By Henry’s law, the solubility of a gas in a liquid is directly proportional to the pressure of that gas above the surface of the solution. JAMA 1989 262:1347-51.Extrinsic PEEP can be used to increase oxygenation. End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. Sanders AB, Kern KB, Otto CW, Milander MM, Ewy GA. Cardiac output and end-tidal carbon dioxide. Weil MH, Besera J, Trevino RP, Rackow EC. End-tidal CO2 as a guide to successful cardiopulmonary resuscitation. N Engl J Med 1988 318:607-11.ģ9 Treveno RP, Bisera J, Weil MH, Rackow EC, Grundler WG. End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. Here are some major references with regard to ETCO2 monitoring and cardiac arrest in generalģ8. Pediatric values would be treated just as adult values. To my knowledge, the only decent review showed no increased survival to hospital discharge with pediatric cardiac arrest even if the ETCO2 was maintained greater than 20 mmHg. There is not any validated work with regard to pediatric resuscitation and end ETCO2. This video explains waveform capnography, it benefits, and various applications. (35-45 mmHg) This increase represents a drastic improvement in blood flow (more CO2 being dumped in the lungs by the circulation) which indicates circulation.įor the intubated patient in cardiac arrest, quantitative waveform capnography is now considered the desired method for monitoring the quality of chest compressions and determining when the patient has a ROSC. When ROSC occurs, There will be a significant increase in the ETCO2. High quality chest compressions are achieved when the ETCO2 value is at least 10-20 mmHg. Evaluating the effectiveness of chest compressions is accomplished in the following manner: Measurement of a low ETCO2 value (< 10 mmHg) during CPR in an intubated patient would indicate that the quality of chest compressions needs improvement. Two very practical uses of waveform capnography in CPR are: 1.) evaluating the effectiveness of chest compressions, and 2.) identification of ROSC. Normal ETCO2 in the adult patient should be 35-45 mmHg. This will cause a decrease in the ETCO2 (end-tidal CO2), and this will be observable on the waveform as well as with the numerical measurement. For example, a decrease in perfusion (cardiac output) will lower the delivery of carbon dioxide to the lungs. It is a direct measurement of ventilation in the lungs, and it also indirectly measures metabolism and circulation. The inhaled and exhaled carbon dioxide is graphically displayed as a waveform on the monitor along with its corresponding numerical measurement.Īs an assessment tool during CPR, capnography can help the ACLS provider determine a number of things. Capnography uses a sample chamber/sensor placed for optimum evaluation of expired CO2. Quantitative waveform capnography is the continuous, noninvasive measurement and graphical display of end-tidal carbon dioxide/ETCO2 (also called PetCO2). Waveform capnography allows providers to monitor CPR quality, optimize chest compressions, and detect ROSC (return of spontaneous circulation) during chest compressions.Īlso, according to the AHA, continuous waveform capnography along with clinical assessment is the most reliable method of confirming and monitoring correct placement of an ET tube. The 2020 AHA Guidelines for ACLS recommend using quantitative waveform capnography in intubated patients during CPR.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |