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Sample records for capnography

  1. Capnography.

    Science.gov (United States)

    Schmitz, B D; Shapiro, B A

    1995-09-01

    Capnography measures exhaled carbon dioxide and is most useful when applied directly to patient care. This is in circumstances of detecting misplacement of the tracheal tube, dysfunction of respiratory apparatuses, detection of abnormal lung function, successful cardiopulmonary resuscitation, and trending of deadspace changes. The least reliable application is to reflect alveolar ventilation (PaCO2). This application is most common during general anesthesia and weaning from mechanical ventilation. Provided the patient has a stable cardiac status, stable body temperature, absence of lung disease, and normal capnogram, PETCO2 monitoring may assist in estimating PaCO2. The use of capnography in patients with severe respiratory failure should be applied with careful reflection. The increased V/Q mismatch that is consistent with a widened P(a-ET) gradient, as well as worsening hypercapnea with increased peripheral carbon dioxide production, can lead to erroneous PETCO2 values. Capnography may be least useful in the sickest patients. PMID:9390853

  2. Clinical Applications of Capnography

    OpenAIRE

    NIKOLOVA-TODOROVA, ZORICA

    2008-01-01

    This article gives a short review of the basic definitions of capnography and its use. The introduction gives an overview of the historical development of this procedure. Technical features of the method are presented, followed by several definitions for understanding the basic terms needed to realize the applications of capnography. The last section is a descriptive part that explains the most important clinical applications of capnography, the strengths and limitations of this method. This ...

  3. Capnography: monitoring CO2.

    Science.gov (United States)

    Casey, Georgina

    2015-10-01

    MONITORING RESPIRATORY and metabolic function by using capnography to measure end tidal carbon dioxide is standard practice in anaesthesia. It is also becoming more common in intensive care units and during procedural sedation. End tidal carbon dioxide (EtCO2) monitoring may also be used to assess effectiveness of cardiopulmonary resuscitation. Capnography is now emerging in general medical and surgical wards to monitor respiratory depression in patients using opioid analgesics. Using EtCO2 to monitor respiratory function offers many benefits over pulse oximetry. It is important to understand the differences between these two monitoring methods, and why capnography is increasingly favoured in many situations. An understanding of the physiological processes involved in CO2 excretion allows nurses to use capnography in a safe and meaningful way, while monitoring at-risk patients in acute care. PMID:26638570

  4. Capnography During Critical Illness.

    Science.gov (United States)

    Nassar, Boulos S; Schmidt, Gregory A

    2016-02-01

    Capnography has made steady inroads in the ICU and is increasingly used for all patients who are mechanically ventilated. There is growing recognition that capnography is rich in information about lung and circulatory physiology and provides insight into many diseases and treatments. These include conditions of impaired matching of ventilation and perfusion, such as pulmonary embolism and obstructive lung diseases; circulatory questions, such as the adequacy of chest compressions during cardiac arrest or fluid responsiveness in patients in shock; and the safety of procedural sedation. In this review, we emphasize analysis of the entire capnographic waveform as a way to glean additional useful information. We also discuss important limitations of capnography, especially when it is considered to be a surrogate for Paco2. PMID:26447854

  5. A systematic review of capnography for sedation.

    Science.gov (United States)

    Conway, A; Douglas, C; Sutherland, J R

    2016-04-01

    We included six trials with 2524 participants. Capnography reduced hypoxaemic episodes, relative risk (95% CI) 0.71 (0.56-0.91), p = 0.02, but the quality of evidence was poor due to high risks of performance bias and detection bias and substantial statistical heterogeneity. The reduction in hypoxaemic episodes was statistically homogeneous in the subgroup of three trials of 1823 adults sedated for colonoscopy, relative risk (95% CI) 0.59 (0.48-0.73), p capnography affected other outcomes, including assisted ventilation, relative risk (95% CI) 0.58 (0.26-1.27), p = 0.17. PMID:26792775

  6. Ventilatory failure due to improper capnography connector

    OpenAIRE

    Prakash, Ravi; Kushwaha, Brij B.; Singh, Brijesh Pratap

    2014-01-01

    Ventilatory failure due to improper or loose breathing circuit connection can occur in anaesthetic practice and may lead to significant morbidity and mortility. We report here an unusual incidence of ventilatory failure due loose capnography connector which obstructed the outer tube of Bain's circuit and presented as airway obstruction.

  7. Developing a Respiratory Depression Scorecard for Capnography Monitoring

    OpenAIRE

    Katie Felhofer, Pharm.D.

    2013-01-01

    Pulse oximetry is the most common way to measure a patient’s respiratory status in the hospital setting; however, capnography monitoring is a more accurate and sensitive technique which can more comprehensively measure respiratory function. Due to the limited number of capnography monitoring equipment at the University of Minnesota Medical Center-Fairview (UMMC-Fairview), we analyzed which patients should preferentially be chosen for capnography monitoring over pulse oximetry based on risk of...

  8. sensor for mainstream capnography based on TDLAS

    Science.gov (United States)

    Hartmann, A.; Strzoda, R.; Schrobenhauser, R.; Weigel, R.

    2014-09-01

    The setup and signal processing for a mainstream capnography sensor is presented in this paper. The probe exhibits an optical path length of 2.5 cm and is equipped with a vertical-cavity surface-emitting laser at 2 μm. The sensor does not need any calibration, since the CO2 absorption line as well as the laser background is measured using direct tunable diode laser absorption spectroscopy. Unavoidable optical fringes are reduced with a self-developed fringe rejection method. The sensor achieves a concentration resolution 30 Hz.

  9. Volumetric capnography in the mechanically ventilated patient.

    Science.gov (United States)

    Blanch, L; Romero, P V; Lucangelo, U

    2006-06-01

    Expiratory capnogram provides qualitative information on the waveform patterns associated with mechanical ventilation and quantitative estimation of expired CO2. Volumetric capnography simultaneously measures expired CO2 and tidal volume and allows identification of CO2 from 3 sequential lung compartments: apparatus and anatomic dead space, from progressive emptying of alveoli and alveolar gas. Lung heterogeneity creates regional differences in CO2 concentration and sequential emptying contributes to the rise of the alveolar plateau and to the steeper the expired CO2 slope. The concept of dead space accounts for those lung areas that are ventilated but not perfused. In patients with sudden pulmonary vascular occlusion due to pulmonary embolism, the resultant high V/Q mismatch produces an increase in alveolar dead space. Calculations derived from volumetric capnography are useful to suspect pulmonary embolism at the bedside. Alveolar dead space is large in acute lung injury and when the effect of positive end-expiratory pressure (PEEP) is to recruit collapsed lung units resulting in an improvement of oxygenation, alveolar dead space may decrease, whereas PEEP-induced overdistension tends to increase alveolar dead space. Finally, measurement of physiologic dead space and alveolar ejection volume at admission or the trend during the first 48 hours of mechanical ventilation might provide useful information on outcome of critically ill patients with acute lung injury or acute respiratory distress syndrome. PMID:16682932

  10. Volumetric capnography and chronic obstructive pulmonary disease staging

    OpenAIRE

    Romero, Pablo V; Rodriguez, Benigno; de Oliveira, Daniela; Blanch, L; Manresa, Federico

    2007-01-01

    Spirometry is difficult for some COPD patient to perform. Volumetric capnography could be a second choice test to evaluate the severity of functional disturbances. The aim of this work is to test this hypothesis. A total number of 98 subjects were classified either as normal ex-smokers (N = 14) or COPD patients. The latter were staged following GOLD recommendations. Spirometry and volumetric capnography recordings were obtained from each patient. Spirometry parameters, Bohr Dead Space (VD Boh...

  11. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    OpenAIRE

    Bhavani Shankar Kodali; Urman, Richard D.

    2014-01-01

    Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 ). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlat...

  12. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  13. Temporal comparison of ultrasound vs. auscultation and capnography in verification of endotracheal tube placement

    DEFF Research Database (Denmark)

    Pfeiffer, P; Rudolph, S S; Neimann, Jens Dupont Børglum;

    2011-01-01

    This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation.......This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation....

  14. Developing a Respiratory Depression Scorecard for Capnography Monitoring

    Directory of Open Access Journals (Sweden)

    Katie Felhofer, Pharm.D.

    2013-01-01

    Full Text Available Pulse oximetry is the most common way to measure a patient’s respiratory status in the hospital setting; however, capnography monitoring is a more accurate and sensitive technique which can more comprehensively measure respiratory function. Due to the limited number of capnography monitoring equipment at the University of Minnesota Medical Center-Fairview (UMMC-Fairview, we analyzed which patients should preferentially be chosen for capnography monitoring over pulse oximetry based on risk of respiratory depression. We conducted a retrospective chart review of all serious opioid-induced over-sedation events that occurred at UMMC-Fairview between January 1, 2008 and June 30, 2012. Thirteen risk factors were identified which predispose patients to respiratory depression. The average patient demonstrated 3.75 risk factors. The most commonly occurring risk factor was the concomitant use of multiple opioids or an opioid and a CNS-active sedative, followed by an ASA score ≥ 3. Based on this data, we developed a scorecard for choosing patients at the most risk of developing respiratory depression; these patients are the best candidates for capnography. Although further studies are necessary to corroborate this research, at this time giving extra consideration to patients demonstrating the previously stated risk factors is prudent when assessing those patients most in need of capnography.

  15. Smartphone Capnography : Evaluation of the concept and the associated CO2 indicating sensor

    OpenAIRE

    Kuutmann, Hanna; Rosén, Emelie

    2014-01-01

    Smartphone capnography is a new concept for respiratory monitoring using a colorimetric sensor in combination with a smartphone and an Android application. Compared to using an infrared spectrophotometric carbon dioxide analyzer (IR-analyzer), the gold standard for respiratory carbon dioxide monitoring, smartphone capnography offers a cheaper and less bulky solution. This master thesis evaluates the performance of smartphone capnography and the colorimetric sensor engineered for this concept....

  16. Analysis of mean transcutaneous capnography in consecutive patients undergoing polysomnography

    OpenAIRE

    Giulio Cesare Pinnola; Patrícia Souza Bastos

    2014-01-01

    Transcutaneous capnography is a noninvasive method useful for analysis of the behavioral tendency of transcutaneous CO2 pressure (PtcCO2) in patients undergoing polysomnography, to evaluate respiratory sleep disorders. Objective Determine normative PtcCO2 values in normal patients undergoing polysomnography. Method One hundred seventy-nine patients who underwent polysomnography with simultaneous PtcCO2 measurement were assessed by means of a transcutaneous capnograph (TCM4 series from Radi...

  17. Forced Expiratory Capnography and Chronic Obstructive Pulmonary Disease (COPD)

    OpenAIRE

    Brown, Robert H.; Brooker, Allison; Wise, Robert A.; Reynolds, Curt; Loccioni, Claudio; Russo, Adolfo; Risby, Terence H.

    2013-01-01

    This report proposes a potentially sensitive and simple physiological method to detect early changes and to follow disease progression in obstructive pulmonary disease (COPD) based upon the usual pulmonary function test. Pulmonary function testing is a simple, although relatively insensitive, method to detect and follow COPD. As a proof-of-concept, we have examined the slope of the plateau for carbon dioxide during forced expiratory capnography in healthy (n=10) and COPD subjects (n=10). We c...

  18. Carbon dioxide kinetics and capnography during critical care

    OpenAIRE

    Anderson, Cynthia T; Breen, Peter H

    2000-01-01

    Greater understanding of the pathophysiology of carbon dioxide kinetics during steady and nonsteady state should improve, we believe, clinical care during intensive care treatment. Capnography and the measurement of end-tidal partial pressure of carbon dioxide (PETCO2) will gradually be augmented by relatively new measurement methodology, including the volume of carbon dioxide exhaled per breath (VCO2,br) and average alveolar expired PCO2 (PA̅E̅CO2). Future directions include the study of oxy...

  19. Promoting the use of capnography in acute care settings: an evidence-based practice project.

    Science.gov (United States)

    Carlisle, Heather

    2015-06-01

    Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid analgesia. End-tidal carbon dioxide monitoring (capnography) has been shown to detect early signs of OIRD earlier than other commonly used monitoring methods. The goal of this evidence-based practice project was to promote the standardized use of capnography to reduce the incidence of OIRD. The project included an updated nursing protocol, an electronic order trigger, improved access to capnography monitors, and staff education about OIRD risk assessment and the use of capnography. A survey of registered nurses was also conducted to gather their perceptions on the ease of use and effectiveness of capnography. Twelve months after introducing the intervention there was an increase in monitoring frequency, with 2.56 times more patients at high risk for OIRD being monitored with capnography than at baseline. Of the 171 registered nurses surveyed during this project, 99% perceived the portable capnography monitors as easy to use and interpret. However, 71% reported systems issues in obtaining the monitoring equipment, and 65% reported problems with patient adherence. The intervention succeeded in increasing the number of high-risk patients being monitored with capnography and reducing the number of cases of OIRD. PMID:26003766

  20. PQRST - a unique aide-memoire for capnography interpretation during cardiac arrest.

    Science.gov (United States)

    Heradstveit, Bård E; Heltne, Jon-Kenneth

    2014-11-01

    The use of capnography is recommended during resuscitation. By implementing the mnemonic "PQRST", rescuers have a ready-made checklist to help them achieve the full potential of capnography. This approach can facilitate efforts to both reduce the hands-off time and individualize the treatment, which can lead to improved survival for our patients.

  1. Capnography for assessing nocturnal hypoventilation and predicting compliance with subsequent noninvasive ventilation in patients with ALS.

    Directory of Open Access Journals (Sweden)

    Sung-Min Kim

    Full Text Available BACKGROUND: Patients with amyotrophic lateral sclerosis (ALS suffer from hypoventilation, which can easily worsen during sleep. This study evaluated the efficacy of capnography monitoring in patients with ALS for assessing nocturnal hypoventilation and predicting good compliance with subsequent noninvasive ventilation (NIV treatment. METHODS: Nocturnal monitoring and brief wake screening by capnography/pulse oximetry, functional scores, and other respiratory signs were assessed in 26 patients with ALS. Twenty-one of these patients were treated with NIV and had their treatment compliance evaluated. RESULTS: Nocturnal capnography values were reliable and strongly correlated with the patients' respiratory symptoms (R(2 = 0.211-0.305, p = 0.004-0.021. The duration of nocturnal hypercapnea obtained by capnography exhibited a significant predictive power for good compliance with subsequent NIV treatment, with an area-under-the-curve value of 0.846 (p = 0.018. In contrast, no significant predictive values for nocturnal pulse oximetry or functional scores for nocturnal hypoventilation were found. Brief waking supine capnography was also useful as a screening tool before routine nocturnal capnography monitoring. CONCLUSION: Capnography is an efficient tool for assessing nocturnal hypoventilation and predicting good compliance with subsequent NIV treatment of ALS patients, and may prove useful as an adjunctive tool for assessing the need for NIV treatment in these patients.

  2. The role of capnography in endoscopy patients undergoing nurse-administered propofol sedation

    DEFF Research Database (Denmark)

    Slagelse, Charlotte; Vilmann, Peter; Hornslet, Pernille;

    2013-01-01

    Abstract Objective. Standard benzodiazepine/opioid cocktail has proven inferior to propofol sedation during complicated endoscopic procedures and in low-tolerance patients. Propofol is a short-acting hypnotic with a potential risk of respiratory depression at levels of moderate to deep sedation. ......-value 0.05). Capnography is able to detect insufficient respiration that may lead to hypoxia prior to changes in pulse oximetry. However, due to a limited clinical benefit and additional costs associated with capnography, we do not find capnography necessary during the use of NAPS....

  3. Implementation of Continuous Capnography Is Associated With a Decreased Utilization of Blood Gases

    OpenAIRE

    Rowan, Courtney M.; Speicher, Richard H.; Hedlund, Terri; Ahmed, Sheikh S.; Swigonski, Nancy L

    2014-01-01

    Background Capnography provides a continuous, non-invasive monitoring of the CO2 to assess adequacy of ventilation and provide added safety features in mechanically ventilated patients by allowing for quick identification of unplanned extubation. These monitors may allow for decreased utilization of blood gases. The objective was to determine if implementation of continuous capnography monitoring decreases the utilization of blood gases resulting in decreased charges. Methods This is a retros...

  4. Capnography for Assessing Nocturnal Hypoventilation and Predicting Compliance with Subsequent Noninvasive Ventilation in Patients with ALS

    OpenAIRE

    Sung-Min Kim; Kyung Seok Park; Hyunwoo Nam; Suk-Won Ahn; Suhyun Kim; Jung-Joon Sung; Kwang-Woo Lee

    2011-01-01

    BACKGROUND: Patients with amyotrophic lateral sclerosis (ALS) suffer from hypoventilation, which can easily worsen during sleep. This study evaluated the efficacy of capnography monitoring in patients with ALS for assessing nocturnal hypoventilation and predicting good compliance with subsequent noninvasive ventilation (NIV) treatment. METHODS: Nocturnal monitoring and brief wake screening by capnography/pulse oximetry, functional scores, and other respiratory signs were assessed in 26 patien...

  5. Capnography monitoring during procedural sedation and analgesia: a systematic review protocol

    OpenAIRE

    Conway, Aaron; Douglas, Clint; Sutherland, Joanna

    2015-01-01

    Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inade...

  6. Capnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage

    OpenAIRE

    Schlag, Christoph; Wörner, Alexandra; Wagenpfeil, Stefan; Kochs, Eberhard F.; Schmid, Roland M; von Delius, Stefan

    2013-01-01

    BACKGROUND: Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea.OBJECTIVE: To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage (PTCD).METHODS: Twenty consecutive patients scheduled for PTCD were included in the study. All patients were sedated during the ...

