:142–145.CrossRefGoogle ScholarPubMed
26. Higgins, D, Hayes, M, Denman, W, Wilkinson, DJ: Effectiveness of using end-tidal carbon dioxide concentration to monitor cardiopulmonary resuscitation. Br Med J 1990;300:581. Letter.CrossRefGoogle ScholarPubMed
27. Varon, AJ, Morinna, J, Civetta, JM: Clinical utility of a colorimetric end-tidal CO2 detector in cardiopulmonary resuscitation and emergency intubation. J Clin Monit 1991;7:289–293.CrossRefGoogle ScholarPubMed
28. Pollard, BJ: A test to verify accurate placement of an endotracheal tube. World Congress of Anaesthesiologists 7,1980 Hamburg; Amsterdam, Excerpta Medica, International Congress Series 553. Abstract 1112.Google Scholar
29. Wee, MYK: The oesophageal detector device: assessment of a new method to distinguish oesophageal from tracheal intubation. Anaesthesia 1988;43:27–29.CrossRefGoogle ScholarPubMed
30. Nunn, JF: The oesophageal detector device. Anaesthesia 1988;43:804. Letter.CrossRefGoogle ScholarPubMed
31. Jenkins, WA, Verdile, VP, Paris, PM: The syringe aspiration technique to verify endotracheal tube position. Am J Emerg Med 1994;12:413–416.CrossRefGoogle ScholarPubMed
32. Bozeman, WP, Hexter, D, Liang, HK, Kelen, GD: The esophageal detector device versus end-tidal CO2 detection in emergency intubations. Acad Emerg Med 1994;1:A77. Abstract.Google Scholar
33. Schaller, R, Huff, S, Zahn, A: Comparison of an esophageal detector device to a colorimetric end-tidal CO2 detector in the prehospital setting. South Med J 1994;87:30. Abstract.Google Scholar
34. Oberly, D, Stein, S, Hess, D, Eitel, D, Simmons, M: An evaluation of the esophageal detector device using a cadaver model. Am J Emerg Med 1992;10:317–320.CrossRefGoogle ScholarPubMed