It is not uncommon in our practice to observe an intubated and ventilated patient, originally monitored with capnography in the operating room, but then transported to the intensive care unit (ICU) without capnography. Although capnography has become an integral part of anesthesia care in operating rooms for more than 25 yr, its value has been limited to these situations and is not well appreciated beyond these confinements. Capnography is mandatory for laparoscopic surgeries for reimbursement). Currently, anesthesiologists in many developing countries follow these recommendations (India, Government of Andhra Pradesh Order, AST/775/F25/dated September 2011. Thanks to the foresight of the American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the Association of Anesthesiologists in Holland, capnography was embraced and incorporated into the standards of monitoring during anesthesia to enhance patient safety. Such a decrease has not been seen in other medical or surgical specialties over this time frame. In the United States, since 1985, there has been a dramatic decrease in the malpractice insurance premiums of anesthesiologists. Ultimately, capnography is a simple process that is useful both in emergency settings and in the hospital.HISTORICALLY, anesthesiologists seem to be the forerunners in implementing tools and standards for safety in the medical fraternity. In addition, mainstream capnography can be prone to technological difficulties and fragility, which is less of an issue with sidestream capnography. However, the non-invasive nature of sidestream capnography means that it can be easily used on non-intubated patients, unlike mainstream capnography, which can be difficult to adapt to non-intubated patients. This results in a couple seconds delay of the analysis and a possible distortion of the analysis, which can be consequential in an emergency situation. This means that the gas sample is transported from the sample site through a plastic tube and analyzed in a sample cell. Sidestream, on the other hand, is non-invasive and diverting. Mainstream capnography is characterized as invasive and non-diverting, meaning that the measurement of the ETCO2 is done at the airway, or the sample site, thus providing a real-time measurement of the carbon dioxide pressure. There are two types of capnography, mainstream and sidestream. The process is relatively simple, as is the equipment. Inspiration, therefore, is shown on the waveform by a drop of the CO2 levels to zero. On the other axis, the taller the waveform, the more ETCO2 is in the breath. Thus faster breathing is represented by a relatively short duration of the waveform, whereas slower breathing is shown with longer waveforms. The length of the wave represents the time, while the height of the wave represents the amount of CO2 in the exhaled breath. What is measured by the capnograph is known as the End Tidal CO2 (ETCO2) or the amount of (or partial pressure of) the carbon dioxide released at the end of expiration, an essential component of measuring cardiac output.Ī normal capnography waveform looks like *image*. The CO2 levels are then displayed on the detector and adjusted for the presence of nitrous oxide, which can also absorb infrared rays and thus can cause some confusion if not accounted for. High CO2 levels are indicated by low infrared, and low CO2 levels result in high amounts of light. The presence or lack of CO2, is inversely indicated by the amount of light that passes through the sensor. When the patient exhales, a beam of infrared light is passed over the gas sample on a sensor. It is grounded on the property that carbon dioxide (CO2) absorbs infrared radiation. Th e essential mechanism of capnography is basic. In a recent survey taken of EMS1 readers, 95 percent of respondents agreed or strongly agreed that capnography is easy to use and an important monitoring tool for many different situations in the field. October 3rd, 2018 pdcapnography Capnography 101Ĭapnography is exceptional both for its utility in the field, and for the ease of its use. Capnography 101 Capno 101: How does capnography work?
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