  7. Accuracy of pulse oximetry and capnography in healthy and compromised horses during spontaneous and controlled ventilation

    OpenAIRE

    Koenig, Judith; McDonell, Wayne; Valverde, Alexander

    2003-01-01

    The objective of this prospective clinical study was to evaluate the accuracy of pulse oximetry and capnography in healthy and compromised horses during general anesthesia with spontaneous and controlled ventilation. Horses anesthetized in a dorsal recumbency position for arthroscopy (n = 20) or colic surgery (n = 16) were instrumented with an earlobe probe from the pulse oximeter positioned on the tip of the tongue and a sample line inserted at the Y-piece for capnography. The horses were al...

  8. Detection of respiratory compromise by acoustic monitoring, capnography, and brain function monitoring during monitored anesthesia care.

    Science.gov (United States)

    Tanaka, Pedro P; Tanaka, Maria; Drover, David R

    2014-12-01

    Episodes of apnea in sedated patients represent a risk of respiratory compromise. We hypothesized that acoustic monitoring would be equivalent to capnography for detection of respiratory pauses, with fewer false alarms. In addition, we hypothesized that the patient state index (PSI) would be correlated with the frequency of respiratory pauses and therefore could provide information about the risk of apnea during sedation. Patients undergoing sedation for surgical procedures were monitored for respiration rate using acoustic monitoring and capnography and for depth of sedation using the PSI. A clinician blinded to the acoustic and sedation monitor observed the capnograph and patient to assess sedation and episodes of apnea. Another clinician retrospectively reviewed the capnography and acoustic waveform and sound files to identify true positive and false positive respiratory pauses by each method (reference method). Sensitivity, specificity, and likelihood ratio for detection of respiratory pause was calculated for acoustic monitoring and capnography. The correlation of PSI with respiratory pause events was determined. For the 51 respiratory pauses validated by retrospective analysis, the sensitivity, specificity, and likelihood ratio positive for detection were 16, 96 %, and 3.5 for clinician observation; 88, 7 %, and 1.0 for capnography; and 55, 87 %, and 4.1 for acoustic monitoring. There was no correlation between PSI and respiratory pause events. Acoustic monitoring had the highest likelihood ratio positive for detection of respiratory pause events compared with capnography and clinician observation and, therefore, may provide the best method for respiration rate monitoring during these procedures. PMID:24420342

  9. Analysis of mean transcutaneous capnography in consecutive patients undergoing polysomnography

    Directory of Open Access Journals (Sweden)

    Giulio Cesare Pinnola

    2014-11-01

    Full Text Available Transcutaneous capnography is a noninvasive method useful for analysis of the behavioral tendency of transcutaneous CO2 pressure (PtcCO2 in patients undergoing polysomnography, to evaluate respiratory sleep disorders. Objective Determine normative PtcCO2 values in normal patients undergoing polysomnography. Method One hundred seventy-nine patients who underwent polysomnography with simultaneous PtcCO2 measurement were assessed by means of a transcutaneous capnograph (TCM4 series from Radiomiter. Results The group classified as normal (N=53 presented a apnea/hypopnea index (AHI <5 events/per hour of sleep and their age groups varied between 7 and 76 years of age. Conclusion Global mean values of PtcCO2 in the normal group had a Gaussian distribution that varied between 33.1 and 50.0 mmHg (SD 4,363. Such findings allowed the establishment of normative PtcCO2 values for normal individuals.

  10. Volumetric capnography: lessons from the past and current clinical applications.

    Science.gov (United States)

    Verscheure, Sara; Massion, Paul B; Verschuren, Franck; Damas, Pierre; Magder, Sheldon

    2016-01-01

    Dead space is an important component of ventilation-perfusion abnormalities. Measurement of dead space has diagnostic, prognostic and therapeutic applications. In the intensive care unit (ICU) dead space measurement can be used to guide therapy for patients with acute respiratory distress syndrome (ARDS); in the emergency department it can guide thrombolytic therapy for pulmonary embolism; in peri-operative patients it can indicate the success of recruitment maneuvers. A newly available technique called volumetric capnography (Vcap) allows measurement of physiological and alveolar dead space on a regular basis at the bedside. We discuss the components of dead space, explain important differences between the Bohr and Enghoff approaches, discuss the clinical significance of arterial to end-tidal CO2 gradient and finally summarize potential clinical indications for Vcap measurements in the emergency room, operating room and ICU. PMID:27334879

  11. Volumetric capnography for the evaluation of chronic airways diseases

    Directory of Open Access Journals (Sweden)

    Veronez L

    2014-09-01

    Full Text Available Liliani de Fátima Veronez,1 Monica Corso Pereira,2 Silvia Maria Doria da Silva,2 Luisa Affi Barcaui,2 Eduardo Mello De Capitani,2 Marcos Mello Moreira,2 Ilma Aparecida Paschoalz2 1Department of Physical Therapy, University of Votuporanga (Educational Foundation of Votuporanga, Votuporanga, 2Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP, Campinas, Sao Paulo, BrazilBackground: Obstructive lung diseases of different etiologies present with progressive peripheral airway involvement. The peripheral airways, known as the silent lung zone, are not adequately evaluated with conventional function tests. The principle of gas washout has been used to detect pulmonary ventilation inhomogeneity and to estimate the location of the underlying disease process. Volumetric capnography (VC analyzes the pattern of CO2 elimination as a function of expired volume.Objective: To measure normalized phase 3 slopes with VC in patients with non-cystic fibrosis bronchiectasis (NCB and in bronchitic patients with chronic obstructive pulmonary disease (COPD in order to compare the slopes obtained for the groups.Methods: NCB and severe COPD were enrolled sequentially from an outpatient clinic (Hospital of the State University of Campinas. A control group was established for the NCB group, paired by sex and age. All subjects performed spirometry, VC, and the 6-Minute Walk Test (6MWT. Two comparisons were made: NCB group versus its control group, and NCB group versus COPD group. The project was approved by the ethical committee of the institution. Statistical tests used were Wilcoxon or Student’s t-test; P<0.05 was considered to be a statistically significant difference.Results: Concerning the NCB group (N=20 versus the control group (N=20, significant differences were found in body mass index and in several functional variables (spirometric, VC, 6MWT with worse results observed in the NCB group. In the comparison between

  12. Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

    Directory of Open Access Journals (Sweden)

    Maria Sammartino

    2010-01-01

    Full Text Available Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation.

  13. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department

    OpenAIRE

    Bou Chebl, Ralphe; Madden, Bryan; Belsky, Justin; Harmouche, Elie; Yessayan, Lenar

    2016-01-01

    Background Diabetic Ketoacidosis (DKA) is a potentially life-threatening emergency that requires prompt diagnosis and treatment. In paediatric populations an end tidal capnography value greater than 36 mmHg was found to be 100 % sensitive in ruling out DKA. Methods A cross sectional observational study of adults ≥ 17 years of age presenting to the emergency department between January 2014 and May 2014 with glucose > 550 mg/dL. In all patients, nasal capnography and venous blood gas analysis w...

  14. Model-based estimation of pulmonary compliance and resistance parameters from time-based capnography.

    Science.gov (United States)

    Abid, Abubakar; Mieloszyk, Rebecca J; Verghese, George C; Krauss, Baruch S; Heldt, Thomas

    2015-08-01

    We propose a highly-simplified single-alveolus mechanistic model of lung mechanics and gas mixing that leads to an analytical solution for carbon dioxide partial pressure in exhaled breath, as measured by time-based capnography. Using this solution, we estimate physiological parameters of the lungs on a continuous, breath-by-breath basis. We validate our model with capnograms from 15 subjects responding positively (>20% FEV1 drop from baseline) to methacholine challenge, and subsequently recovering with bronchodilator treatment. Our results suggest that parameter estimates from capnography may provide discriminatory value for lung function comparable to spirometry, thus warranting more detailed study. PMID:26736601

  15. Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Soleimanpour, Hassan

    2013-11-01

    Full Text Available Introduction: Metabolic acidosis confirmed by arterial blood gas (ABG analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA. Given the direct relationship between end-tidal carbon dioxide (ETco2, arterial carbon dioxide (PaCO2 and metabolic acidosis, measuring ETco2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED with increased blood sugar levels and probable diagnosis of DKA.Methods: In a cross-sectional prospective descriptive-analytic study carried out in an ED, we studied 181 patients older than 18 years old with blood sugar levels of higher than 250 mg/dl and probable DKA. ABG and capnography were obtained from all patients. To determine predictive value, sensitivity, specificity and cut-off points, we developed receiver operating characteristic curves.Results: Sixty-two of 181 patients suffered from DKA. We observed significant differences between both groups (DKA and non-DKA regarding age, pH, blood bicarbonate, PaCO2 and ETco2 values (P≤0.001. Finally, capnography values more than 24.5 mmHg could rule out the DKA diagnosis with a sensitivity and specificity of 0.90.Conclusion: Capnography values greater than 24.5 mmHg accurately allow the exclusion of DKA in ED patients suspected of that diagnosis. Capnography levels lower that 24.5 mmHg were unable to differentiate between DKA and other disease entities. [West J Emerg Med. 2013;14(6:590–594.

  16. Volumetric capnography: In the diagnostic work-up of chronic thromboembolic disease

    OpenAIRE

    Moreira, Marcos Mello; Terzi, Renato Giuseppe Giovanni; Cortellazzi, Laura; Falcão, Antonio Luis Eiras; Junior, Heitor Moreno; Martins, Luiz Cláudio; Coelho, Otavio Rizzi

    2010-01-01

    The morbidity and mortality of pulmonary embolism (PE) have been found to be related to early diagnosis and appropriate treatment. The examinations used to diagnose PE are expensive and not always easily accessible. These options include noninvasive examinations, such as clinical pretests, ELISA D-dimer (DD) tests, and volumetric capnography (VCap). We report the case of a patient whose diagnosis of PE was made via pulmonary arteriography. The clinical pretest revealed a moderate probability ...

  17. Capnography for monitoring non-intubated spontaneously breathing patients in an emergency room setting.

    OpenAIRE

    Egleston, C. V.; Ben Aslam, H; Lambert, M A

    1997-01-01

    OBJECTIVE: To examine the feasibility of using expiratory capnography as an indicator of airway obstruction in non-intubated resuscitation room patients. METHODS: Patients with potential respiratory compromise admitted to the resuscitation room were assessed for widespread expiratory wheeze. This was taken as clinical evidence of airways obstruction. Expiratory capnograms of these patients and patients who had no wheeze were obtained. The traces were analysed for basic morphology and where ap...

  18. A novel application of capnography during controlled human exposure to air pollution

    OpenAIRE

    Fila Michael; Urch Bruce; Lukic Karl Z; Faughnan Marie E; Silverman Frances

    2006-01-01

    Abstract Background The objective was to determine the repeatability and stability of capnography interfaced with human exposure facility. Methods Capnographic wave signals were obtained from five healthy volunteers exposed to particle-free, filtered air during two consecutive 5 min intervals, 10 min apart, within the open and then the sealed and operational human exposure facility (HEF). Using a customized setup comprised of the Oridion Microcap® portable capnograph, DA converter and AD card...

  19. Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy

    OpenAIRE

    Saunders, Rhodri; Erslon, Mary; Vargo, John

    2016-01-01

    Background and study aims: The addition of capnography to procedural sedation/analgesia (PSA) guidelines has been controversial due to limited evidence of clinical utility in moderate PSA and cost concerns. Patients and methods: A comprehensive model of PSA during gastrointestinal endoscopy was developed to capture adverse events (AEs), guideline interventions, outcomes, and costs. Randomized, controlled trials and large-scale studies were used to inform the model. The model compared outcomes...

  20. Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

    OpenAIRE

    Soleimanpour, Hassan; Taghizadieh, Ali; Niafar, Mitra; Rahmani, Farzad; Golzari, Samad EJ; Mehdizadeh Esfanjani, Robab

    2013-01-01

    Introduction: Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETco2), arterial carbon dioxide (PaCO2) and metabolic acidosis, measuring ETco2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED) ...

  1. The utility of cardiac sonography and capnography in predicting outcome in cardiac arrest

    OpenAIRE

    Nelson, Bret P; Patel, Vaishali R.; Norris, Marlaina M.; Richardson, Barbara K.

    2008-01-01

    Emergency physicians and intensivists are increasingly utilizing capnography and bedside echocardiography during medical resuscitations. These techniques have shown promise in predicting outcomes in cardiac arrest, and no cases of return of spontaneous circulation in the setting of sonographic cardiac standstill and low end-tidal carbon dioxide have been reported. This case report illustrates an example of such an occurrence. Our aims are to report a case of return of spontaneous circulation ...

  2. Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

    OpenAIRE

    Maria Sammartino; Barbara Volpe; Fabio Sbaraglia; Rossella Garra; Alessandro D'Addessi

    2010-01-01

    Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of res...

  3. Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note

    OpenAIRE

    Agarwal Anil; Bhagat Hemant; Sharma Manish S

    2008-01-01

    Abstract Background To determine whether monitoring end- tidal Carbon Dioxide (capnography) can be used to reliably identify the phrenic nerve during the supraclavicular exploration for brachial plexus injury. Methods Three consecutive patients with traction pan-brachial plexus injuries scheduled for neurotization were evaluated under an anesthetic protocol to allow intraoperative electrophysiology. Muscle relaxants were avoided, anaesthesia was induced with propofol and fentanyl and the airw...

  4. Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note

    Directory of Open Access Journals (Sweden)

    Agarwal Anil

    2008-05-01

    Full Text Available Abstract Background To determine whether monitoring end- tidal Carbon Dioxide (capnography can be used to reliably identify the phrenic nerve during the supraclavicular exploration for brachial plexus injury. Methods Three consecutive patients with traction pan-brachial plexus injuries scheduled for neurotization were evaluated under an anesthetic protocol to allow intraoperative electrophysiology. Muscle relaxants were avoided, anaesthesia was induced with propofol and fentanyl and the airway was secured with an appropriate sized laryngeal mask airway. Routine monitoring included heart rate, noninvasive blood pressure, pulse oximetry and time capnography. The phrenic nerve was identified after blind bipolar electrical stimulation using a handheld bipolar nerve stimulator set at 2–4 mA. The capnographic wave form was observed by the neuroanesthetist and simultaneous diaphragmatic contraction was assessed by the surgical assistant. Both observers were blinded as to when the bipolar stimulating electrode was actually in use. Results In all patients, the capnographic wave form revealed a notch at a stimulating amplitude of about 2–4 mA. This became progressively jagged with increasing current till diaphragmatic contraction could be palpated by the blinded surgical assistant at about 6–7 mA. Conclusion Capnography is a sensitive intraoperative test for localizing the phrenic nerve during the supraclavicular approach to the brachial plexus.

  5. Response to comments on "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note"

    Directory of Open Access Journals (Sweden)

    Agarwa Anil

    2008-10-01

    Full Text Available Abstract Response to comments on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008

  6. Response to comments on "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note"

    OpenAIRE

    Agarwa Anil; Bhagat Hemant; Sharma Manish S

    2008-01-01

    Abstract Response to comments on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008)

  7. Volumetric capnography: In the diagnostic work-up of chronic thromboembolic disease

    Directory of Open Access Journals (Sweden)

    Marcos Mello Moreira

    2010-05-01

    Full Text Available Marcos Mello Moreira1, Renato Giuseppe Giovanni Terzi1, Laura Cortellazzi2, Antonio Luis Eiras Falcão1, Heitor Moreno Junior2, Luiz Cláudio Martins2, Otavio Rizzi Coelho21Department of Surgery, 2Department of Internal Medicine, State University of Campinas, School of Medical Sciences, Campinas, Sao Paulo, BrazilAbstract: The morbidity and mortality of pulmonary embolism (PE have been found to be related to early diagnosis and appropriate treatment. The examinations used to diagnose PE are expensive and not always easily accessible. These options include noninvasive examinations, such as clinical pretests, ELISA D-dimer (DD tests, and volumetric capnography (VCap. We report the case of a patient whose diagnosis of PE was made via pulmonary arteriography. The clinical pretest revealed a moderate probability of the patient having PE, and the DD result was negative; however, the VCap associated with arterial blood gases result was positive. The patient underwent all noninvasive exams following admission to hospital and again eight months after discharge. Results gained from invasive tests were similar to those produced by image exams, highlighting the importance of VCap as an important noninvasive tool.Keywords: pulmonary embolism, pulmonary hypertension, volumetric capnography, d-dimers, pretest probability

  8. Current methodological and technical limitations of time and volumetric capnography in newborns.

    Science.gov (United States)

    Schmalisch, Gerd

    2016-01-01

    Although capnography is a standard tool in mechanically ventilated adult and pediatric patients, it has physiological and technical limitations in neonates. Gas exchange differs between small and adult lungs due to the greater impact of small airways on gas exchange, the higher impact of the apparatus dead space on measurements due to lower tidal volume and the occurrence of air leaks in intubated patients. The high respiratory rate and low tidal volume in newborns, especially those with stiff lungs, require main-stream sensors with fast response times and minimal dead-space or low suction flow when using side-stream measurements. If these technical requirements are not fulfilled, the measured end-tidal CO2 (P et CO 2 ), which should reflect the alveolar CO2 and the calculated airway dead spaces, can be misleading. The aim of this survey is to highlight the current limitations of capnography in very young patients to avoid pitfalls associated with the interpretation of capnographic parameters, and to describe further developments. PMID:27576441

  9. Capnography Guided Awake Nasal Intubation in a 4 Month Infant with Pierre Robin Syndrome for Cleft Lip Repair-A Better Technique

    OpenAIRE

    Pramod Patra

    2009-01-01

    Summary This four-month-old Pierre Robin child was admitted for cleft lip repair with history of two failed attempts at intubation and subsequent cancellation of surgery. The capnography guided awake nasal intubation was considered as the child's parents were desperate to get the surgery done. A modified cuffless endotracheal tube was used with a capnography sampling tube placed within it. With the capnograph guidance the expiratory gas flow was followed to successfully intubate the child.Thi...

  10. Reference values for volumetric capnography-derived non-invasive parameters in healthy individuals.

    Science.gov (United States)

    Tusman, Gerardo; Gogniat, Emiliano; Bohm, Stephan H; Scandurra, Adriana; Suarez-Sipmann, Fernando; Torroba, Agustin; Casella, Federico; Giannasi, Sergio; Roman, Eduardo San

    2013-06-01

    The aim of this study was to determine typical values for non-invasive volumetric capnography (VCap) parameters for healthy volunteers and anesthetized individuals. VCap was obtained by a capnograph connected to the airway opening. We prospectively studied 33 healthy volunteers 32 ± 6 years of age weighing 70 ± 13 kg at a height of 171 ± 11 cm in the supine position. Data from these volunteers were compared with a cohort of similar healthy anesthetized patients ventilated with the following settings: tidal volume (VT) of 6-8 mL/kg, respiratory rate 10-15 bpm, PEEP of 5-6 cmH₂O and FiO₂ of 0.5. Volunteers showed better clearance of CO₂ compared to anesthetized patients as indicated by (median and interquartile range): (1) an increased elimination of CO₂ per mL of VT of 0.028 (0.005) in volunteers versus 0.023 (0.003) in anesthetized patients, p < 0.05; (2) a lower normalized slope of phase III of 0.26 (0.17) in volunteers versus 0.39 (0.38) in anesthetized patients, p < 0.05; and (3) a lower Bohr dead space ratio of 0.23 (0.05) in volunteers versus 0.28 (0.05) in anesthetized patients, p < 0.05. This study presents reference values for non-invasive volumetric capnography-derived parameters in healthy individuals. Mechanical ventilation and anesthesia altered these values significantly. PMID:23389294

  11. [Use of microstream capnography and alveolar recruitment during off-pump coronary artery bypass grafting].

    Science.gov (United States)

    Suborov, E V; Postnikova, E A; Kapinos, A A; Kuz'kov, V V; Smetkin, A A; Kirov, M Iu

    2009-01-01

    The aim of the study was to investigate changes in EtCO2 and its correlation with PaCO2, and cardiac function during off-pump coronary artery bypass grafting (OPCAB) and to evaluate whether the recruitment maneuver was effective in improving gas exchange after OPCAB. Twenty adult patients scheduled for elective OPCAB were enrolled in a prospective randomized study. Anesthesia was maintained with midazolam, propofol, and fentanyl. After OPCAB the patients were randomized to a control group receiving conventional ventilation (n=10) or to a RM group (n=10) having ventilation and RM. RM was performed at min 15 after transfer to an ICU, by increasing airway pressure to 40 cm H2O for 40 sec subsequently adjusting PEEP to a level of 2 cm H2O above the lower inflection point of the pressure-volume curve. The measurements included hemodynamics, microstream capnography, respiratory parameters, and blood gasses. The baseline EtCO2 correlated with PaCO2 and cardiac index in both group (r = 0.7 and 0.81, respectively; p recruitment, EtCO, increased transiently whereas PaO2/FiO2 return to the baseline level. There was a moderate correlation between EtCO2 and PaCO2 before and after RM (r = 0.7 and 0.8, respectively; p < 0.05). The Bland-Altman analysis has shown that the difference between PaCO2 an EtCO2 was 1.9 +/- 11.4 mm Hg (M +/- 2SD). Thus, during OPCAB, EtCO2 measured by microstream capnography cor related well with PaCO2 and cardiac function. The use of RM after OPCAB increases CO2 elimination and improve arterial oxygenation. PMID:19824412

  12. A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

    OpenAIRE

    Adi, Osman; Chuan, Tan Wan; Rishya, Manikam

    2013-01-01

    Background In emergency settings, verification of endotracheal tube (ETT) location is important for critically ill patients. Ignorance of oesophageal intubation can be disastrous. Many methods are used for verification of the endotracheal tube location; none are ideal. Quantitative waveform capnography is considered the standard of care for this purpose but is not always available and is expensive. Therefore, this feasibility study is conducted to compare a cheaper alternative, bedside upper ...

  13. Principes et utilisation de la capnographie et de la capnométrie en anesthésiologie des carnivores domestiques

    OpenAIRE

    Jame, Germain

    2002-01-01

    La capnométrie (la mesure) et la capnographie (l'enregistrement graphique) de la pression partielle du dioxyde de carbone exhalé sont deux méthodes utiles pour surveiller les fonctions cardiovasculaires et respiratoires lors d'une anesthésie. Cependant, la capnographie apparaît comme la technologie la moins utilisée, en pratique vétérinaire. . Pour beaucoup de vétérinaires, les données capnométriques et capnographiques semblent être trop subtiles et donc trop difficiles à exploiter par rappor...

  14. Capnography Guided Awake Nasal Intubation in a 4 Month Infant with Pierre Robin Syndrome for Cleft Lip Repair-A Better Technique

    Directory of Open Access Journals (Sweden)

    Pramod Patra

    2009-01-01

    Full Text Available This four-month-old Pierre Robin child was admitted for cleft lip repair with history of two failed attempts at intubation and subsequent cancellation of surgery. The capnography guided awake nasal intubation was considered as the child′s parents were desperate to get the surgery done. A modified cuffless endotracheal tube was used with a capnography sampling tube placed within it. With the capnograph guidance the expiratory gas flow was followed to successfully intubate the child.This technique was found to be very convenient and helpful. The use of this technique in an infant has not been reported so far.

  15. Increased volume of conducting airways in idiopathic pulmonary fibrosis is independent of disease severity: a volumetric capnography study.

    Science.gov (United States)

    Plantier, Laurent; Debray, Marie-Pierre; Estellat, Candice; Flamant, Martin; Roy, Carine; Bancal, Catherine; Borie, Raphaël; Israël-Biet, Dominique; Mal, Hervé; Crestani, Bruno; Delclaux, Christophe

    2016-03-01

    Bronchiectasis, bronchiolectasis, and bronchiolisation of alveolar regions are salient features of idiopathic pulmonary fibrosis (IPF). We asked whether IPF was associated with physiological changes consistent with increases in the volume of conducting airways, and whether airway volume was related to the severity of lung fibrosis. Patients with IPF (N  =  57, vital capacity-VC: 73  ±  20%), patients with non-IPF interstitial lung disease (non-IPF ILD, N  =  24, VC  =  78  ±  18%) and controls without lung disease (N  =  51, VC  =  112  ±  21%) underwent volumetric capnography for the determination of conducting airway volume using Fletcher's equal area method, reported to predicted total lung capacity to control for the effect of lung size (VDaw/TLCp, mL/L). VDaw/TLCp was higher in patients with IPF (45.3  ±  12.8 ml L(-1)) in comparison with controls (34.2  ±  11.0 ml L(-1), p  capnography showed higher conducting airway volume in IPF patients in comparison with controls and non-IPF ILDs, independent of disease severity. This result is consistent with either anatomical predisposition or dilation/longitudinal growth of conducting airways in IPF. PMID:26828240

  16. Long-term tolerability of capnography and respiratory inductance plethysmography for respiratory monitoring in pediatric patients treated with patient-controlled analgesia

    Science.gov (United States)

    Miller, Karen M.; Kim, Andrew Y.; Yaster, Myron; Kudchadkar, Sapna R.; White, Elizabeth; Fackler, James; Monitto, Constance L.

    2016-01-01

    Background The Anesthesia Patient Safety Foundation has advocated the use of continuous electronic monitoring of oxygenation and ventilation to preemptively identify opioid-induced respiratory depression. In adults, capnography is the gold standard in respiratory monitoring. An alternative technique used in sleep laboratories is respiratory inductance plethysmography (RIP). However, it is not known if either monitor is well tolerated by pediatric patients for prolonged periods of time. Aim The goal of this study was to determine whether capnography or RIP is better tolerated in non-intubated, spontaneously breathing pediatric patients being treated with intravenous patient-controlled analgesia (IVPCA). Methods Nasal cannula capnography with oral sampling and thoracic and abdominal inductance plethysmography bands were placed along with routine monitors on pediatric patients being treated for acute pain with IVPCA. Study monitors were left in place for as long as they were tolerated by the patient, for a maximum of 24 consecutive hours. If the patient did not wear a particular study monitor for any reason, but tolerated the remaining monitor, participation in the study continued. If the patient would not wear either monitor, participation was terminated. Results Twenty-six patients (18 female, 8 male, average age 10.1 ± 5.5 years) consented to participate, but only 14 patients attempted to wear one or both devices. Among those who wore either device, median time to device removal was 8.33 hours (range 0.3–23.6 hours) for capnography and 23.5 hours (range 0.7–24 hours) for RIP bands. Conclusion Children did not tolerate wearing capnography cannulae for prolonged periods of time, limiting the usefulness of this device as a continuous monitor of ventilation in children. RIP bands were better tolerated; however, they require further assessment of their utility. Until more effective, child-friendly monitors are developed and their utility validated, guidelines

  17. Correspondence in relation to the case report "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note." published in May issue of Journal of Brachial Plexus and Peripheral Nerve Injury

    OpenAIRE

    Bhakta Pradipta

    2008-01-01

    Abstract Comment on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008)

  18. A novel application of capnography during controlled human exposure to air pollution

    Directory of Open Access Journals (Sweden)

    Fila Michael

    2006-10-01

    Full Text Available Abstract Background The objective was to determine the repeatability and stability of capnography interfaced with human exposure facility. Methods Capnographic wave signals were obtained from five healthy volunteers exposed to particle-free, filtered air during two consecutive 5 min intervals, 10 min apart, within the open and then the sealed and operational human exposure facility (HEF. Using a customized setup comprised of the Oridion Microcap® portable capnograph, DA converter and AD card, the signal was acquired and saved as an ASCII file for subsequent processing. The minute ventilation (VE, respiratory rate (RR and expiratory tidal volume (VTE were recorded before and after capnographic recording and then averaged. Each capnographic tracing was analyzed for acceptable waves. From each recorded interval, 8 to 19 acceptable waves were selected and measured. The following wave parameters were obtained: total length and length of phase II and III, slope of phase II and III, area under the curve and area under phase III. In addition, we recorded signal measures including the mean, standard deviation, mode, minimum, maximum – which equals end-tidal CO2 (EtCO2, zero-corrected maximum and true RMS. Results Statistical analysis using a paired t-test for means showed no statistically significant changes of any wave parameters and wave signal measures, corrected for RR and VTE, comparing the measures when the HEF was open vs. sealed and operational. The coefficients of variation of the zero-corrected and uncorrected EtCO2, phase II absolute difference, signal mean, standard deviation and RMS were less than 10% despite a sub-atmospheric barometric pressure, and slightly higher temperature and relative humidity within the HEF when operational. Conclusion We showed that a customized setup for the acquisition and processing of the capnographic wave signal, interfaced with HEF was stable and repeatable. Thus, we expect that analysis of capnographic

  19. Detection of optimal PEEP for equal distribution of tidal volume by volumetric capnography and electrical impedance tomography during decreasing levels of PEEP in post cardiac-surgery patients

    OpenAIRE

    Blankman, P; Shono, A.; Hermans, B. J. M.; Wesselius, T.; Hasan, D; Gommers, D

    2016-01-01

    Background Homogeneous ventilation is important for prevention of ventilator-induced lung injury. Electrical impedance tomography (EIT) has been used to identify optimal PEEP by detection of homogenous ventilation in non-dependent and dependent lung regions. We aimed to compare the ability of volumetric capnography and EIT in detecting homogenous ventilation between these lung regions. Methods Fifteen mechanically-ventilated patients after cardiac surgery were studied. Ventilator settings wer...

  20. The effects of cardiac output and pulmonary arterial hypertension on volumetric capnography derived-variables during normoxia and hypoxia.

    Science.gov (United States)

    Mosing, Martina; Kutter, Annette P N; Iff, Samuel; Raszplewicz, Joanna; Mauch, Jacqueline; Bohm, Stephan H; Tusman, Gerardo

    2015-02-01

    The aim of this study was to test the effect of cardiac output (CO) and pulmonary artery hypertension (PHT) on volumetric capnography (VCap) derived-variables. Nine pigs were mechanically ventilated using fixed ventilatory settings. Two steps of PHT were induced by IV infusion of a thromboxane analogue: PHT25 [mean pulmonary arterial pressure (MPAP) of 25 mmHg] and PHT40 (MPAP of 40 mmHg). CO was increased by 50% from baseline (COup) with an infusion of dobutamine≥5 μg kg(-1) min(-1) and decreased by 40% from baseline (COdown) infusing sodium nitroglycerine≥30 μg kg(-1) min(-1) plus esmolol 500 μg kg(-1) min(-1). Another state of PHT and COdown was induced by severe hypoxemia (FiO2 0.07). Invasive hemodynamic data and VCap were recorded and compared before and after each step using a mixed random effects model. Compared to baseline, the normalized slope of phase III (SnIII) increased by 32% in PHT25 and by 22% in PHT40. SnIII decreased non-significantly by 4% with COdown. A combination of PHT and COdown associated with severe hypoxemia increased SnIII by 28% compared to baseline. The elimination of CO2 per breath decreased by 7% in PHT40 and by 12% in COdown but increased only slightly with COup. Dead space variables did not change significantly along the protocol. At constant ventilation and body metabolism, pulmonary artery hypertension and decreases in CO had the biggest effects on the SnIII of the volumetric capnogram and on the elimination of CO2. PMID:24908108

  1. Correspondence in relation to the case report "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note." published in May issue of Journal of Brachial Plexus and Peripheral Nerve Injury

    Directory of Open Access Journals (Sweden)

    Bhakta Pradipta

    2008-10-01

    Full Text Available Abstract Comment on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008

  2. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy La capnografía es superior a la pulsioximetría en la detección de depresión respiratoria durante las colonoscopias

    OpenAIRE

    G. Cacho; J. L. Pérez-Calle; Barbado, A.; J. L. Lledó; R. Ojea; C. M. Fernández-Rodríguez

    2010-01-01

    Background: pulse oximetry is a widely accepted procedure for ventilatory monitoring during gastrointestinal endoscopy, but this method provides an indirect measurement of the respiratory function. In addition, detection of abnormal ventilatory activity can be delayed, especially if supplemental oxygen is provided. Capnography offers continuous real-time measurement of expiratory carbon dioxide. Objective: we aimed at prospectively examining the advantages of capnography over the standard pul...

  3. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy La capnografía es superior a la pulsioximetría en la detección de depresión respiratoria durante las colonoscopias

    Directory of Open Access Journals (Sweden)

    G. Cacho

    2010-02-01

    Full Text Available Background: pulse oximetry is a widely accepted procedure for ventilatory monitoring during gastrointestinal endoscopy, but this method provides an indirect measurement of the respiratory function. In addition, detection of abnormal ventilatory activity can be delayed, especially if supplemental oxygen is provided. Capnography offers continuous real-time measurement of expiratory carbon dioxide. Objective: we aimed at prospectively examining the advantages of capnography over the standard pulse oximetry monitoring during sedated colonoscopies. Patients and methods:fifty patients undergoing colonoscopy were simultaneously monitored with pulse oximetry and capnography by using two different devices in each patient. Several sedation regimens were administered. Episodes of apnea or hypoventilation detected by capnography were compared with the occurrence of hypoxemia. Results: twenty-nine episodes of disordered respiration occurred in 16 patients (mean duration 54.4 seconds. Only 38% of apnea or hypoventilation episodes were detected by pulse oximetry. A mean delay of 38.6 seconds was observed in the events detected by pulse oximetry (two episodes of disturbed ventilation were simultaneously detected by capnography and pulse oximetry. Conclusions: apnea or hypoventilation commonly occurs during colonoscopy with sedation. Capnography is more reliable than pulse oximetry in early detection of respiratory depression in this setting.

  4. Clinical application of capnography in obstructive lung disease%二氧化碳图在阻塞性肺疾病中的临床应用进展

    Institute of Scientific and Technical Information of China (English)

    孙晓丽; 刘锦铭; 杨文兰

    2009-01-01

    Capnography is a kind of pulmonary function test with clinical practicability and bright future.The changes of some parameters and measurement of exhaled carbon dioxide in capnography are described to assist in identifying various pathology situations.With the development of the research,the value of capnography in obstructive lung disease has been accepted by more and more clinical doctors.%二氧化碳图是一种具有发展前景和临床实用价值的啼功能测定技术.该技术通过测量分析呼出气二氧化碳的水平,以及一系列参数指标的变化来评估肺内不同疾病状态下的病理生理状况的改变.近年来随着研究的深入,二氧化碳图在阻塞性肺疾病治疗评估方面有了新的突破和意义.

