CAPNOGRAPHY

MONITORING
A10 Slide Production by
James Rubino USAF RT
CAPNOGRAPHY –
WHAT IS THAT?
 The analysis of exhaled carbon dioxide via
numeric and graphical trends.
 Helpful in reducing ABG draws in stable
patients.
HOW IS THAT DONE IN THE PICU
 Transcutaneous - TcCO2
 More Accurate and Precise
 CO2 measured through the Skin via heated electrode
 Used often in neonates
 Must change every few hours to avoid skin burns
 End Tidal CO2 – EtCO2
 Measured between the end of the ETT and the
Ventilator Circuit
 Based on IR light Absorption of CO2 at 4.3 μm
 Mainstream – gas measured at end of ETT
 Slipstream – sampling line carries gas from ETT to
machine for analysis
 Some of the exhaled Vt and Ve can be lost to sampling line
WHAT MUST I ABSOLUTELY
KNOW?
 Often need calibration to room air & known
control sample
 When Capnography begins it is always
tracked along with an initial set (2-4) ABGs
to see how they correlate.
 Exact number matches not important
 Direct Correlation VERY IMPORTANT!
 Capnography and ABG should consistently change
in direct relation with one another.
 Capnography is an approximation of PaCO2 – not
the same
WHAT ELSE?
 Can be used to assess CPR effectiveness
 IfCO2 = 0 then metabolism has stopped and
death has occurred. CPR should cease.
 Sepis
 Can double CO and slightly decrease CO2
 Cardiogenic Shock
 Reduced CO and slightly increases CO2
 ALVEOLAR VENTILATION
 Inversely effects CO2
 Double Alveolar Ventilation – Halve CO2
 Halve Alveolar Ventilation – Double CO2
INTERESTING INFORMATION
 Average adult creates 200ml CO2 per minute
 Fever and Exorcise Increase CO2 output
 Hypothermia, Sleep, Sedation Decrease CO2 output
 PetCO2 – Partial Pressure Endtidal CO2
 Usually 1-5 mmHg less then PaCO2 in an upright well
ventilated and perfused adult
 Capnography works best when:
 There is a V/Q match
NORMAL BLOOD GAS &
CAPNOGRAPHY

PaCO2 ~40 mmHg

PvCO2 ~46 mmHg
PACO2 (actual exhaled) 35 – 43 mmHg
PetCO2 (end tidal) 35 – 43 mmHg
FACO2 (Exhaled %) 5% - 6%
FACO2 (end tidal %) 5% - 6%

FYI: Dead Space Ratio

Quantifies inactive respiration using an ABG and Capnography.

Vd/Vt = (PaCO2 – PetCO2) / PaCO2  This is the “Dead Space Ratio”

Multiply the Vd/Vt by the Vt to find the “Dead Space” volume in

the respiratory system.
HOW TO MAKE ABG’S LESS
NECESSARY
 Arterial End-tidal CO2 Gradient
 [P(a-et)CO2]
 Whenreliably determined (repeatable) can use
Capnography alone
 Steps
 Draw ABG and Record PetCO2
 PaCO2 – PetCO2 = [P(a-et)CO2]
 If [P(a-et)CO2] is similar over 2-4 ABG draws then
considered reliable
 You can accurately approximate the PaCO2 and
make ventilation changed as necessary
CASE STUDY
 Stabilized patient on ventilator ABG 1
 SIMVPC 24/5 Rate 10 RR 18
 PaCO2 40 & PetCO2 36
 What is the [P(a-et)CO2]?
 Same Stable Patient Same Settings ABG 2
 PaCO2 44 & PetCO2 39
 What is the [P(a-et)CO2]?
 Same Stable Patient on Ventilator
 PetCO2 44
 What changes if any could be made?
 The patients PaCO2 = 48 mmHg & Vt = 700. What is the
Dead Space volume for this patient at this time?
THE END