Title: Application of Capnography in Pediatric Emergency Department

Third QPEM Conference 11-13th of January 2019

Name:Journa Liza Suyat Regala RTRP.BSRT.BSN

 DISCLOSURE

I do not have any relevant financial

relationship with commercial interest to
disclose.
 Learning Objectives
At the end of the presentation, the attendee will be able to:

1
Understand importance of monitoring end-tidal carbon dioxide and the
valuable information it provide for patient assessment and treatment.

2 Identify the cause of High and Low ETtCO2

values.

3 Understand importance of capnography in monitoring respiratory

status of spontaneous beating patient .
Capnography (End-Tidal Capnography)

Refers to the graphical measurement of the partial pressure of carbon dioxide

(EtCO2,PetCO2).First establish in the 1930s,clinical use of EtCO2 measurement become
accessible in the 1950s.

More generally end-tidal capnography is used in the following settings:

• General anesthesia
• Procedural sedation, including sedation with monitored anesthesia care
• Analysis of ventilation in mechanical ventilated patient.
• Cardiac arrest ,to confirm tracheal intubation and adequacy of chest compression.
• Ensure ventilation as to confirm a spontaneously ventilating patient.
The use of Capnography in Spontaneous Breathing Patient

In July 2013, the journal of Emergency medicine published

article titled(Capnography for the non-intubated patient in
the Emergency setting)

Capnography can be an effective tool for measuring RR and

adequacy of ventilation Ex: narcotic, analgesis,
benzodiazepines and seizure management.

Hypercabnia can exist in the presence of normal

oxygenation.

Capnography gave advanced warning for low oxygenation

condition.

Capnography was 100% sensitive for predicting hypoxia.

Using of capnography is cost efficiencies in the ER

environment.
EX: DKA (fewer blood draws)
PE( reducing unnecessary CT scans)
Indication of Capnography in Spontaneous breathing patient

Respiratory distress is one of the most common patient complain.

• Waveform capnography is a valuable tool to determine the cause and severity of
respiratory distress.
• Monitor the patients response to treatment.
• Capnography also detects shocks.

Pathology and the Capnography

Cause of High EtCO2 Cause of Low EtCO2
Malignant hyperthermia Hypothermia
Shivering Low cardiac output
Fever Pulmonary Embolism
Sepsis Hyperventilation
Endocrine disease
Hypoventilation
Normal Capnogram and Phase

Normal Capnogram - Phase I Normal Capnogram - Phase II Normal Capnogram - Phase III Normal Capnogram - Phase IV
Normal Value of PaCO2 vs PETCO2

• PaCO2 Normal Values :

• 35- 45 mmHg

• ETCO2 Normal Values:

30- 43 mmHg
4.0-5.7 kPa
4.0-5.6%
Note :Arterial - End Tidal CO2 Gradient
• In healthy lungs the normal a-ETco2 gradient is 2-5 mmHg
The gradient will increase due to ventilation/perfusion mismatch, decreased cardiac function
and decreased pulmonary blood flow
 Normal and Abnormal waveform

Normal Absent ETCO2 level and waveform

Air way obstruction Reduced ETCO2 level

Decreasing ETCO2 level towards Increased ETCO2 level from Sudden significant increase
normal normal Curare cleft
in ETCO2

Increased ETCO2 values toward normal

Take home messages
The shape of the capnography waveform helps determine the cause of the problem.

Think respiratory failure when ETCO2 is high

Think perfusion, metabolic or psychological problem when ETCO2 is low

Capnography provides real-time feedback on response to

treatment.

Hyperventilation with a BVM is harmful and capnography can help

prevent it.