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3 results

  • 18 - Volumetric capnography for monitoring lung recruitment and PEEP titration

  • from 1 - Ventilation
  • Edited by J. S. Gravenstein, University of Florida, Michael B. Jaffe, Nikolaus Gravenstein, University of Florida, David A. Paulus, University of Florida
  • Book:
    Capnography
    Published online:
    05 August 2011
    Print publication:
    17 March 2011, pp 160-168

  • Summary

    Capnography and capnometry provide useful information that may help improve decision-making and reduce complications during transport. This chapter reviews specific clinical applications of capnography and capnometry: assuring proper endotracheal tube placement, monitoring airway circuit integrity, monitoring the consistency of mechanical ventilation, improving safety in procedural sedation, assessing cardiac output, and evaluating patients in cardiac arrest. Capnometry and capnography aid in the confirmation of correct endotracheal tube placement. End-tidal CO2 (ETCO2) measurement can accurately detect esophageal intubation because CO2 is exhaled through the trachea, and not the esophagus. Once an airway device is in place, continuous monitoring is important to assure ventilator circuit patency, including that of the endotracheal tube, and to assure consistent levels of ventilation. Capnography is the gold standard for monitoring patients on airway appliances and ventilator circuits, and there are useful roles for the technology during procedural sedation and evaluating patients in the time surrounding arrest states.

  • 15 - Capnography in non-invasive positive pressure ventilation

  • from 1 - Ventilation
  • Edited by J. S. Gravenstein, University of Florida, Michael B. Jaffe, Nikolaus Gravenstein, University of Florida, David A. Paulus, University of Florida
  • Book:
    Capnography
    Published online:
    05 August 2011
    Print publication:
    17 March 2011, pp 135-144

  • 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.

  • Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement

  • Rosaleen Chun, Andrew W. Kirkpatrick, M. Sirois, A.E. Sargasyn, S. Melton, D.R. Hamilton, S. Dulchavsky
  • Journal:
    Prehospital and Disaster Medicine / Volume 19 / Issue 4 / December 2004
    Published online by Cambridge University Press:
    28 June 2012, pp. 366-369
    Print publication:
    December 2004
  • Introduction:

    The diagnosis of endotracheal tube (ETT) mal-position may be delayed in extreme environments. Several methods are utilized to confirm proper ETT placement, but these methods can be unreliable or unavailable in certain settings. Thoracic sonography, previously utilized to detect pneumothoraces, has not been tested to assess ETT placement.

    Hypothesis:

    Thoracic sonography could correlate with pulmonary ventilation, and thereby, help to confirm proper ETT placement.

    Methods:

    Thirteen patients requiring elective intubation under general anesthesia, and data from two trauma patients were evaluated. Using a portable, hand-held, ultrasound (PHHU) machine, sonographic recordings of the chest wall visceral-parietal pleural interface (VPPI) were recorded bilaterally in each patient during all phases of airway management: (1) preoxygenation; (2) induction; (3) paralysis; (4) intubation; and (5) ventilation. Results: The VPPI could be well-imaged for all of the patients. In the two trauma patients, right mainstem intubations were noted in which specific pleural signals were not seen in the left chest wall VPPI after tube placement. These signs returned after correct repositioning of the ETT tube. In all of the elective surgery patients, signs correlating with bilateral ventilation in each patient were imaged and correlated with confirmation of ETT placement by anesthesiology.

    Conclusions:

    This report raises the possibility that thoracic sonography may be another tool that could be used to confirm proper ETT placement. This technique may have merit in extreme environments, such as in remote, prehospital settings or during aerospace medical transports, in which auscultation is impossible due to noise, or capnography is not available, and thus, requires further scientific evaluation.