Interpret your capnogram

Bhavani Shankar Kodali MD

Compiled: by Ahalya Kodali

This section provides a variety of capnograms put together in one group. Several E-mails have prompted us to compile this section. If you happen to see a
capnogram and you wanted to know what the underlying cause is, this section should provide an answer. Match your capnogram against the following; the
explanation is either self explanatory or' click' on the 'detail' to open a new window. Close the window to return to this page. Majority of these capnograms
have bee discussed elsewhere in the website. If you do not see a matching capnogram, please E-mail us (capnoman@gmail.com) with your explanation or
explanation referenced elsewhere for inclusion.

Air-leak - Loose connection between sampling

tube
Rebreathing capnogram of Mapleson D circuit.
and capnograph / broken connection or filter.
Bain circuit.
Details
Details
Following one lung transplantation.
Exhausted CO2 absorber. See below ()
If the tip of the endotracheal tube is too close
to the carina thereby resulting in differential
lung ventilation due to partial obstruction. (see
15 and 23)

Cardiogenic oscillations - Ripple effect - Seen

during low frequency ventilation. Bronchospasm / COPD / Emphysema/ obstructed endotracheal tube -Slanting and
prolonged phase 2 and increased slope of phase 3 (see 14)
Details

Contamination of capnograph
Trend showing abrupt elevation of baseline Trend capnogram during cardiac arrest / resuscitation.
and capnogram. See 43

Upward slanting of phase 4. A normal variant

in pregnant women during anesthesia. Trend showing gradual elevation of baseline.
Rebreathing
Details
Curare cleft (see 10) Resembling curare cleft due to an artifact created by surgeon leaning on the chest, or
pushing against the diaphragm during expiration.
Partial disconnect of main stream capnometer

Details

Dilution of expiratory gases by the forward

Elevation of base line- A classic representation of rebreathing.
flow of fresh gases during the later part of
expiration when expiratory flow rate
Exhausted CO2 absorber
decreases below the forward gas flow rate.

Occasionally, there can be a reverse phase 3 slope seen in patients with emphysema.
A gradual decrease in end tidal carbon dioxide Most like this may be due to destruction of alveolar capillary system in emphysematous
can occur during reduced metabolism, lungs resulting in the delivery of carbon dioxide to expired gases.
hypothermia, hyperventilation, small tidal
volume ventilation due to inadequate alveolar
sampling, and leaks in the sampling
system,decrease in cardiac output see 13

Endobronchial intubation may not result in a

characteristic waveform. However,
occasionally, it may be like the one seen in The CO2 waveform has two humps. Kyphoscoliosis resulted in a compression of the right
COPD or the above. Read the 3 sections. lung. Differential lung emptying. Details

Details Details Details Details see (15)

Esophageal intubation: Small CO2 spikes. Esophageal or gastric CO2 due to mask
Esophageal intubation.
ventilation
Warming up CO2 analyzer is necessary before
The monitor will zero periodically. Will show CO2 numerical value with no waveform.
it begins recording CO2 wave forms.

Ventilator IMV breath during spontaneous

Sticking inspiratory valve - Inspiratory flip - Red indicates possible rebreathing
ventilation.

Lung transplant - Dual capnogram Details see 1, 15 and 23

Air leak due to a broken connection between
sampling tube and capnograph Details see
(1)

Capnogram during spontaneous ventilation in adults (see 27)

Increased CO2 due to hypoventilation,
hypermetabolic states and rebreathing. See 8,
39

These capnograms can occur in children and

neonates. Variations are normal and due to
faster respiratory rates, smaller tidal volumes,
relatively longer response time of the
capnographs. Recent technological advances
such as micro-stream analyzers are reducing
the artifacts due to faster response time and
thereby producing normal looking capnograms
even in children and neonates.
 Sampling problems such air or oxygen dilution during nasal or mask sampling of carbon
dioxide in spontaneously breathing patients.

A terminal upswing at the end of phase 3, known as phase 4, can occur in pregnant
Slit sampling tube can result in a pig tail
subjects, obese subjects and low compliance states. Details see also physiology section-
capnogram. A variation of 23 Details
phase 4.

Expiratory valve malfunction can result in prolonged abnormal phase 2 and phase 0.Details

Inspiratory valve malfunction predominantly results in abnormal phase 0. Details

Esophageal intubation resulting few abnormal capnograms with relatively normal initial CO2 numerical values. Details

Hyperventilation gradually results in lowering of ETCO 2 values. see 13

 Hypoventilation gradually increases CO2 values with normal base line. see 8 and 25

Rebreathing producing gradual elevation of base line and ETCO2 values. See 8

Carbonated beverages in the stomach can result in abnormal capnograms with progressively decreasing CO 2 values following
esophageal intubation. See other variations 17, 18, 37

Unrecognized exhaustion of CO2 absorber resulted in substantial rebreathing and rising ETCO2 values. The closed circuit without
functioning absorber mimicked Mapleson D circuit. Details

Contamination of capnometer results in the sudden elevation of base line as well as ETCO 2 values. See 5