  5. Comparison of the pulmonary dead-space fraction derived from ventilator volumetric capnography and a validated equation in the survival prediction of patients with acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    Yu-Jiao Zhang; Xin-Jing Gao; Zhi-Bo Li; Zhi-Yong Wang; Quan-Sheng Feng; Cheng-Fen Yin; Xing Lu

    2016-01-01

    Purpose:This prospective observational study aims to evaluate the accuracy of dead-space fraction derived from the ventilator volumetric capnography (volumetric CO2) or a prediction equation to predict the survival of mechanically ventilated patients with acute respiratory distress syndrome (ARDS).Methods:Consecutive VD/VT measurements were obtained based upon a prediction equation validated by Frankenfield et al for dead-space ventilation fraction:VD/VT 0.320 + 0.0106 (PaCO2-ETCO2) + 0.003 (RR) + 0.0015 (age) in adult patients who had infection-related severe pneumonia and were confirmed as having ARDS.Here PaCO2 is the arterial partial pressure of carbon dioxide in mmHg;ETCO2,the endtidal carbon dioxide measurement in mmHg;RR,respiratory rate per minute;and age in years.Once the patient had intubation,positive end expiratory pressure was adjusted and after Phigh reached a steady state,VD/VT was measured and recorded as the data for the first day.VD/VT measurement was repeated on days 2,3,4,5 and 6.Meanwhile we collected dead-space fraction directly from the ventilator volumetric CO2 and recorded it as Vd/Vt.We analyzed the changes in VD/VT and Vd/Vt over the 6-day period to determine their accuracy in predicting the survival of ARDS patients.Results:Overall,46 patients with ARDS met the inclusion criteria and 24 of them died.During the first 6 days of intubation,VD/VT was significantly higher in nonsurvivors on day 4 (0.70 ± 0.01 vs 0.57 ± 0.01),day 5 (0.73 ± 0.01 vs.0.54 ± 0.01).and day 6 (0.73 ± 0.02 vs.0.54 ± 0.01) (all p =0.000).Vd/Vt showed no significant difference on days 1-4 but it was much higher in nonsurvivors on day 5 (0.45 ± 0.04 vs.0.41 ± 0.06) and day 6 (0.47 ± 0.05 vs.0.40 ± 0.03) (both p =0.008).VD/VT on the fourth day was more accurate to predict survival than Vd/Vt.The area under the receiver-operating characteristic curve for VD/VT and Vd/Vt in evaluating ARDS patients survival was day 4 (0.974 ± 0.093 vs.0.701 ± 0.023,p 0

  6. Capnografia volumétrica como auxílio diagnóstico não-invasivo no tromboembolismo pulmonar agudo Volumetric capnography as a noninvasive diagnostic procedure in acute pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    Marcos Mello Moreira

    2008-05-01

    Full Text Available O tromboembolismo pulmonar é uma situação freqüente que pode ser diagnosticada pela cintilografia pulmonar, angiotomografia computadorizada, arteriografia pulmonar e, como método de exclusão, dosagem do dímero-D. Como estes exames nem sempre estão disponíveis, a validação de outros métodos diagnósticos é fundamental. Relata-se o caso de uma paciente com hipertensão pulmonar crônica, agudizada por tromboembolismo pulmonar. Confirmou-se o diagnóstico por cintilografia, angiotomografia computadorizada, arteriografia pulmonar; a dosagem do dímero-D resultou positiva. A capnografia volumétrica associada à gasometria arterial foi realizada na admissão e após o tratamento. As variáveis obtidas foram comparadas com os resultados dos exames de imagem.Pulmonary thromboembolism is a common condition. Its diagnosis usually requires pulmonary scintigraphy, computed angiotomography, pulmonary arteriography and, in order to rule out other diagnoses, the measurement of D-dimer levels. Due to the fact that these diagnostic methods are not available in most Brazilian hospitals, the validation of other diagnostic techniques is of fundamental importance. We describe a case of a woman with chronic pulmonary hypertension who experienced a pulmonary thromboembolism event. Pulmonary scintigraphy, computed angiotomography and pulmonary arteriography were used in the diagnosis. The D-dimer test result was positive. Volumetric capnography was performed at admission and after treatment. The values obtained were compared with the imaging test results.

  7. 容积二氧化碳图在气道反应性测定中的应用%Application of volumetric capnography in the measurement of bronchial hyperresponsiveness

    Institute of Scientific and Technical Information of China (English)

    孙晓丽; 刘锦铭; 杨文兰

    2010-01-01

    Objective To investigate the sensitivity and specificity of volumetric capnography (VCap) parameters in the measurement of bronchial hyperresponsiveness (BHR) and bronchodilator responsiveness,and compared with the routine spirometry method. Methods Sixty chronic cough suspect cough variation asthmatic outpatients were selected randomly to perform bronchial challenge test with VCap and spirometry respectively, VCap were measured firstly every step. Results Positive rate of BHR was 50%. In the posifive group, FEV1 ,PEF and VDT, VDF, VDW,dC3/DV were significantly changed between the postchallenge value and the baseline value(P0.05),VDT、VDF、VDW激发后和舒张后值之间差异有统计学意义(P<0.05).所有患者的基础值、激发后、舒张后数据,FEV1均与PEF、Vcap各参数(除dC2/DV、dC3/DV、SR23外)呈显著直线相关(P<0.05).激发试验过程中各死腔参数的下降提前于FEV1和PEF的下降.激发试验终止时,ROC曲线提示VDT、VDF为最敏感指标,VDT较基础值增加28%、VDF较基础值增加20%,可作为Vcap气道高反应性阳性判断标准.结论 Vcap是一种定量评估支气管阻塞严重性的有效方法,可应用于气道反应性测定.

  8. 容积二氧化碳图对支气管哮喘患者急性加重分级的意义%The significance of volumetric capnography in assessment of asthmatic acute exacerbation staging

    Institute of Scientific and Technical Information of China (English)

    刘锦铭; 胡华成; 施敏华; 杨文兰; 郑卫; 王英敏

    2008-01-01

    %呈正相关(r值分别为0.69、0.54、0.59、0.54,P均<0.01);dC3/DV与FEV1占预计值%、FEV1/FVC、PEF占预计值%、MMEF占预计值%呈显著负相关(r值分别为-0.62、-0.45、-0.69、-0.58,P均<0.01);SR23与FEV1占预计值%、FEV1/FVC、PEF占预计值%、MMEF占预计值%呈显著负相关(r值分别为-0.75、-0.52、-0.74、-0.62,P均<0.01).结论 Vcap是一种简便易行、可定量评估哮喘患者支气管阻塞严重程度的有效方法.%Objective To investigate the diagnostic value of volumetric capnography in the assessment of asthmatic exacerbation.Methods Sixty-four patients with asthma exacerbation and 20 normal controls performed spirometry and volumetric capnography recording.The patients with asthma were divided into three sub-groups according to FEV1% pred(A:>80%,B:40%~80%,C:<40%).Results FEV1% pred,FEV1/FVC,PEF% pred and MMEF% pred were(98±9)%,(80±6)%,(91 ± 15)% and (73±7)% respectively in the control group,but were(52±20)%,(50±10)%,(49±16)% and(28±16)%respectively in the asthma group,the difference being significant(t=6.93-13.29,all P<0.01).Compared with the control group,dC2/DV[(19±6)%/L vs(31±8)%/L,t=5.09,P<0.01]showed a decrease in the asthma group.dC3/DV[(2.9±1.2)%/L vs(1.0±0.4)%/L,t=-6.14,P<0.01] and SR23[(16.8±10.6)%vs(3.3±1.5)%,t=-6.54,P<0.01]showed an increase in the asthma group compared to the control group,the difference being significant.Compared with that of the control group,dC2/DV[B:(17±5)%/L,C:(13±4)%/L]showed a decrease(t=-11.82,-16.75,all P<0.01)and dC3/DV[B:(3.2±0.8)%/L,C:(4.1 ±1.2)%/L]and SR23[B:(17.2 ± 3.5)%,C:(28.3±6.9)%]showed an increase(t=2.16-26.08,all P<0.01)in asthma sub-groups B and C.For dC3/DV and SR23, the difference was significant between asthma sub-groups(t=0.91-22.18,all P<0.05).In Pearson correlation analysis,dC2/DV(r=0.69.0.54.0.59,0.54,all P<0.01)and dC3/DV(r=-0.62.-0.45,-0.69,-0.58,all P<0.01)and SR23(r=-0.75,-0.52,-0.74,-0.62,all P<0.01)correlated with FEV1% pred

  9. 容积二氧化碳图在气道反应性测定中的应用%Application of volumetric capnography in the measurement of bronchial hyperresponsiveness

    Institute of Scientific and Technical Information of China (English)

    孙晓丽; 刘锦铭; 杨文兰

    2010-01-01

    目的 探讨容积二氧化碳图(volumetric capnography,Vcap)参数在组胺激发试验中的反应性变化并与肺通气测定法做比较.方法 对60例门诊慢性咳嗽,疑诊咳嗽变异性哮喘患者进行组胺支气管激发实验,于基础状态、每次吸入组胺后,及吸入支气管扩张药后,先进行Vcap测定,再进行肺通气功能测定.使用Vcap来评价气道反应性.结果 60例患者气道高反应性的阳性率为50%.激发试验阳性组第1秒用力呼气容积(FEV1)、最大用力呼气峰流量(PEF)及Vcap参数Threshold死腔(VDT)、Fowler死腔(VDF)、Wolff死腔(VDW)、Ⅲ期斜率(dC3/DV)在基础值和激发后值之间差异均有统计学意义(P<0.01),激发后和舒张后值之间差异也有统计学意义(P<0.05).阴性组FEV1、PEF在基础值和激发后值之间、激发后和舒张后值之间差异无统计学意义(P>0.05),VDT、VDF、VDW激发后和舒张后值之间差异有统计学意义(P<0.05).所有患者的基础值、激发后、舒张后数据,FEV1均与PEF、Vcap各参数(除dC2/DV、dC3/DV、SR23外)呈显著直线相关(P<0.05).激发试验过程中各死腔参数的下降提前于FEV1和PEF的下降.激发试验终止时,ROC曲线提示VDT、VDF为最敏感指标,VDT较基础值增加28%、VDF较基础值增加20%,可作为Vcap气道高反应性阳性判断标准.结论 Vcap是一种定量评估支气管阻塞严重性的有效方法,可应用于气道反应性测定.

  10. Change of slope parameters in volumetric capnography of asthma patients at acute episodes%急性发作期支气管哮喘患者的容积二氧化碳图斜率参数变化

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 顾文超; 杨文兰; 郭建; 王英敏; 郑卫; 徐黎青

    2016-01-01

    Objective: To investigate the diagnostic value of volumetric capnography (VCap) parameters for asthma patients at acute episodes. Methods:VCap and spirometry were performed in 53 asthma patients at acute episodes and 43 healthy subjects. Correlation between VCap slope parameters and spirametory parameters were tested by Pearson analysis. Diagnostic performance of VCap slope for differentiating asthma patients from healthy subjects was evaluated by receiver operator characteristic (ROC) curve. Result: dC3/DV and SR23 were negatively correlated with FEV1/pre and FEV1/FVC%, respectively (P<0.05), while dC2/DV was positively correlated with FEV1/FVC% (P<0.05). dC3/DV and SR23 increased significantly in asthma group than those in healthy subjects. ROC curve analysis showed that AUC for dC2/DV, dC3/DV and SR23 were 0.605,0.724 and 0.757, respectively. Conclusions: Change of slope parameters in VCap is a simple method, which could provide references for diagnosing asthma patient at acute episode.%目的:探讨容积二氧化碳图(volumetric capnography,VCap)斜率参数对急性发作期支气管哮喘(以下简称哮喘)的诊断价值。方法:对53例急性发作期哮喘患者(哮喘组)及43名健康者(健康组)进行肺通气功能及VCap测定。采用Pearson相关性分析检验肺通气功能与VCap斜率指标间的相关性,采用独立样本t检验比较哮喘组与健康组间的VCap斜率指标差异,并用受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)分析VCap斜率指标对急性发作期哮喘患者与健康人的鉴别效能。结果:Ⅲ相斜率(dC3/DV)、SR23分别与一秒钟用力呼气量(forced expiratory volume in one second,FEV1)占预计值百分比(FEV1/pre)、FEV1/用力肺活量(forced vital capacity, FVC)%呈负相关(P<0.05)。 dC2/DV与FEV1/FVC%成正相关(P<0.05)。哮喘组dC3/DV、SR23均较健康组增大,差异有统计学意义(P<0.01

  11. The similar and different changes of volumetric capnography dead spaces in chronic obstructive pulmonary disease and asthma%容积二氧化碳图死腔参数在慢性阻塞性肺疾病和支气管哮喘中的异同特点分析

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 周志才; 顾文超; 奚峰; 杨文兰; 吴浩

    2012-01-01

    目的 探讨死腔参数在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)与支气管哮喘(简称哮喘)中变化趋势的异同.方法 对49例COPD患者、35例哮喘患者和35名健康志愿者的肺通气指标及Threshhold死腔(VDT)、Langley死腔(VDL)、Fowler死腔(VDF)、Wolff死腔(VDW)和Bohr死腔(VDB)进行测定分析.结果 与健康对照组比较,COPD组VDT显著减小,而VDW、VDB则显著增大,差异均有统计学意义(P<0.05),COPD组中VDL、VDF与健康对照组比较差异无统计学意义;在哮喘组中,VDT、VDL、VDF、VDW均较健康对照组显著减小,而VDB与健康对照组比较差异无统计学意义.阻塞程度相同的COPD与哮喘患者比较,VDF、VDW和VDB在COPD组显著高于哮喘组,而VDT、VDL在两组间差异则无统计学意义.相关分析显示,在COPD组中,VDT、VDF、VDW及VDB均与FEV1/FVC呈负相关(P<0.05).VDF、VDW及VDB还与FEV1呈负相关(P<0.05).而在哮喘组中,除VDB与FEV1呈负相关外(P<0.05),其余死腔参数与FEV1/FVC、FEV1均无明显相关性(P>0.05).结论 由于COPD和哮喘患者在呼吸生理方面变化的异同,其各容积二氧化碳图死腔参数的变化也有所区别.通过分析两者死腔参数的变化趋势,可为临床工作者在COPD和哮喘的诊断及鉴别诊断中提供参考.%Objective To evaluate the similar and different changes of volumetric capnography dead spaces between chronic obstructive pulmonary disease(COPD) and asthma.Methods Forty-nine COPD patients,thirty-five asthma patients and thirty-five healthy volunteers were enrolled in this study.We measured their spirometry indices and volumetric capnography dead spaces such as VDT,VDL,VDF,VDW and VDB.Results Compared with the healthy controls,VDT in COPD patients decreased significantly,while VDW and VDB significantly increased on the other hand.There were no difference about VDL and VDF between COPD patients and healthy controls.Except for VDB,all of the dead

  12. Influência da insuflação de gás traqueal sobre a capnografia de pacientes anestesiados Influencia de la insuflación de gas traqueal sobre la capnografía de pacientes anestesiados Influence of tracheal gas insufflation during capnography in anesthetized patients

    Directory of Open Access Journals (Sweden)

    Ana Carolina Ortiz

    2008-10-01

    in anesthetized patients. METHODS: Eleven patients, ages 18 to 60 years, ASA I or II, without lung diseases were evaluated prospectively. After tracheal intubation, a TGI catheter was inserted 2 to 3 cm from the carina. Patients underwent volume-controlled ventilation. The volumetric capnography curve was recorded during 20 minutes and blood was drawn to determine the PaCO2. Twenty minutes after TGI was instituted, the capnograph curve was recorded and blood was drawn once more to measure PaCO2. The end-tidal partial pressure of CO2 (P ET CO2 and PaCO2 were evaluated before and after TGI. The capnography curve was observed before and during TGI. RESULTS: PaCO2 and P ET CO2 without TGI were: 33.48 ± 6.81 and 36.91 ± 6.54 mmHg (mean ± standard deviation, respectively, and after TGI, 33.85 ± 8.31 and 36.55 ± 7.93 mmHg, respectively. Parameters were not statistically different before and after TGI, both for PaCO2 and P ET CO2 (p = 0.65 and 0.82. The capnography curve showed changes in alveolar air during expiration. CONCLUSIONS: The use of TGI did not result in a reduction in PaCO2 or P ET CO2, but it altered the morphology of the capnography curve.

  13. Capnografia volumétrica como meio de detectar obstrução pulmonar periférica precoce em pacientes com fibrose cística Volumetric capnography as a tool to detect early peripheric lung obstruction in cystic fibrosis patients

    Directory of Open Access Journals (Sweden)

    Maria Ângela G. O. Ribeiro

    2012-12-01

    Full Text Available OBJETIVO: Comparar a espirometria e a capnografia volumétrica (CapV para determinar se os valores amostrados pela capnografia acrescentam informações sobre doenças pulmonares precoces em pacientes com fibrose cística (FC. MÉTODOS: Este foi um estudo do tipo corte transversal envolvendo pacientes com FC: Grupo I (42 pacientes, 6-12 anos de idade e Grupo II (22 pacientes, 13-20 anos de idade. Os grupos controle correspondentes eram formados por 30 e 50 indivíduos saudáveis, respectivamente. A capacidade vital forçada (CVF, o volume expiratório forçado no primeiro segundo (VEF1 e a relação VEF1/CVF foram determinados pela espirometria. Através da CapV, medimos a saturação periférica de oxigênio (SpO2, a frequência respiratória (FR, o tempo inspiratório (TI, o tempo expiratório (TE e o slope da fase III normalizado pelo volume corrente (slope da fase III/Vc. RESULTADOS: Em comparação com os grupos controle, todos os pacientes com FC apresentaram valores de slope da fase III/Vc (p OBJECTIVE: To compare spirometry and volumetric capnography (VCap to determine if the capnographic values add more information about early lung disease in cystic fibrosis (CF patients. METHODS: This was a cross-sectional study involving CF patients: Group I (42 patients, 6-12 years of age; and Group II (22 patients, 13-20 years of age. The corresponding control groups were comprised of 30 and 50 healthy subjects, respectively. Forced vital capacity (FVC, forced expiratory volume in one second (FEV1, and the FEV1/FVC ratio was determined by spirometry. Using VCap, we measured peripheral oxygen saturation (SpO2, respiratory rate (RR, inspiratory time (IT, expiratory time (ET, and the phase III slope normalized by expiratory volume (phase III slope/Ve. RESULTS: In comparison with control groups, all CF patients presented higher phase III slope/Ve values (p < 0.001 independent of the pulmonary disease stage. The phase III slope/Ve was significantly

  14. Do all mechanically ventilated pediatric patients require continuous capnography?

    Science.gov (United States)

    Hamel, Donna S; Cheifetz, Ira M

    2006-09-01

    With most patients in modern ICUs requiring mechanical ventilation, any technology that may lead to more optimal ventilatory strategies would be invaluable in the management of critically ill patients. The focus of most ventilator strategies is protecting the lung from the deleterious effects of mechanical ventilation. Every effort is made to minimize the duration of mechanical ventilation while optimizing the potential for successful extubation. A concise organized plan based on objective criteria that is adjusted to meet changes in patient status is clearly recommended. Continuous capnographic monitoring provides clinicians with clear, precise, objective data that may prove beneficial in the design and implementation of mechanical ventilatory strategies. There are no clear-cut methods for achieving the optimal ventilator strategy for a specific patient. Although guidelines and management theories exist throughout the medical literature, in practice, they often merely serve as loose guidelines. The dynamic properties of an acutely ill patient make the management of mechanical ventilation an ongoing process requiring clinical assessment and planning by multidisciplinary members of the patient care team. Comprehensive evaluation of ventilatory management strategies and patient responses must be made by a collaborative effort of physicians, respiratory care practitioners, and nurses. An objective, consistent approach to the overall management is essential. Although still controversial, it is the authors' opinion that volumetric capnograph provides the data necessary to establish adequate gas delivery, optimal PEEP, and effective ventilation with the least amount of mechanical assistance, regardless of clinician or institutional preferences. PMID:16952808

  15. Volumetric capnography: lessons from the past and current clinical applications

    OpenAIRE

    Verscheure, Sara; Massion, Paul B; Verschuren, Franck; Damas, Pierre; Magder, Sheldon

    2016-01-01

    Dead space is an important component of ventilation–perfusion abnormalities. Measurement of dead space has diagnostic, prognostic and therapeutic applications. In the intensive care unit (ICU) dead space measurement can be used to guide therapy for patients with acute respiratory distress syndrome (ARDS); in the emergency department it can guide thrombolytic therapy for pulmonary embolism; in peri-operative patients it can indicate the success of recruitment maneuvers. A newly available techn...

