HP Card.Capnography.

pages
What Is Capnography? Use of Capnography During Intubation

Capnography is the sensing of exhaled CO2. Carbon diox-
ide is produced in the body as a by-product of metabo-
lism and is eliminated by exhaling.
By measuring exhaled CO2, many types of pulmonary
assessments can be made.
Carbon dioxide is eliminated from the lungs, but not from
the stomach or esophagus (unless a carbonated beverage
has been consumed). It is easy to determine when a tube,
such as an endotracheal or nasogastric tube, has been
placed in the trachea. When tracheal placement occurs, a
capnogram shows exhaled CO2.
Capnogram after successful placement of endotracheal tube

CO2 Applications of Capnography

11/1/00
• Detecting esophageal placement of endotracheal tubes
Monitoring during intubation.
By Tom Ahrens, RN, DNS, CCRN, CS • Detecting tracheal placement of nasogastric tubes.
• Disconnection of the patient from mechanical

8:17 AM
ventilation.
• Predicting survival in cardiopulmonay resuscitation.
• Avoiding ABG analysis in selected clinical sitiuations.
• Detecting changes in dead space (eg, pulmonary

emboli).
• Identifying end-expiration on hemodynamic waves.
• Identifying alveolar emptying (eg, effectiveness of
bronchodilator therapy).
• Identifying attempts to breathe while paralyzed.
Characteristics of a Normal Capnogram
Page 1
If esophageal placement occurs, a flat line occurs or no
CO2 is detected.
Flat line indicating the endotracheal tube is not in the trachea
or the patient has become disconnected from the ventilator

PETCO2
(or end-expiration)

Beginning of
Slow rise in CO2 with inspiration
plateau at end-expiration Detecting Disconnection from Mechanical
Ventilation

Capnography is the fastest way to determine if a patient has

become disconnected from the ventilator. Capnography,
unlike ventilator alarms, monitors the patient. Immediately
A supplement to CRITICAL CARE NURSE® upon disconnection from the ventilator, the waveform on the
Agilent #5968-9027E
Printed in USA 2/00 Expiration capnogram disappears and goes flat.
 HP Card.Capnography.pages
Detecting Changes in Pulmonary Dead Space Avoiding Unnecessary Arterial Blood Gas Testing Predicting Survival in Cardiopulmonary Arrest
Normally, the PETCO2 level correlates closely with PaCO2. When the PaCO2-PETCO2 gradient is normal, the PaCO2 can Exhaled CO2, specifically PETCO2, is a noninvasive indica-
The PETCO2 is usually 1 to 5 mm Hg lower than the be estimated from the PETCO2. It is important to note the tor of cardiac output. The lower the cardiac output, the
PaCO2. The difference between the PaCO2 and PETCO2 is gradient when results of ABG analysis are obtained. lower the PETCO2. If PETCO2 is less than 10 mm Hg after
called the PaCO2-PETCO2 gradient. 20 minutes of cardiopulmonary resuscitation, the code is
·
·
VE 5 L/min
When using PETCO2 to estimate PaCO2, it is helpful to almost always unsuccessful.
Q 5
L/min PETCO2 Normally, if the PaCO2 increases, simultaneously measure expired ventilation (ªE). If the ªE
40
so will the PETCO2. The relation- Capnogram during cardiopulmonary arrest showing a PETCO2 of 8 mm Hg
and PETCO2 remain constant, then the PaCO2-PETCO2 gradi-
ship between the PaCO2 and ent is unlikely to have changed.
2.5 PETCO2 is lost when the pul-
2.5
monary dead space increases. If the ªE has changed, it is probably unwise to estimate

11/1/00
5 5 PaCO2 from the PETCO2.

46
40

Pw
– CO 2
Pa CO2
C
O Pa Recognizing Spontaneous Breathing Attempts
2 Alveoli

46
in a Patient Who Is Paralyzed The higher the PETCO2, the more effective the resuscitation

8:17 AM
40 In a patient who is paralyzed, one of the first indications of efforts.
PaCO2 40 incomplete paralysis is movement of the diaphragm, which Capnogram during cardiopulmonary arrest showing a PETCO2 of 21 mm Hg
can be detected by noting a dip in the capnogram waveform.
Pulmonary Capillaries

When a condition such as pulmonary embolism (PE) Dip in the exhaled capnogram wave indicating

Page 2
occurs, blood flow to a part of the lung is decreased. a spontaneous breathing attempt
· ·
Q VE 5 L/min
5 L/min PETCO2 Exhaled air from the
poorly perfused part of
the lung contains a very
small amount of CO2. This

· 5
Q
reduced CO2 level is End-Expiration in Hemodynamic Waveforms
detected by capnography.

·
VE
5
VE·

5
40
Pa O2
C
By locating the PETCO2 level, end-expiration is often easily
Pa

Pa
C O
identified through the use of capnography.

C
2 20

O2
Embolism

40
Recognizing the Adequacy of Alveolar Emptying End-expiration indicated Decrease in PETCO2 indicates
PaCO2 40 Abnormal capnogram waveform showing ineffective by waves in the circle where to locate end-expiration
bronchodilator therapy.
Two patients with shortness of breath and
a potential diagnosis of pulmonary emboli
Patient 1 Patient 2
PaCO2 36 mm Hg 39 mm Hg
PETCO2 32 mm Hg 21 mm Hg
Interpretation No significant PE. PE should be considered.
Normal PaCO2-PETCO2 Widened PaCO2-PETCO2
gradient. gradient.