Department of

Emergency Medicine and Critical

Care Technology

Capnography
CO2 Monitoring
Kota Vamshi
2111BS080048
 Contents

• Physiology of Vascular
system
• CO2 Metabolism
• Capnograph
• Capnography
2
 Physiology of Respiratory system
• Peripheral gas exchange is also known as
‘internal respiration’, as it involves the
respiratory processes that occur within the
tissues of the body rather than the lungs. 
This can be seen in the adjacent image.

• At this point the final stage of respiration

occurs as the much needed O2 is absorbed
by the tissues and the waste CO2 that the
tissues have created is diffuses back into
the blood and is transported back to the
lungs to be exhaled. This exchange of 3gases
at tissue level is called peripheral gas
The process of internal respiration and the volume of gas exchange depends on
several factors, these are:

1. The amount of O2 within the blood – the less O2 in the blood then the less diffusion
of O2 will occur

2. The amount of CO2 in the tissues – the less CO2 in the tissues then the less
diffusion of CO2 will  occur

3. The amount of blood flow – with less blood in the tissues less gas will be
exchanged.

4. The local conditions at the tissue – when tissues are producing a lot of H+ ions
(becoming acidic) and are getting warm from doing lots of work, the rate of diffusion
of O2 and CO2 increases.  4
 CO2 Metabolism
• Cellular respiration converts ingested
nutrients in the form of glucose
(C6H12O6) and oxygen to energy in the
form of adenosine triphosphate (ATP).
• CO2 is produced as a byproduct of this
reaction.

C6H12O6 + 6O2 --> 6CO2 + 6H2O

• The O2 needed for cellular respiration

is obtained via inhalation. The CO2 that
is generated is removed from the body
5
via exhalation
 CO2 Monitoring
• ETCO2 is an indispensable tool in assessing the
severity of obstructive respiratory disease in the
emergency department. ETCO2 is higher in
patients with COPD exacerbation who are
admitted to the hospital compared to those who
are discharged from the emergency department.
• ETCO2 can be recommended as a noninvasive
method for determination of metabolic acidosis
and can be used to detect early metabolic
acidosis in patients with spontaneous breathing.
• According to the relationship between ETCO 2
and PaCO2, CO2 Monitoring can be used to
identify individuals with high risk of cerebral
6
edema.
 Capnometry
Capnometry is the measurement of CO2 in
exhaled gas using colorimetric techniques
or infrared spectrophotometry.
Colorimetric Capnometry:
 The colorimetric detection of CO2 in
exhaled gas is a quick and simple
method of determining if an ET Tube
has been placed in the lungs.
 The standard of care following
placement of an ET Tube because
auscultation for breath sounds is an
unreliable method of determining if an
ET Tube is in the Oesophagus or 7

Trachea.
 Predictive value
The accuracy of this Colorimetric device for predicting the success of ET intubation is
shown below
 A colour change from purple to tan yellow almost always indicates successful
intubation of the trachea.
 The absence of colour change from purple indicates that the ET Tube is not
successful.

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 Capnogram
 The shape of the normal capnogram has been described as “the outline of a snake that
has swallowed an elephant”.
 The PCO2 at the onset of expiration is negligible because the gas in the upper airways is
first to leave the lungs.
 As exhalation proceeds, gas from the alveoli begins to contribute to the exhaled gas, and
the exhaled PCO2 begins to rise steadily.
 The rate of rise eventually declines, and the exhaled PCO2 reaches a plateau.
 When gas exchange is normal, the PCO2 at the end of expiration is equivalent to the
PCO2 in End Capillary blood.

END TIDAL vs ARTERIAL PCO2

 The difference between EtCO2 and PaCO2 represents the pulmonary dead space. Acute
increase in dead space, such as in pulmonary
9 embolism, widens this gap. This criterion
also indicates the presence of shunting.
10
 Capnography
A monitoring device that measures the Molecular
concentration of carbon dioxide in exhaled air and Correlation
Spectrograp
displays a numerical readout and waveform hy
tracing. Mass
Spectrograp
hy
It is usually presented as a graph of CO2 (measured
in kilopascals, "kPa" or millimeters of mercury,
"mmHg") plotted against time, or, less commonly, Capnographs
but more usefully, expired volume (known as
volumetric capnography). The plot may also show  Raman  Photoacoust
Spectrograp ic
the inspired CO2, which is of interest when  hy Spectrograp
rebreathing systems are being used. When the   hy 

measurement is taken at the end of a breath Infra-red

Spectrograp
(exhaling), it is called "end tidal" CO2 (PETCO2). hy
11
There are five Physical methods used in
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 Indications
•Assessing Airway Integrity
•Confirmation of E.T
Placement
•Predictor of Outcomes in the
I.C.U
•Intraoperative Complications
(ie. air embolism,
thromboembolism, etc.)
•CPR use in ACLS
•Procedural Sedation
Monitoring 13
 Working of Capnography
Capnography is based on the principle
that CO2 molecules absorb infrared
radiation at specific wavelengths. The
capnograph contains special photo
detectors tuned to these wavelengths
that enable the calculation of CO2
levels in the breath sample.

The normal values for patients

regardless of age, sex, race, or size
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range between 35-45 mm Hg, or about
 Waves of Capnography
•Phase I (inspiratory baseline) reflects inspired
gas, which is normally devoid of carbon dioxide.

•Phase II (expiratory upstroke) is the transition

between VDana, which does not participate in gas
exchange, and alveolar gas from the respiratory
bronchioles and alveoli.

•Phase III is the alveolar plateau. Traditionally,

PCO2 of the last alveolar gas sampled at the
airway opening is called the PETCO2.

•Phase 0  is the inspiratory downstroke, the 15

beginning of the next inspiration
Abnormal graphs

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 Contraindications

No Appropriate
Contraindications

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