  16. Volumetric capnography for the evaluation of chronic airways diseases

    OpenAIRE

    Veronez L; Pereira MC; Doria da Silva SM; Barcaui LA; De Capitani EM; Moreira MM; Paschoal IA

    2014-01-01

    Liliani de Fátima Veronez,1 Monica Corso Pereira,2 Silvia Maria Doria da Silva,2 Luisa Affi Barcaui,2 Eduardo Mello De Capitani,2 Marcos Mello Moreira,2 Ilma Aparecida Paschoalz2 1Department of Physical Therapy, University of Votuporanga (Educational Foundation of Votuporanga), Votuporanga, 2Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Sao Paulo, BrazilBackground: Obstructive lung diseases of different etiologies pre...

  17. Changes and clinical value of dead space parameters in volumetric capnography of chronic obstructive pulmonary disease%慢性阻塞性肺疾病中容积二氧化碳图死腔参数的变化及其临床价值

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 顾文超; 杨文兰; 郭健; 徐黎青; 郑卫; 王英敏

    2016-01-01

    Objective To investigate the application value of volumetric capnography (VCap) dead space pa-rameters in diagnosis of chronic obstructive pulmonary disease (COPD). Methods Seventy-four patients with COPD (COPD group) and 38 healthy volunteers (healthy group) in our hospital for outpatient and inpatient treatment from 2013 to 2014 were selected as the research subjects. The pulmonary ventilation, volume and dispersion index, Threshold dead space (VDT), Langley dead space (VDL), Fowler dead space (VDF), Wolff dead space (VDW) and Bohr dead spaces (VDB) were measured in all the subjects. First, the formula for predicted value was obtained through multiple regression analysis with dead space as the dependent variable, and gender, age, height, weight, tidal volume, respiratory frequency as the independent variables. The predicted values of all subjects were computed by the formula. The difference between the predicted value and the measured value of dead space in COPD group was compared by paired t test. The discriminant effi-ciency of dead space on COPD patients and healthy people was analyzed by discriminant analysis. Correlations between dead space parameters and routine pulmonary function parameters were analyzed by partial correlation analysis. Results In the COPD group, the measured value of VDT was lower than the predicted value [(79.51 ± 39.29) mL vs (97.42 ± 30.53) mL, P<0.01], while the measured values of VDF, VDW, and VDB were significantly increased than the predicted values [(190.20 ± 57.41) mL vs 177.18±38.99) mL, (214.04±73.35) mL vs (183.86±46.63) mL, (294.89±93.12) mL vs (237.44±62.27) mL, P<0.05]. In the discriminant analysis of dead space on COPD patients and healthy people, only VDT and VDB entered the equation, with the total classification accuracy of 87.9% (116/132). In COPD group, VDT and VDF were negatively correlated with FEV1, FEV1/FVC and DLCO (P<0.05). VDW was negatively correlated with FEV1, FEV1/FVC and DLCO (P<0.05), which was

  18. Evaluation on volumetric capnography diagnosing dysfunction of ventilation in patients with chronic obstruction pulmonary disease%容积二氧化碳图及其指标诊断慢性阻塞性肺疾病患者换气功能的评价

    Institute of Scientific and Technical Information of China (English)

    王集红; 刘歆; 季玉珍; 陈湘平; 刘少滨

    2011-01-01

    目的 评价容积二氧化碳图(VCap)及其指标诊断慢性阻塞性肺疾病(COPD)患者换气功能障碍的临床应用价值.方法 比较分析COPD组92例与对照组48例VCap及其11项指标[Bohr测定法死腔(VD-B)、呼气末最大CO2浓度(CO2max)、呼出气CO2浓度为25%~50%时的容量(Vm25-50)、呼出气CO2浓度为50%~75%时的容量(Vm50 75)、潮气量(VT)、VD-B/VT、Vm25-50/VT、Vm50-75/VT、Ⅱ期斜率(dC/dV2)、Ⅲ期斜率(dC/dV3)和Ⅲ期斜率/Ⅱ期斜率× 100(SR23)]的差别.结果 COPD组与对照组CO2 max、Vm50-75、VT、VD-B/VT、Vm25 50/VT、Vm50-75/VT、dC/dV2、dC/dV3和SR23等9项指标差异有统计学意义(P<0.05).在COPD组中,Ⅱ级与Ⅲ级的VD-B/VT、Vm25-50/VT、dC/dV3和SR23等4项指标差异有统计学意义(P<0.05);Ⅱ级与Ⅳ级的dC/dV2、dC/dV3和SR23等3项指标差异有统计学意义(P<0.05);Ⅲ级与Ⅳ级dC/dV3和SR23等2项指标差异有统计学意义(P<0.05).结论 COPD组VCap曲线形态有异常改变,dC/dV3和SR23可作为最佳诊断指标.VCap检测技术具有无创性和价廉等优点,是诊断COPD换气功能状况的好方法.%Objective To evaluate on volumetric capnography ( VCap) change of patients with chronic obstructive pulmonary diseases (COPD), diagnosing their dysfunction of ventilation. Methods Compard the differences between the 92 patients of COPD group and 48 healthly people of control group on VCap and its indices ( VD-B, CO2max, Vm25-50, Vm50-57 , VT, VD-B/VT, Vm25-50/VT, Vm50-57/VT,dC/dV2 ,dC/dV3 and SR23). Results There were significant differences ( P <0. 05) between COPD group and control group on VCap and its indices (CO2max, Vm50 75 ,VT,VD-B/VT,Vm25-50/VT, Vm50-57/VT,dC/dV2 ,dC/dV3 and SR23), between COPDⅡ and COPD Ⅲ on VCap indices (VD-B/VT, Vm25 50/VT,dC/dV3 and SR23), between COPD Ⅱ and COPDIV on VCap indices (dC/dV2 ,dC/dV3 and SR23),between COPDⅢ and COPDIV on dC/dV3 and SR23. Conclusions The shape of VCap curve of the COPD group were

  19. Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation Efeitos da manobra de compressão e descompressão torácica nos volumes pulmonares, capnografia e oximetria de pulso em pacientes submetidos à ventilação mecânica

    Directory of Open Access Journals (Sweden)

    Fabiana Della Via

    2012-10-01

    Full Text Available OBJECTIVES: The aims of this study were to evaluate whether there are changes in lung volumes, capnography, pulse oximetry and hemodynamic parameters associated with manual chest compression-decompression maneuver (MCCD in patients undergoing mechanical ventilation (MV. Method: A prospective study of 65 patients undergoing to MV after 24 hours. All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1, 5, 10, 15, 20, 25, 30, 35 and 40 minutes following application of the maneuver. RESULTS: There were statistical significant (pOBJETIVOS: Avaliar a presença de alterações nos volumes pulmonares, oximetria de pulso, capnografia e alterações hemodinâmicas associadas à intervenção da manobra de compressão e descompressão torácica (MCDT nos pacientes submetidos à ventilação mecânica (VM. Método: Tratou-se de um estudo prospectivo em que foram incluídos 65 pacientes em VM há mais de 24 horas. O protocolo consistiu na aplicação de manobras de higiene brônquica e, após 30 minutos, os pacientes eram submetidos a dez repetições da MCDT em dez respirações consecutivas no hemitórax direito e, posteriormente, no hemitórax esquerdo, coletando os dados antes e após a aplicação da manobra nos tempos 1, 5, 10, 15, 20, 25, 30, 35 e 40 minutos. RESULTADOS: Constatou-se aumento significante (p<0,001 do volume corrente inspiratório (pré: 458,2±132,1 ml; pós 1 minuto: 557,3±139,1; pós 40 minutos: 574,4±151, volume minuto corrente (pré: 7,0±2,7 L/min; pós 1 minuto: 8,7±3,3; pós 40 minutos: 8,8±3,8 e oximetria de pulso (pré: 97,4±2,2%; pós 1 minuto: 97,9±1,8; pós 40 minutos: 98,2±1,6; p<0,05. Ocorreu redução no CO2 expirado (pré: 35,1±9,0 mmHg; pós 1 minuto: 31,5±8,2; pós 40

  20. Diagnosis and evaluation of volumetric capnography for pulmonary gas exchange dysfunction in patients with pulmonary disease%呼出气CO2容积曲线对肺部疾病换气功能障碍的诊断与评价

    Institute of Scientific and Technical Information of China (English)

    赵明华; 韩克斯; 王辉

    2008-01-01

    注失调间接指标.③Vm50-75/VT%≥10%和dC/dV3≥1.3%/L用于评价肺气肿有较高敏感度和特异度.%Objective To evaluate the diagnostic and clinical value of volumetric capnography(VCap)for pulmonary gas exchange dysfunction in patients with pulmonary disease. Methods VCap was performedon all patients with pulmonary disease, including 287 chronic obstructive pulmonary disease (COPD)patients,251 asthma patients, 45 interstitial lung diseases(ILD) patients and 94 control subjects. Mainvariables: maximum CO2 concentration(CO2 max), the slope of phase3 (dC/dV3), volume between 25% and50 % of CO2 max (Vm25-50), volume between 50% and 75% of CO2 max (Vm50-75), Vm25-50/VT, Vm50-75/VT.Results (1)Four variables of Vcap exhibited statistical differences (P<0.01) between three disease groups(ILD,asthma,COPD) and control group; (2) Vm50-75/VT and dC/dV2 had no statistical differences betweenlight asthma and light COPD, but showed statistical differences (P<0.01) between moderate, severeasthma and COPD, and had no statistical differences between COPD(emphysema) and asthma combiningwith emphysema; (3) Vm50-75/VT and dC/dV3 had high sensitivity (98.3%, 96.50%) and specificity (91.4 %,86.1%) in estimating COPD(emphysema). Conclusions (1)The values and pattern of VCap are obviouslyabnormal,which can be used for diagnosing pulmonary gas exchange dysfunction of patients with COPD.dC/dV3 (≥1.3%) has a prominent rise in COPD patients and relates to the severity of COPD, showing anunequal pulmonary gas distributing;(2)Vm50-75/VT and Vm25-50/VT are less affected by physiological factorsand expired volume, Vm25-50/VT (≥7%), Vm50-75/VT≥10%) indirectly reflects alveolar dead spaceincreasing and unequal ventilation-perfusion ratio commendably; (3)VCap is simple, rapid, non-invasive, andsecure and can be repeated well.

  1. Bench test assessment of mainstream capnography during high frequency oscillatory ventilation.

    Science.gov (United States)

    Hartdorff, Caroline M; van Heerde, Marc; Markhorst, Dick G

    2014-02-01

    To assess the feasibility, stability and predictability of pCO2 measurement (PETCO2) using a main stream capnograph in a high frequency oscillatory ventilation circuit. A commercially available capnograph was mounted into a high frequency oscillatory ventilator patient circuit, adjustable CO2 flow was introduced into an artificial lung and the output of the CO2 sensor assessed under varying ventilator settings. Influence of oxygen content, pressures, heat and moisture were recorded. A linear relationship between CO2 flow rate and PETCO2 was found. Varying ventilator settings influenced the measurements, but the results for PETCO2 remained within a range of 1.5 mmHg above or under then mean measurement value. Measurements remained stable despite humidification, heat, pressure amplitudes or mean airway pressure changes. From this bench test, we conclude it is feasible to measure PETCO2 using a main stream capnograph during high frequency oscillatory conditions, these measurements were stable during the experiment. Changes in CO2 production or output can be detected. The system may prove to be of clinical value, but further in vivo measurements are warranted. PMID:23974630

  2. Mainstream time-capnography: an aid to select an appropriate uncuffed endotracheal tube in small children.

    Science.gov (United States)

    Neema, Praveen Kumar; Jayant, Aveek; Sethuraman, Manikandan; Rathod, Ramesh C

    2008-12-01

    Uncuffed endotracheal tubes are commonly used in children in an attempt to decrease the potential for pressure induced tracheal injury. However, uncuffed endotracheal tube may increase the risk of aspiration and lead to erratic delivery of preset tidal volume during mechanical ventilation. Therefore, it is desirable to intubate trachea with an appropriate but not an oversized endotracheal tube. In children, for selecting an endotracheal tube, a variety of formulas and techniques are used to find the endotracheal tube size that minimizes both pressure induced tracheal injury and aspiration potential or variable ventilation. Air-leak following tracheal intubation can be recognized by the presence of audible leak, by auscultation over the trachea, by palpation over the trachea and by observing effects of positive end-expiratory pressure on inspiratory expiratory tidal volume difference during mechanical ventilation. We describe mainstream time-capnograph as an aid to recognize leak around the endotracheal tube and its utility to determine appropriate endotracheal tube size in small children. PMID:19083104

  3. Volumetric capnography: In the diagnostic work-up of chronic thromboembolic disease

    OpenAIRE

    Marcos Mello Moreira; Renato Giuseppe Giovanni Terzi; Laura Cortellazzi; et al

    2010-01-01

    Marcos Mello Moreira1, Renato Giuseppe Giovanni Terzi1, Laura Cortellazzi2, Antonio Luis Eiras Falcão1, Heitor Moreno Junior2, Luiz Cláudio Martins2, Otavio Rizzi Coelho21Department of Surgery, 2Department of Internal Medicine, State University of Campinas, School of Medical Sciences, Campinas, Sao Paulo, BrazilAbstract: The morbidity and mortality of pulmonary embolism (PE) have been found to be related to early diagnosis and appropriate treatment. The examinations used...

  4. Capnography during cardiac resuscitation: a clue on mechanisms and a guide to interventions

    OpenAIRE

    Gazmuri, Raúl J.; Kube, Erika

    2003-01-01

    Measurement of the end-tidal partial pressure of carbon dioxide (PETCO2) during cardiac arrest has been shown to reflect the blood flow being generated by external means and to prognosticate outcome. In the present issue of Critical Care, Grmec and colleagues compared the initial and subsequent PETCO2 in patients who had cardiac arrest precipitated by either asphyxia or ventricular arrhythmia. A much higher PETCO2 was found immediately after intubation in instances of asphyxial arrest. Yet, a...

  5. Oxygenator Exhaust Capnography for Prediction of Arterial Carbon Dioxide Tension During Hypothermic Cardiopulmonary Bypass

    OpenAIRE

    Baraka, Anis; El-Khatib, Mohamad; Muallem, Eva; Jamal, Salim; Haroun-Bizri, Sania; Aouad, Marie

    2005-01-01

    Continuous monitoring and control of arterial carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CPB) is essential. A reliable, accurate, and inexpensive system is not currently available. This study was undertaken to assess whether the continuous monitoring of oxygenator exhaust carbon dioxide tension (PexCO2) can be used to reflect PaCO2 during CPB. A total of 33 patients undergoing CPB for cardiac surgery were included in the study. During normothermia (37°C) and stable hypother...

  6. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography

    DEFF Research Database (Denmark)

    Pfeiffer, P; Bache, Stefan Holst; Isbye, D L;

    2012-01-01

    Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capno...

  7. The application of capnography to differentiate peri-chest tube air leak from parenchymal leak following pulmonary surgery

    OpenAIRE

    Oparka, Jonathan D.; Walker, William S

    2014-01-01

    Prolonged air leak is a common complication of pulmonary resection. However, while a bubbling chest drain is commonly related to parenchymal air leakage, it may also be caused by air entering the pleural cavity via an incomplete seal of the tissues at the chest tube insertion site. Examination alone is not sufficient to guide the surgeon as to which of the above complications is responsible for drain bubbling. We describe a simple method, whereby a CO2 monitoring device is attached to the che...

  8. Cerebral hemodynamic and oxygenation changes induced by inner and heard speech: a study combining functional near-infrared spectroscopy and capnography

    Science.gov (United States)

    Scholkmann, Felix; Klein, Sabine D.; Gerber, Ursina; Wolf, Martin; Wolf, Ursula

    2014-01-01

    The aim of this study was to investigate the effects of inner and heard speech on cerebral hemodynamics and oxygenation in the anterior prefrontal cortex (PFC) using functional near-infrared spectroscopy and to test whether potential effects were caused by alterations in the arterial carbon dioxide pressure (PaCO2). Twenty-nine healthy adult volunteers performed six different tasks of inner and heard speech according to a randomized crossover design. During the tasks, we generally found a decrease in PaCO (only for inner speech), tissue oxygen saturation (StO), oxyhemoglobin ([O2Hb]), total hemoglobin ([tHb]) concentration and an increase in deoxyhemoglobin concentration ([HHb]). Furthermore, we found significant relations between changes in [OHb], [HHb], [tHb], or StO and the participants' age, the baseline PETCO2, or certain speech tasks. We conclude that changes in breathing during the tasks led to lower PaCO (hypocapnia) for inner speech. During heard speech, no significant changes in PaCO occurred, but the decreases in StO, [OHb], and [tHb] suggest that changes in PaCO were also involved here. Different verse types (hexameter and alliteration) led to different changes in [tHb], implying different brain activations. In conclusion, StO, [OHb], [HHb], and [tHb] are affected by interplay of both PaCO reactivity and functional brain activity.

