cardiac studies

1. Crystal Carty
Theodore Duncan
Sharna Kaye Scott
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2.  At the end of this session students will be
able to:
1. Define Capnography
2. State the indications for Capnography
3. Identify the phases of Capnography.
4. State the contraindications for
Capnography.
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3.  Capnography is the measurement, display,
and monitoring of the concentration or partial
pressure of CO₂ (PETCO₂) in the respiratory
gases at the end of expiration.
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4.  The capnogram displays the maximum
inspiratory and expiratory CO₂ concentrations
during a respiratory cycle, which indirectly
reflect the production of CO₂ by the tissues
and the transport of CO₂ to the lungs.
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5.  Sudden changes in CO₂ elimination should be
monitored in selected cardiorespiratory
patients and postoperatively after major
cardiothoracic surgeries.
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6.  Capnography can also be used to verify ETT
position and monitor the effectiveness of
CPR.
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7.  A monitoring device that measures the
concentration of carbon dioxide in exhaled
air and displays a numerical readout and
waveform tracing (Merriam Webster
dictionary).
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8.  The graphical measurement of carbon dioxide
partial pressure (mm Hg) during expiration is
referred to has End-tidal capnography .
 First established in the 1930s,
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9.  Clinical use of end-tidal carbon dioxide
measurement became accessible in the 1950s
with the production and distribution of
capnograph monitors.
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10.  With continuous technological advancements,
end-tidal carbon dioxide monitoring has
become a key component in the advancement
of patient safety within anesthesiology.
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11.  The American Society of Anesthesiologists
(ASA) endorses end-tidal capnography as a
standard of care for general anesthesia,
moderate sedation, and deep sedation.
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12.  Specialties, including critical care and
emergency medicine, are more frequently
implementing end-tidal capnography
monitoring.
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13.  General anesthesia
 Monitored anesthesia care
 Procedural sedation and analgesia
 Cardiac arrest (confirm tracheal intubation)
 Cardiopulmonary arrest (determine adequate
chest compression)
 Analysis of ventilation
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14.  Cellular metabolism produces carbon dioxide,
 The balance between production and
elimination can be followed in the rise and
fall of end-tidal carbon dioxide as measured
by capnography.
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15.  End-tidal carbon dioxide waveforms provide
clinicians with a tool for quick and reliable
diagnoses of pulmonary pathophysiology.
 End-tidal carbon dioxide is displayed as a
waveform with partial pressure of carbon
dioxide on the Y-axis and time on the X-axis.
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16. 16

17.  Phase I of the capnogram represents baseline
inspired gas (normally devoid of carbon
dioxide).
 Phase II represents expired air with an
upward sloping curve This phase displays the
transition from dead space air flow to alveolar
air flow.
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18.  Phase III, the plateau, represents the partial
pressure of carbon dioxide exchanged at the
alveoli. This plateau number represents end-
tidal carbon dioxide.
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19.  Phase IV, downward deflection, represents
the inspiratory point in the ventilatory cycle.
This phase displays the transition from
alveolar air flow to fresh air inflow, or
“scrubbed” air in a closed circuit.
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20. 20

21.  The information captured by end-tidal
capnography (partial pressure of carbon dioxide)
is devoid of volumetric information. Therefore,
capnography should be used with end-tidal
volume measurements to fully assess ventilation
parameters.
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22.  Continuous end-tidal carbon dioxide
monitoring can be an early warning sign to
hypoxia. Several studies demonstrate that
respiratory depression is detected via end-
tidal capnography 30-60 seconds prior to
detection via oxygen saturation (SpO2).
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23.  Long periods of a flat wave form indicate:
◦ apnea
◦ dislodged endotracheal tube
◦ esophageal intubation
◦ patient disconnected from ventilator
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24.  There are no absolute contraindications to
capnography in mechanically ventilated
patients provided that the data obtained are
evaluated with consideration given to the
patient’s clinical condition.
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25.  Jones, J & Fix, B. (2009). Critical Care Notes:
Clinical Pocket Guide. Philadelphia.
 MCG Health, Inc. Respiratory Care Services:
ETCO2/Capnography/Capnometry . Retreived
from https://paws.augusta.edu/pub/respira-
tory/Documents/adult_protocol/ETCO2policy
pdf
 Merriam Webster dictionary. (1828). Retreived
from https://www.merriam
webster.com/dictionary/capnograph
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26.  Press, D, C. Desai, M, A. Tanaka, P,P. Macario,
A. (2015). End-Tidal Capnography.
Retreived from
https://emedicine.medscape.com/article/
2116444- overview#a5
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