  9. Development of application and studies of volume-capnography in critical patients%容量-呼气末二氧化碳分压波在危重患者中临床应用解析

    Institute of Scientific and Technical Information of China (English)

    江学成

    2011-01-01

    Background Volume PETCO2 is a sigal-wave plot based on the expired carbon dioxide fraction,which is the standard tool for understanding carbon dioxide elimination and the dead space. Objective The basic principles and clinical significance of normal and abnormal waveform of v-PETCO2 is introduced. Content v-PETCO2 wave morphology depends on production, transport (pulmonary perfusion) and diffusion of the carbon dioxide, as well as any changes in respiratory pathophysiology, v-PETCO2 can be used to study the dynamics of CO2. This plot yields three parts: first phase is carbon dioxide free;phase Ⅱ represents the transition between gas from the airways and alveolar gas, and phase Ⅲ represents alveolar gas. The respiratory dysfunction reduces ventilation in some units more than others, causing an increased scatter of ventilation/perfusion (V/Q)ratios and thus of the range of alveolar PCO2 values. They results in increased slope of phase 3 and three dead space estimates derived from the v-capnogram, including the anatomical dead space, alveolar dead space and physiological dead space. This can differentiate a patient with a pulmonary embolism from a healthy patient or a COPD, ARDS or asthma patients. Trend v-PETCO2 is the standard tool for understanding carbon dioxide elimination and the dead space concept.%背景容量-呼气末二氧化碳分压图(volume-capnogram,v-PETCO2)是根据呼吸周期中呼出气量对应CO2水平描记的单波图,是评价呼吸障碍患者死腔或分流的最有价值的无创性新工具。目的讲述v-PETCO2的基本原理、正常波形和异常波形的临床意义。内容v-PETCO2波的形态取决于CO2产生、运输(肺灌注)和弥散以及任何原因引起的肺病理生理学改变,可用来更好地了解和研究CO2动力学过程。v-PETCO2有3个呼气相:相Ⅰ,呼出的为无CO2的气道气体,相Ⅱ是气道和肺泡混合气体,相Ⅲ完全是肺泡气体。呼吸障碍时通气/灌注比率不匹配,导致肺泡序贯性排空,呼出气CO2水平不同,v-PETCO2波的相Ⅲ斜率增加,解剖死腔、肺泡死腔和/或生理死腔及及其计算参数增加。根据v -PETCO2波的相Ⅲ斜率能将肺栓塞与肺疾患轻易区别,通过死腔参数较精确地评价急性呼吸窘迫综合征(acute respiratory distresssyndrome,ARDS)、哮喘、慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)等严重程度和鉴别。趋向PETCO2波对危重患者肺功能临床评价和研究具有突破性贡献和非常高的价值。

  10. Study on volumetric capnography in patients with bronchial asthma%支气管哮喘患者容积二氧化碳图改变的研究

    Institute of Scientific and Technical Information of China (English)

    周童; 刘锦铭; 杨文兰; 高蓓兰

    2007-01-01

    目的 探讨容积二氧化碳图参数在支气管哮喘诊疗方面的临床价值.方法 对34例支气管哮喘急性发作期患者在治疗前后及20例健康者进行肺通气功能以及容积二氧化碳图测定.所有受试者首先进行容积二氧化碳图测定,随后完成肺通气功能测定.结果 肺通气功能检测FEV1/pre、FEV1/FVC、PEF/pre、MMEF/pre 支气管哮喘组较对照组明显下降,容积二氧化碳图参数dC2/DV支气管哮喘组较对照组下降,dC3/DV及SR23支气管哮喘组较对照组显著增大,差异有统计学意义(P<0.05);支气管哮喘组治疗后较治疗前肺通气功能检测FEV1/pre、FEV1/FVC、PEF/pre、MMEF/pre显著升高,容积二氧化碳图检测dC2/DV增大,dC3/DV及SR23明显下降,差异有统计学意义(P<0.05);治疗前后dC2/DV、dC3/DV及SR23与FEV1/pre、FEV1/FVC、PEF/pre、MMEF/pre有显著的相关性.结论 容积二氧化碳图是一种定量评估支气管阻塞严重性的有效方法,它简便易行且只需潮气呼吸即可测得,可应用于支气管哮喘的临床诊断及疗效观察等.

  11. 二氧化碳浓度测量法在诊断睡眠呼吸暂停综合征中的应用研究%CLINICAL APPLICATION OF CAPNOGRAPHY IN DIAGNOSIS OF SLEEP APNEA SYNDROME

    Institute of Scientific and Technical Information of China (English)

    刘升明

    2002-01-01

    目的 同时采用热敏传感器和二氧化碳浓度测量仪监测睡眠呼吸暂停综合征(SAS)患者,探讨二氧化碳浓度测量法在诊断SAS中的临床价值.方法 对25例患者进行多导睡眠图和呼出气二氧化碳浓度描记图及呼气末二氧化碳分压(PetCO2)监测,并对PetCO2值与呼吸紊乱指数(AHI)的关系进行分析,统计方法 采用t检验和相关分析.结果 以热敏传感器所得结果 为标准,呼吸暂停、低通气和呼吸紊乱阳性诊断率分别为84.5%±9.6%,72.7%±8.0%,81.2%±8.4%;未发现假阳性.夜间平均PetCO2和最高PetCO2与窒息指数(AI)、低通气指数(HI)、AHI均无显著相关性.结论 二氧化碳浓度测量法监测SAS具有较高的诊断率.

  12. Capnografia volumétrica como auxílio diagnóstico não-invasivo no tromboembolismo pulmonar agudo Volumetric capnography as a noninvasive diagnostic procedure in acute pulmonary thromboembolism

    OpenAIRE

    Marcos Mello Moreira; Renato Giuseppe Giovanni Terzi; Mônica Corso Pereira; Tiago de Araújo Guerra Grangeia; Ilma Aparecida Paschoal

    2008-01-01

    O tromboembolismo pulmonar é uma situação freqüente que pode ser diagnosticada pela cintilografia pulmonar, angiotomografia computadorizada, arteriografia pulmonar e, como método de exclusão, dosagem do dímero-D. Como estes exames nem sempre estão disponíveis, a validação de outros métodos diagnósticos é fundamental. Relata-se o caso de uma paciente com hipertensão pulmonar crônica, agudizada por tromboembolismo pulmonar. Confirmou-se o diagnóstico por cintilografia, angiotomografia computado...

  13. Respiratory Monitoring for Anesthesia and Sedation

    OpenAIRE

    Anderson, Jay A.

    1987-01-01

    This article reviews the theory and practice of routine respiratory monitoring during anesthesia and sedation. Oxygen monitoring and capnography methods are reviewed. The current ventilation monitoring system of choice is considered a combination of the pulse oximeter and capnography. Guidelines are provided for monitoring standards.

  14. Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and laryngeal mask airway placement

    OpenAIRE

    Wojtczak, Jacek A.; Cattano, Davide

    2014-01-01

    Waveform capnography was recommended as the most reliable method to confirm correct endotracheal tube or laryngeal mask airway placements. However, capnography may be unreliable during cardiopulmonary resuscitation and during low flow states. It may lead to an unnecessary removal of a well-placed endotracheal tube, re-intubation and interruption of chest compressions. Real-time upper airway (laryngo-tracheal) ultrasonography to confirm correct endotracheal tube placement was shown to be very ...

  15. 呼出气二氧化碳和体表氧饱和度监测在慢性阻塞性肺疾病呼吸衰竭患者中的应用%Application of capnography and SpO2 measurement in the evaluation of respiratory failure in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    刘杰; 陈荣昌; 钟南山

    2010-01-01

    目的 在慢性阻塞性肺疾病(COPD)患者中探索应用呼出气二氧化碳分压(PCO2)监测推算动脉血二氧化碳分压(PaCO2)的方法和在特定范围内应用SpO2推算PaO2和计算氧合指数(OI)的准确性和误差范围,为临床动态监测、无创评估和在没有血气分析的基层医院中对呼吸衰竭病人的评价提供方法学依据.方法 30例COPD并呼吸衰竭患者给予常规药物治疗,如支气管解痉剂、祛痰剂、糖皮质激素及抗生素等,部分患者联用BiPAP呼吸机鼻(面)罩双水平正压辅助通气,治疗疗程5~7 d,治疗前后均采用平静呼气法和延长呼气法记录呼出气PCO2和SpO2数据.结果 治疗前平静呼吸呼气末二氧化碳分压[PETCO2(Q)]为(50.72±8.93)mmHg,延长呼吸呼气末二氧化碳分压[PETCO2(P)]为(70.35±8.91)mmHg,PaCO2为(71.25±9.08)mmHg.PETCO2(Q)显著低于PaCO2(P0.05);治疗后结果与治疗前类似.通过直线相关分析,治疗前后的PETCO2(P)和PaCO2均呈高度相关(r前=0.96和r后=0.97,P0.05);同时,由PaO2(Y)计算得到OI(Y)为219.15±24.63,用PaO2计算的OI为215.70±22.77,两者差异无统计学意义(P>0.05).运用直线相关分析,PaO2与PaO2(Y)具有较好的相关性(r=0.81,P<0.01);OI与OI(Y)亦具有较好的相关性(r=0.95,P<0.01).结论 对于COPD伴Ⅱ型呼吸衰竭患者,采用改进的呼出气CO2监测方法和调节吸入氧浓度使SpO2在90%左右时,可较准确地估计PaCO2和PaO2,适合于无创动态监测和在没有血气分析条件的基层医院用于评估呼吸衰竭.

  16. The Similar and Different Changes of Volumetric Capnography Dead Spaces in Chronic Obstructive Pulmonary Disease and Asthma%容积二氧化碳图死腔参数在慢性阻塞性肺疾病和支气管哮喘中的异同特点分析

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 周志才; 顾文超; 奚峰; 杨文兰; 吴浩

    2012-01-01

    目的 探讨死腔参数在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)与支气管哮喘(简称哮喘)中变化趋势的异同.方法 对49例COPD患者、35例哮喘患者和35名健康志愿者的肺通气指标及Threshhold死腔(VDT)、Langley死腔(VDL)、Fowler死腔(VDF)、Wolff死腔(VDW)和Bohr死腔(VDB)进行测定分析.结果 与健康对照组比较,COPD组VDT显著减小,而VDW、VDB则显著增大,差异均有统计学意义(P<0.05),COPD组中VDL、VDF与健康对照组比较差异无统计学意义;在哮喘组中,VDT、VDL、VDF、VDW均较健康对照组显著减小,而VDB与健康对照组比较差异无统计学意义.阻塞程度相同的COPD与哮喘患者比较,VDF、VDW和VDB在COPD组显著高于哮喘组,而VDT、VDL在两组间差异则无统计学意义.相关分析显示,在COPD组中,VDT、VDF、VDW及VDB均与FEV1/FVC呈负相关(P<0.05).VDF、VDW及VDB还与FEV1呈负相关(P<0.05).而在哮喘组中,除VDB与FEV1呈负相关外(P<0.05),其余死腔参数与FEV1/FVC、FEV1均无明显相关性(P>0.05).结论 由于COPD和哮喘患者在呼吸生理方面变化的异同,其各容积二氧化碳图死腔参数的变化也有所区别.通过分析两者死腔参数的变化趋势,可为临床工作者在COPD和哮喘的诊断及鉴别诊断中提供参考.

  17. Prolonged expiratory method and curve fitting method used in exploratory study of expiratory capnography in elderly patients with chronic obstructive pulmonary disease%延长呼气法和曲线拟合法在老年慢性阻塞性肺疾病呼吸衰竭患者呼出气二氧化碳图中的应用

    Institute of Scientific and Technical Information of China (English)

    刘杰; 陈荣昌; 陈瑞; 纪笑英; 王华; 钟南山

    2010-01-01

    目的 探讨老年慢性阻塞性肺疾病(COPD)呼吸衰竭患者应用呼出气二氧化碳分压(PCO2)监测估算动脉血PCO2(PaCO2)的方法,为无创动态监测COPD呼吸衰竭患者的PaCO2提供方法学依据.方法 30例COPD急性加重期(AECOPD)患者给予常规药物治疗,部分患者联用BiPAP呼吸机鼻(面)罩双水平正压辅助通气,疗程为5~7d,治疗前后均采用平静呼气法和延长呼气法记录呼出气PCO2曲线图.结果 患者治疗前平静呼吸呼气末PCO2[PETCO2(Q)]为(50.72±8.93)mm Hg(1mm Hg=0.133 kPa),延长呼气第5s末PCO2[(PETCO2(P)]为(70.35±8.91)mm Hg,PaCO2为(71.25±9.08)mm Hg.治疗前PETCO2(Q)显著低于PaCO2(F=38.73,P<0.01),PETCO2(P)与PaCO2基本一致(P>0.05),PETCO2(P)基本能反映PaCO2;治疗后复查的结果与治疗前类似.治疗前和治疗后PETCO2(P)和PaCO2均呈正相关(r=0.96和r=0.97,P<0.01).治疗前,根据从呼气开始到PCO2与PaCO2相等的时间(TABG)呼气时间,从平静呼气二氧化碳-时间拟合曲线公式求得PCO2(C)为(71.78±9.04)mm Hg,与PaCO2比较差异无统计学意义(P>0.05);治疗后复查的结果与治疗前类似.治疗前后PCO2(C)与PaCO2均呈正相关(r=0.97和r=0.98,P<0.01).结论 对于COPD伴Ⅱ型呼吸衰竭患者,延长呼气法测定PETCO2(P)可较准确地预测PaCO2,适合于PaCO2的动态预测.对于部分重度和极重度COPD患者,延长呼气法测定受到一定限制,平静呼气外推PCO2(C)值与延长呼气法测定PETCO2(P),均可较准确地预测PaCO2.%Objective To find noninvasive estimation of partial pressure of carbon dioxide in artery (PaCO2) by measuring the end-tidal CO2 partial pressure (PETCO2) in elderly patients with respiratory failure with chronic obstructive pulmonary disease (COPD). Methods All the 30 acutely exacerbated COPD subjects received routine clinical treatment including bronchodilators,mucolytics, glucocorticosteroid, antibiotics and oxygen therapy for 5-7 days, and part of them received noninvasive positive-pressure ventilation (NIPPV) treatment concurrently. They were both tested by eupnea method and prolonged expiratory method before and after treatment. Results Before treatment, PET CO2 (Q) (end-tidal CO2 pressure with eupnea, (50.72±8.93) mm Hg wassignificantly lower than PaCO2 (F=38.73, P<0.01 ). Yet, PETCO2(P) (end-tidal CO2 pressure with prolong expiration) was (70.35±8.91) mm Hg and PaCO2 was (71.25±9.08) mm Hg. There was no significant difference between PETCO2 (P) and PaCO2 (P>0.05). The similar results were found after treatment. By linear regression analysis, PetCO2(P) was remarkably positive correlated with PaCO2 before and after treatment (r=0.96 and 0.97, respectively, P<0.01). According to TABG,PCO2(C) which was calculated by the average expiratory time of fitting curve was (71.78±9.04)mm Hg. And there was no significant difference between PCO2 (C) and PaCO2 (P>0.05);Thesimilar results were founcl after treatment. By linear regression analysis, PCO2 (C) was remarkably positively correlated with PaCO2 (r=0.97 and 0.98, respectively, P<0.01) before and after treatment. Conclusions In COPD patients with type Ⅱ respiratory failure, conventional PETCO2 (Q) is significantly lower than PaCO2. Yet, PETCO2 (P) could exactly estimate PaCO2 and is appropriate to its dynamic monitoring. And PCO2 (C) which is calculated by mode Boltzmann on eupnea curve also obtain similar results.

  18. Capnografia volumétrica como meio de detectar obstrução pulmonar periférica precoce em pacientes com fibrose cística Volumetric capnography as a tool to detect early peripheric lung obstruction in cystic fibrosis patients

    OpenAIRE

    Maria Ângela G. de O. Ribeiro; Marcos T. N. Silva; José Dirceu Ribeiro; Marcos M. Moreira; Celize C. B. Almeida; Armando A. Almeida-Junior; Ribeiro, Antonio F; Monica C. Pereira; Gabriel Hessel; Ilma A. Paschoal

    2012-01-01

    OBJETIVO: Comparar a espirometria e a capnografia volumétrica (CapV) para determinar se os valores amostrados pela capnografia acrescentam informações sobre doenças pulmonares precoces em pacientes com fibrose cística (FC). MÉTODOS: Este foi um estudo do tipo corte transversal envolvendo pacientes com FC: Grupo I (42 pacientes, 6-12 anos de idade) e Grupo II (22 pacientes, 13-20 anos de idade). Os grupos controle correspondentes eram formados por 30 e 50 indivíduos saudáveis, respectivamente....

  19. РОЛЬ ВУГЛЕКИСЛОГО ГАЗУ В ОРГАНІЗМІ ЛЮДИНИ

    OpenAIRE

    LYZOGUB V.G.; SAVCHENKO A.V.; ZAPEKA J.S.; BAYTSER M.S.

    2015-01-01

    Carbon dioxide is a potent vasodilator of blood vessels, in the article the role of carbon dioxide in the life of the organism, occurrence of hypertension. These characteristics are such states as hyperventilation and hypoventilation. Described a syndrome of chronic neurogenic hyperventilation hyperventilation and multiple organhypoxia. Highlight research methods of carbon dioxide capnometer and capnography.

  20. Splendors and miseries of expired CO2 measurement in the suspicion of pulmonary embolism

    OpenAIRE

    Verschuren, Franck; Perrier, Arnaud

    2010-01-01

    Capnography has been studied for decades as a potential diagnostic tool for suspected pulmonary embolism. Despite technological refinements and its combination with other non-invasive instruments, no evidence to date allows recommending the use of expired carbon dioxide measurement as a rule-out test for pulmonary embolism without additional radiological testing. Further investigations are, however, still warranted.

  1. Estimation of respiratory rates based on photoplethysmographic measurements at the sternum

    DEFF Research Database (Denmark)

    Chreiteh, Shadi; Belhage, Bo; Hoppe, Karsten;

    2015-01-01

    rate is extracted using photoplethysmography (PPG) on the chest bone (sternum). Sternal PPG signals were acquired from 10 healthy subjects resting in a supine position. As reference signals, finger PPG, electrocardiogram (ECG), and capnography were simultaneously recorded during spontaneous and paced...... breathing. The sternal PPG signals were then compared with the reference signals in terms of Bland-Altman analysis, the power spectrum analysis and the magnitude squared coherence. The Bland-Altman analysis showed an average bias of 0.21 breaths/min between RR extracted from sternal PPG and capnography....... The respiratory power content at the sternum was 78.8 (38) % in terms of the median and (the interquartile range). The cardiac content was 19 (18.4) % within the cardiac region. The results from the magnitude squared coherence analysis was 0.97 (0.09) in the respiratory region (6 to 27 breaths/min) and 0.98 (0...

  2. The PEP respiratory monitor: a validation study

    OpenAIRE

    Brookes, C; Whittaker, J.; Moulton, C; Dodds, D

    2003-01-01

    The search for a reliable and accurate respiratory rate monitor for use in non-intubated patients has proved to be a long and fruitless one. A new device fulfilling the criteria for such a monitor has recently been described. The pyroelectric polymer (PEP) device is safe, non-invasive, and cheap. In this study the PEP device, transthoracic impedance, and standard observer counting were all compared with the existing gold standard of capnography in 12 healthy adult volunteers. Using a standard...

  3. Effects of respiratory mechanics on the capnogram phases: importance of dynamic compliance of the respiratory system

    OpenAIRE

    Babik, Barna; Csorba, Zsófia; Czövek, Dorottya; Mayr, Patrick N; Bogáts, Gábor; Peták, Ferenc

    2012-01-01

    Introduction The slope of phase III of the capnogram (SIII) relates to progressive emptying of the alveoli, a ventilation/perfusion mismatch, and ventilation inhomogeneity. SIII depends not only on the airway geometry, but also on the dynamic respiratory compliance (Crs); this latter effect has not been evaluated. Accordingly, we established the value of SIII for monitoring airway resistance during mechanical ventilation. Methods Sidestream capnography was performed during mechanical ventilat...

  4. A simple, disposable end-tidal carbon dioxide detector.

    OpenAIRE

    Rosenberg, M; Block, C. S.

    1991-01-01

    Detection of expired carbon dioxide is one of the most reliable methods of avoiding accidental esophageal intubation. Although capnography has become a standard monitoring technique in the hospital operating room, it is rarely available in the office setting or other arenas where emergency endotracheal intubation may be required. A new and inexpensive device, however, has been developed for assessing end-tidal carbon dioxide. This semi-quantitative detector fits between the endotracheal tube ...

  5. Carbon dioxide monitoring and evidence-based practice – now you see it, now you don't

    OpenAIRE

    Gattas, David; Ayer, Raj; Suntharalingam, Ganesh; Chapman, Martin

    2004-01-01

    Carbon dioxide has been monitored in the body using a variety of technologies with a multitude of applications. The monitoring of this common physiologic variable in medicine is an illustrative example of the different levels of evidence that are required before any new health technology should establish itself in clinical practice. End-tidal capnography and sublingual capnometry are two examples of carbon dioxide monitoring that require very different levels of evidence before being dissemin...

  6. Prehospital determination of tracheal tube placement in severe head injury

    OpenAIRE

    Grmec, S; Mally, S

    2004-01-01

    Methods: All adult patients (>18 years) with severe head injury, maxillofacial injury with need of protection of airway, or polytrauma were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry and capnography was performed (infrared method). Emergency physicians evaluated capnogram and partial pressure of end tidal carbon dioxide (EtCO2) in millimetres of mercury. Determination of final tube placement was performed by a seco...

  7. Unidirectional valve malfunction by the breakage or malposition of disc - two cases report -

    OpenAIRE

    Lee, Chol; Lee, Kyu Chang; Kim, Hye Young; Kim, Mi Na; Choi, Eun Kyung; Kim, Ji-Sub; Lee, Won Sang; Lee, Myeong Jong; Kim, Hyung Tae

    2013-01-01

    Malfunction of the unidirectional valve in a breathing circuit system may cause hypercapnia from the rebreathing of expired gas, ventilation failure, and barotrauma. Capnography is a useful method for monitoring the integrity of the unidirectional valve. We experienced two cases of malfunction of a unidirectional valve which caused leakage and reverse flow, diagnosed early as a change of the capnographic waveform. One case was caused by expiratory unidirectional valve breakage. The other was ...

  8. PET(CO2) measurement and feature extraction of capnogram signals for extubation outcomes from mechanical ventilation.

    Science.gov (United States)

    Rasera, Carmen C; Gewehr, Pedro M; Domingues, Adriana Maria T

    2015-02-01

    Capnography is a continuous and noninvasive method for carbon dioxide (CO2) measurement, and it has become the standard of care for basic respiratory monitoring for intubated patients in the intensive care unit. In addition, it has been used to adjust ventilatory parameters during mechanical ventilation (MV). However, a substantial debate remains as to whether capnography is useful during the process of weaning and extubation from MV during the postoperative period. Thus, the main objective of this study was to present a new use for time-based capnography data by measuring the end-tidal CO2 pressure ([Formula: see text]), partial pressure of arterial CO2 ([Formula: see text]) and feature extraction of capnogram signals before extubation from MV to evaluate the capnography as a predictor of outcome extubation in infants after cardiac surgery. Altogether, 82 measurements were analysed, 71.9% patients were successfully extubated, and 28.1% met the criteria for extubation failure within 48 h. The ROC-AUC analysis for quantitative measure of the capnogram showed significant differences (p < 0.001) for: expiratory time (0.873), slope of phase III (0.866), slope ratio (0.923) and ascending angle (0.897). In addition, the analysis of [Formula: see text] (0.895) and [Formula: see text] (0.924) obtained 30 min before extubation showed significant differences between groups. The [Formula: see text] mean value for success and failure extubation group was 39.04 mmHg and 46.27 mmHg, respectively. It was also observed that high CO2 values in patients who had returned MV was 82.8  ±  21 mmHg at the time of extubation failure. Thus, [Formula: see text] measurements and analysis of features extracted from a capnogram can differentiate extubation outcomes in infant patients under MV, thereby reducing the physiologic instability caused by failure in this process. PMID:25582400

  9. Monitoring during Mechnical Ventilation

    OpenAIRE

    Dean Hess

    1996-01-01

    Monitoring is a continuous, or nearly continuous, evaluation of the physiological function of a patient in real time to guide management decisions, including when to make therapeutic interventions and assessment of those interventions. Pulse oximeters pass two wavelengths of light through a pulsating vascular bed and determine oxygen saturation. The accuracy of pulse oximetry is about ±4%. Capnography measures carbon dioxide at the airway and displays a waveform called the capnogram. End-tida...

  10. Sidestream Capnographic Monitoring Reduces the Incidence of Arterial Oxygen Desaturation During Propofol Ambulatory Anesthesia for Surgical Abortion

    OpenAIRE

    Zongming, Jiang; Zhonghua, Chen; Xiangming, Fang

    2014-01-01

    Background This study investigated whether early intervention based on additional use of sidestream capnography could reduce the incidence of oxygen desaturation and hypoxic events in patients receiving propofol anesthesia during surgical abortion. Material/Methods We recruited 704 ASAI-III female patients, 18–52 years old and scheduled for planned painless surgical abortion, and randomized them into a control group (n=359) receiving standard monitoring and an experimental group (n=341) recei...

  11. Non-invasive respiratory monitoring in paediatric intensive care unit.

    OpenAIRE

    Nadkarni U; Shah A; Deshmukh C

    2000-01-01

    Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU), as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2) and transcutaneous PCO2 (PtcCO2) using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Cons...

  12. Kapnographie zur Überwachung der Propofol-basierten Sedierung während Endoskopien : eine randomisierte, kontrollierte Studie

    OpenAIRE

    Welte, Maria-Noemi

    2015-01-01

    BACKGROUND AND STUDY AIMS: Capnography enables the measurement of end-tidal CO2 and thereby the early detection of apnea, prompting immediate intervention to restore ventilation. Studies have shown that capnographic monitoring is associated with a reduction of hypoxemia during sedation for endoscopy and early detection of apnea during sedation for colonoscopy. The primary aim of this prospective randomized study was to evaluate whether capnographic monitoring without tracheal intubation reduc...

  13. New mainstream double-end carbon dioxide capnograph for human respiration

    Science.gov (United States)

    Yang, Jiachen; An, Kun; Wang, Bin; Wang, Lei

    2010-11-01

    Most of the current respiratory devices for monitoring CO2 concentration use the side-stream structure. In this work, we engage to design a new double-end mainstream device for monitoring CO2 concentration of gas breathed out of the human body. The device can accurately monitor the cardiopulmonary status during anesthesia and mechanical ventilation in real time. Meanwhile, to decrease the negative influence of device noise and the low sample precision caused by temperature drift, wavelet packet denoising and temperature drift compensation are used. The new capnograph is proven by clinical trials to be helpful in improving the accuracy of capnography.

  14. The Lack, Magill and Bain anaesthetic breathing systems: a direct comparison in spontaneously-breathing anaesthetized adults.

    OpenAIRE

    Humphrey, D.

    1982-01-01

    The performances of the Lack (Mapleson A), Magill (Mapleson A) and Bain (Mapleson D) anaesthetic breathing systems were compared in each of 20 anaesthetized adult patients breathing spontaneously with fresh gas flows of 70 ml kg-1 min-1. In every patient the Lack system caused the least rebreathing, as seen by the lowest inspired and end-expired CO2 tensions using capnography. The Magill caused more rebreathing than the Lack though less than the Bain. Comparative fresh gas flows for each syst...

  15. Paradoxical air embolus during endoscopic retrograde cholangiopancreatography: an uncommon fatal complication.

    Science.gov (United States)

    Markin, Nicholas W; Montzingo, Candice R

    2015-04-01

    Air embolism during endoscopic retrograde cholangiopancreatography is a rare but potentially fatal complication. A 66-year-old man underwent endoscopic retrograde cholangiopancreatography and remained stable until the end of the procedure, when he was found to have mottling on his right side and became hypoxic and unresponsive. Transesophageal echocardiography showed air within the left ventricle, consistent with systemic air embolism. Mortality resulted from significant cardiac and cerebral ischemia. The literature suggests that capnography is helpful in early diagnosis of air embolus, but it could not be used in this case because the patient's trachea was not intubated. PMID:25827860

  16. Non-invasive respiratory monitoring in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Nadkarni U

    2000-04-01

    Full Text Available Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU, as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2 and transcutaneous PCO2 (PtcCO2 using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Considering the financial and maintenance constraints pulse oximetry with end tidal CO2 monitoring can be considered as most feasible.

  17. Non invasive monitoring in mechanically ventilated pediatric patients.

    Science.gov (United States)

    Al-Subu, Awni M; Rehder, Kyle J; Cheifetz, Ira M; Turner, David A

    2014-12-01

    Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy. PMID:25119483

  18. Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia.

    Science.gov (United States)

    McCarthy, Caroline; Brady, Paul; O'Halloran, Ken D; McCreary, Christine

    2016-01-01

    Hyperventilation can be a manifestation of anxiety that involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation. Pulse oximetry is the gold standard respiratory-related index in conscious sedation. Although the parameter has great utility in determining oxygen desaturation, it provides no additional information on respiratory function, including, for example, respiratory rate. In this case, we found capnography to be a very useful aid to monitor respiration in this patient and also to treat the hypocapnia. PMID:26866408

  19. PETCO2 measurement and feature extraction of capnogram signals for extubation outcomes from mechanical ventilation

    International Nuclear Information System (INIS)

    Capnography is a continuous and noninvasive method for carbon dioxide (CO2) measurement, and it has become the standard of care for basic respiratory monitoring for intubated patients in the intensive care unit. In addition, it has been used to adjust ventilatory parameters during mechanical ventilation (MV). However, a substantial debate remains as to whether capnography is useful during the process of weaning and extubation from MV during the postoperative period. Thus, the main objective of this study was to present a new use for time-based capnography data by measuring the end-tidal CO2 pressure (PETCO2), partial pressure of arterial CO2 (PaCO2) and feature extraction of capnogram signals before extubation from MV to evaluate the capnography as a predictor of outcome extubation in infants after cardiac surgery. Altogether, 82 measurements were analysed, 71.9% patients were successfully extubated, and 28.1% met the criteria for extubation failure within 48 h. The ROC-AUC analysis for quantitative measure of the capnogram showed significant differences (p < 0.001) for: expiratory time (0.873), slope of phase III (0.866), slope ratio (0.923) and ascending angle (0.897). In addition, the analysis of PETCO2 (0.895) and PaCO2  (0.924) obtained 30 min before extubation showed significant differences between groups. The PETCO2 mean value for success and failure extubation group was 39.04 mmHg and 46.27 mmHg, respectively. It was also observed that high CO2 values in patients who had returned MV was 82.8  ±  21 mmHg at the time of extubation failure. Thus, PETCO2 measurements and analysis of features extracted from a capnogram can differentiate extubation outcomes in infant patients under MV, thereby reducing the physiologic instability caused by failure in this process. (paper)

  20. Oxygraphy: an unexplored perioperative monitoring modality.

    Science.gov (United States)

    Gadhinglajkar, Shrinivas Vitthal; Sreedhar, Rupa; Unnikrishnan, K P

    2009-06-01

    Capnography waveforms and capnometry are useful perioperative monitoring tools. The paramagnetic oxygen analyzers incorporated in many clinical monitoring systems estimate oxygen concentration in the breathing circuit during various phases of ventilation. The oxygen concentration is plotted as a real-time waveform and displayed as an oxygraph. However, the clinical utility of oxygraphy is under evaluated. We are reporting four different clinical scenarios in neurosurgical patients, wherein the information yielded by oxygraphy were either not available on the capnograph or were revealed in a more promising way on the oxygraph than on the capnograph. A real-time oxygraphy waveform has four phases similar to a capnograph, although displayed in a reverse manner. Oxygraphy was useful in our patient to determine the adequacy of preoxygenation. Airway complications and unwanted neuromuscular recovery can be detected earlier by oxygraphy compared to capnography. The oxygraphy peak-to-baseline scale difference can be compressed to as low as to 6% of oxygen concentration. When the peak-to-baseline scale difference is 6 mmHg, the oxygraph becomes sensitive to even minute changes in respiratory flow characteristics. Oxygraphy may have a potential role in clinical monitoring. PMID:19353279

  1. A mainstream monitoring system for respiratory CO2 concentration and gasflow.

    Science.gov (United States)

    Yang, Jiachen; Chen, Bobo; Burk, Kyle; Wang, Haitao; Zhou, Jianxiong

    2016-08-01

    Continuous respiratory gas monitoring is an important tool for clinical monitoring. In particular, measurement of respiratory [Formula: see text] concentration and gasflow can reflect the status of a patient by providing parameters such as volume of carbon dioxide, end-tidal [Formula: see text] respiratory rate and alveolar deadspace. However, in the majority of previous work, [Formula: see text] concentration and gasflow have been studied separately. This study focuses on a mainstream system which simultaneously measures respiratory [Formula: see text] concentration and gasflow at the same location, allowing for volumetric capnography to be implemented. A non-dispersive infrared monitor is used to measure [Formula: see text] concentration and a differential pressure sensor is used to measure gasflow. In developing this new device, we designed a custom airway adapter which can be placed in line with the breathing circuit and accurately monitor relevant respiratory parameters. Because the airway adapter is used both for capnography and gasflow, our system reduces mechanical deadspace. The finite element method was used to design the airway adapter which can provide a strong differential pressure while reducing airway resistance. Statistical analysis using the coefficient of variation was performed to find the optimal driving voltage of the pressure transducer. Calibration between variations and flows was used to avoid pressure signal drift. We carried out targeted experiments using the proposed device and confirmed that the device can produce stable signals. PMID:26178886

  2. Estimation of respiratory rates based on photoplethysmographic measurements at the sternum.

    Science.gov (United States)

    Chreiteh, Shadi S; Belhage, Bo; Hoppe, Karsten; Branebjerg, Jens; Haahr, Rasmus; Duun, Sune; Thomsen, Erik V

    2015-08-01

    The respiratory rate (RR) is a clinically important vital sign and is a frequently used parameter in the general hospital wards. In current clinical practice, the monitoring of the RR is by manual count of the chest movement for one minute. This paper addresses a new approach where the respiratory rate is extracted using photoplethysmography (PPG) on the chest bone (sternum). Sternal PPG signals were acquired from 10 healthy subjects resting in a supine position. As reference signals, finger PPG, electrocardiogram (ECG), and capnography were simultaneously recorded during spontaneous and paced breathing. The sternal PPG signals were then compared with the reference signals in terms of Bland-Altman analysis, the power spectrum analysis and the magnitude squared coherence. The Bland-Altman analysis showed an average bias of 0.21 breaths/min between RR extracted from sternal PPG and capnography. The respiratory power content at the sternum was 78.8 (38) % in terms of the median and (the interquartile range). The cardiac content was 19 (18.4) % within the cardiac region. The results from the magnitude squared coherence analysis was 0.97 (0.09) in the respiratory region (6 to 27 breaths/min) and 0.98 (0.01) in the cardiac pulse region (30-120 beats/min). This preliminary study demonstrates the possibility of monitoring the RR from sternal PPG on a healthy group of subjects during rest. PMID:26737798

  3. Monitoring minute ventilation versus respiratory rate to measure the adequacy of ventilation in patients undergoing upper endoscopic procedures.

    Science.gov (United States)

    Holley, Katherine; MacNabb, C Marshall; Georgiadis, Paige; Minasyan, Hayk; Shukla, Anurag; Mathews, Donald

    2016-02-01

    Endoscopic procedures performed under conscious sedation require careful monitoring of respiratory status to prevent adverse outcomes. This study utilizes a non-invasive respiratory volume monitor (RVM) that provides continuous real-time measurements of minute ventilation (MV), tidal volume and respiratory rate (RR) to assess the adequacy of ventilation during endoscopy. Digital respiratory traces were collected from 51 patients undergoing upper endoscopy with propofol sedation using an impedance-based RVM. Baseline MV for each patient was derived from a 30 s period of quiet breathing prior to sedation (MVBASELINE). Capnography data were also collected. Because RR from capnography was frequently unavailable, the RVM RR's were used for analysis. RR rate values were compared the MV measurements and sensitivity and specificity of RR to predict inadequate ventilation (MV 70 % low MV measurements were missed; at 6 bpm, >82 % were missed; and at 4 bpm, >90 % were missed). A cut-off of 6 bpm had a sensitivity of only 18.2 %; while <40 % of all RR alarms would have coincided with a low MV (39.4 % PPV). Low RR measurements alone do not reflect episodes of low MV and are not sufficient for accurate assessment of respiratory status. RVM provides a new way to collect MV measurements which provide more comprehensive data than RR alone. Further work is ongoing to evaluate the use of MV data during procedural sedation. PMID:25735263

  4. Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients

    Directory of Open Access Journals (Sweden)

    Melody Ni

    2014-12-01

    Full Text Available Nasogastric (NG tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.

  5. [Bilateral diaphragmatic paralysis due to Parsonage-Turner syndrome].

    Science.gov (United States)

    Tissier-Ducamp, D; Martinez, S; Alagha, K; Charpin, D; Chanez, P; Palot, A

    2015-09-01

    We report the case of a 49-years-old patient who presented to the accident and emergency department with sudden onset dyspnea associated with acute shoulder pain. He was breathless at rest with supine hypoxemia. He had an amyotrophic left shoulder with localized paresis of the shoulder. Both hemi-diaphragms were elevated on chest X-rays. Pulmonary function tests showed a restrictive pattern and both phrenic nerve conduction velocities were decreased. At night, alveolar hypoventilation was evidenced by elevated mean capnography (PtcCO2: 57mmHg). Neuralgic amyotrophy, Parsonage-Turner syndrome was the final diagnosis. This syndrome is a brachial plexus neuritis with a predilection for the suprascapular and axillary nerves. Phrenic nerve involvement is rare but where present can be the most prominent clinical feature as in our case report.

  6. [Resuscitation - Adult advanced life support].

    Science.gov (United States)

    Gräsner, Jan-Thorsten; Bein, Berthold

    2016-03-01

    Enhanced measures for resuscitation of adults are based on basic measures of resuscitation. The central elements are highly effective chest compressions and avoidance of disruptions that are associated with poor patient outcomes that occur within seconds. The universal algorithm distinguishes the therapy for ventricular fibrillation from the therapy in asystole or pulseless electrical activity (PEA) by the need of defibrillation, and amiodarone administration in the former. Defibrillation is biphasic. In all other aspects, there are no differences in therapy. In each episode of cardiac arrest, reversible causes should be excluded or treated. For the diagnosis during resuscitation, sonography can be helpful. What is new in the 2015 ERC recommendations is the use of capnography, which can be used for the assessment of ROSC (return of spontaneous circulation), ventilation, resuscitation and intubation quality. Mechanical resuscitation devices can be used in selected situations. Successful primary resuscitation should be directly followed by measures of the post-resuscitation care. PMID:27022698

  7. Enhanced Monitoring of the Preterm Infant during Stabilization in the Delivery Room.

    Science.gov (United States)

    Finn, Daragh; Boylan, Geraldine B; Ryan, C Anthony; Dempsey, Eugene M

    2016-01-01

    Monitoring of preterm infants in the delivery room (DR) remains limited. Current guidelines suggest that pulse oximetry should be available for all preterm infant deliveries, and that if intubated a colorimetric carbon dioxide detector should provide verification of correct endotracheal tube placement. These two methods of assessment represent the extent of objective monitoring of the newborn commonly performed in the DR. Monitoring non-invasive ventilation effectiveness (either by capnography or respiratory function monitoring) and cerebral oxygenation (near-infrared spectroscopy) is becoming more common within research settings. In this article, we will review the different modalities available for cardiorespiratory and neuromonitoring in the DR and assess the current evidence base on their feasibility, strengths, and limitations during preterm stabilization. PMID:27066463

  8. Enhanced Monitoring of the Preterm Infant during Stabilisation in the Delivery Room

    Directory of Open Access Journals (Sweden)

    Daragh eFinn

    2016-03-01

    Full Text Available Monitoring of preterm infants in the delivery room remains limited. Current guidelines suggest that pulse oximetry should be available for all preterm infant deliveries, and that if intubated a colormetric carbon dioxide detector should provide verification of correct endotracheal tube placement. These two methods of assessment represent the extent of objective monitoring of the newborn commonly performed in the delivery room. Monitoring non-invasive ventilation effectiveness (either by capnography or respiratory function monitoring, and cerebral oxygenation (near infrared spectroscopy are becoming more common within research settings. In this article, we will review the different modalities available for cardio-respiratory and neuro-monitoring in the delivery room, and assess the current evidence base on their feasibility, strengths and limitations during preterm stabilisation.

  9. A systematic review of lung function testing in asthmatic young children.

    Science.gov (United States)

    Ioan, Iulia; Varechova, Silvia; Marchal, François; Pleşca, Doina-Anca

    2015-01-01

    Asthma diagnosis is difficult in young children being mainly based on clinical signs and parents' history, which is sometimes difficult to obtain. Lung function testing may improve asthma diagnosis by objectively assessing its main features, airway obstruction, spontaneously reversible or after use of a bronchodilator drug, ventilation inhomogeneity during an acute bronchoconstriction and airway hyperresponsiveness. In young children that cannot cope with classical tests, it is important to use and develop simple, short lasting methods, made in spontaneous ventilation without active cooperation. Such techniques are a measurement of respiratory resistance by forced oscillations or the interrupter technique, of specific airway resistance by plethysmography and capnography. All these parameters are sensitive to the presence of an airway obstruction and to a bronchodilator or bronchoconstrictor agent, but their cutoff values in differentiating between asthmatic and healthy children as well as their specific indications in asthma management remain to be established. PMID:26506667

  10. Ventriculoperitoneal Shunt Insertion Under Monitored Anesthesia Care in a Patient With Severe Pulmonary Hypertension.

    Science.gov (United States)

    Burbridge, Mark A; Brodt, Jessica; Jaffe, Richard A

    2016-07-15

    A 32-year-old man with severe pulmonary arterial hypertension and Eisenmenger syndrome secondary to congenital ventricular septal defects presented for ventriculoperitoneal shunt insertion. Consultation between surgical and anesthesia teams acknowledged the extreme risk of performing this case, but given ongoing symptoms related to increased intracranial pressure from a large third ventricle colloid cyst, the case was deemed urgent. After a full discussion with the patient, including an explanation of anesthetic expectations and perioperative risks, the case was performed under monitored anesthesia care. Anesthetic management included high-flow nasal cannula oxygen with capnography and arterial blood pressure monitoring, dexmedetomidine infusion, boluses of midazolam and ketamine, and local anesthetic infiltration of the cranial and abdominal incisions as well as the catheter track. Hemodynamic support was provided with an epinephrine infusion, small vasopressin boluses, and inhaled nitric oxide. The patient recovered without any significant problems and was discharged home on postoperative day 3. PMID:27224039

  11. Prevention of the Occurrence of Hypoxia in the Treatment of the Uterine Cavity in the Treatment of the Patients with the Carbon Dioxide by the Observation of the Carbon Dioxide by the Nasopharyngeal Airway%通过鼻咽通气道观察二氧化碳波形对治疗性宫腔镜中低氧血症发生的预防

    Institute of Scientific and Technical Information of China (English)

    陈晨; 李敏; 杨林译; 卜晓萱; 沈江

    2015-01-01

    Objective To investigate whether capnography is superior to pulse oximetry and visual assessment for the prevention of hypoxemia during therapeutic hysteroscopy. Methods 60 patients undergoing sedation and analgesia procedure receiving therapeutic hysteroscopy were randomly divided into two groups (C group and P group).P group received standard monitoring that included HR, ECG,NBP and pulse oximetry.C group received capnography monitoring through modified nasopharyngeal airway plus standard monitoring.Apnea and disordered respiration (ADR)and incidence of hypoxemia were investigated and rectified.Results Thirty-three episodes of ADR were discovered in C group while sixteen episodes of ADR were found in P group.There were two cases of hypoxemia and nine cases in P group.The incidence of hypoxemia in C group was significantly lower than in P group (6.7%vs.30%, <0.05). Conclusion Capnography is superior to pulse oximetry and visual assessment for the prevention of hypoxemia during therapeutic hysteroscopy.Modified nasopharyngeal airway provides a"closed loop"which is beneficial to capnography monitoring while it is minimal invasive and easy to practice.%目的:比较在治疗性宫腔镜镇静镇痛过程中通过改良鼻咽通气道监测二氧化碳波形和通过监测脉搏氧饱和度和肉眼观察对低氧血症的预防。方法观察60例接受丙泊酚和芬太尼联合镇静镇痛行治疗性宫腔镜手术的女性患者,随机分为两组:接受二氧化碳波形监护的C组和不接受二氧化碳波形监测而使用脉搏氧饱和度监测和肉眼观察的P组。观察两组患者不同监测手段对窒息和呼吸紊乱等不良呼吸事件的发生的预警次数和低氧血症发生率。结果 C组检测到ADR33次,P组监测到16次;C组发生低氧血症为2例(6.7%),明显低于P组9例(30%),差异有统计学意义(<0.05)。结论与脉搏氧饱和度相比,二氧化碳波形监测能够更早更多的

  12. Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit.

    Science.gov (United States)

    van Vonderen, Jeroen J; van Zanten, Henriëtte A; Schilleman, Kim; Hooper, Stuart B; Kitchen, Marcus J; Witlox, Ruben S G M; Te Pas, Arjan B

    2016-01-01

    Neonatal resuscitation is one of the most frequently performed procedures, and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant's condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography, and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can not only be used directly to guide care but also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this narrative review, we will give an update of the current developments in monitoring neonatal resuscitation. PMID:27148507

  13. [Monitoring Required for Monitored Anesthesia Care (MAC) and Specific MAC Methodologies].

    Science.gov (United States)

    Suzuki, Toshiyasu

    2015-03-01

    Many physicians responsible for monitored anesthesia care (MAC) are not anesthesiologists and are not acquainted with treatment in response to sudden changes in patient condition. In particular, rapid response and early detection are essential for respiratory depression. Physicians engaged in MAC require pharmacological knowledge regarding sedative and analgesic medications, need to be able to accurately evaluate physiological responses to sedative and anesthetic levels, and need to be acquainted with emergency procedures such as basic life support (BLS) and advanced cardiovascular life support (ACLS). Patient management focusing on both ventilation and oxygenation, through the use of capnography and continuous respiratory monitoring, in addition to oxygenation monitoring using a pulse oximeter, and measuring ECGs and blood pressure in the management of sedated patients, is also important. PMID:26121782

  14. Cerebral venous blood oxygenation monitoring during hyperventilation in healthy volunteers with a novel optoacoustic system

    Science.gov (United States)

    Petrov, Andrey; Prough, Donald S.; Petrov, Irene Y.; Petrov, Yuriy; Deyo, Donald J.; Henkel, Sheryl N.; Seeton, Roger; Esenaliev, Rinat O.

    2013-03-01

    Monitoring of cerebral venous oxygenation is useful to facilitate management of patients with severe or moderate traumatic brain injury (TBI). Prompt recognition of low cerebral venous oxygenation is a key to avoiding secondary brain injury associated with brain hypoxia. In specialized clinical research centers, jugular venous bulb catheters have been used for cerebral venous oxygenation monitoring and have demonstrated that oxygen saturation capnography. Good temporal correlation between decreases in optoacoustically measured SSS oxygenation and decreases in EtCO2 was obtained. Decreases in EtCO2 from normal values (35-45 mmHg) to 20-25 mmHg resulted in SSS oxygenation decreases by 3-10%. Intersubject variability of the responses may relate to nonspecific brain activation associated with voluntary hyperventilation. The obtained data demonstrate the capability of the optoacoustic system to detect in real time minor changes in the SSS blood oxygenation.

  15. Clustering of capnogram features to track state transitions during procedural sedation.

    Science.gov (United States)

    Mieloszyk, Rebecca J; Guo, Margaret G; Verghese, George C; Andolfatto, Gary; Heldt, Thomas; Krauss, Baruch S

    2015-08-01

    Procedural sedation has allowed many painful interventions to be conducted outside the operating room. During such procedures, it is important to maintain an appropriate level of sedation to minimize the risk of respiratory depression if patients are over-sedated and added pain or anxiety if under-sedated. However, there is currently no objective way to measure the patient's evolving level of sedation during a procedure. We investigated the use of capnography-derived features as an objective measure of sedation level. Time-based capnograms were recorded from 30 patients during sedation for cardioversion. Through causal k-means clustering of selected features, we sequentially assigned each exhalation to one of three distinct clusters, or states. Transitions between these states correlated to events during sedation (drug administration, procedure start and end, and clinical interventions). Similar clustering of capnogram recordings from 26 healthy, non-sedated subjects did not reveal distinctly separated states. PMID:26736604

  16. Module for measurement of CO2 concentration in exhaled air

    Science.gov (United States)

    Puton, Jaroslaw; Palko, Tadeusz; Knap, Andrzej; Jasek, Krzysztof; Siodlowski, Boguslaw

    2003-09-01

    The objective of this work consists in working out of a detection module for capnography (carbon dioxide concentration measurement in anaesthesiology and intensive care). The principle of operation of the module consists of the NDIR method. The basic assumption for construction of this model was using of directly modulated thermal IR source in it. A few models of IR sources were worked out. Their heaters were made from thick platinum layers and foil. Limits of modulation frequency for IR sources were greater than 30 Hz. The detection module consists of an optical part, analogue electronics and microprocessor system with a suitable program. The time dependent concentration of CO2, end tidal concentration of CO2, mean concentration of N2O and breath frequency are output values of the detection module. Measurements are executed 30 times per second. The accuracy of CO2 concentration measurement equals to 5%.

  17. Cardiorespiratory monitoring during neonatal resuscitation for direct feedback and audit

    Directory of Open Access Journals (Sweden)

    Jeroen Johannes van Vonderen

    2016-04-01

    Full Text Available Neonatal resuscitation is one of the most frequently performed procedures and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant’s condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, colour and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can be used directly to guide care, but can also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this review we will give an update of the current developments in monitoring neonatal resuscitation.

  18. [Bilateral diaphragmatic paralysis due to Parsonage-Turner syndrome].

    Science.gov (United States)

    Tissier-Ducamp, D; Martinez, S; Alagha, K; Charpin, D; Chanez, P; Palot, A

    2015-09-01

    We report the case of a 49-years-old patient who presented to the accident and emergency department with sudden onset dyspnea associated with acute shoulder pain. He was breathless at rest with supine hypoxemia. He had an amyotrophic left shoulder with localized paresis of the shoulder. Both hemi-diaphragms were elevated on chest X-rays. Pulmonary function tests showed a restrictive pattern and both phrenic nerve conduction velocities were decreased. At night, alveolar hypoventilation was evidenced by elevated mean capnography (PtcCO2: 57mmHg). Neuralgic amyotrophy, Parsonage-Turner syndrome was the final diagnosis. This syndrome is a brachial plexus neuritis with a predilection for the suprascapular and axillary nerves. Phrenic nerve involvement is rare but where present can be the most prominent clinical feature as in our case report. PMID:25534571

  19. [Pediatric advanced life support].

    Science.gov (United States)

    Muguruma, Takashi

    2011-04-01

    Important changes or points of emphasis in the recommendations for pediatric advanced life support are as follows. In infants and children with no signs of life, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds. New evidence documents the important role of ventilations in CPR for infants and children. Rescuers should provide conventional CPR for in-hospital and out-of-hospital pediatric cardiac arrests. The initial defibrillation energy dose of 2 to 4J/kg of either monophasic or biphasic waveform. Both cuffed and uncuffed tracheal tubes are acceptable for infants and children undergoing emergency intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position.

  20. MRI of ventilated neonates and infants: respiratory pressure as trigger signal

    International Nuclear Information System (INIS)

    Introduction: motivated by the difficulties often encountered in the setup of respiratory trigger in MR imaging of mechanical ventilated pediatric patients, a simplified approach in terms of time and reliability was sought. Method: with the help of a male-to-male Luer-Lock adapter in combination with a 3-way adapter the tube of the respiratory compensation bellow was fixed to the output channel for capnography of the airway filter. Ten patients (age 4 months to 6 years) were tested with spin echo imaging and either respiration compensation (T1-weighted imaging) or respiratory triggered (T2-weighted imaging). Results: a clear trigger signal was achieved in all cases. No negative influence on the quality or security of the mechanical ventilation of the patients was observed. Summary: the proposed adapter is safe, efficient and fast to install in patients undergoing MR imaging in general anaesthesia. (orig.)

  1. Measuring dead-space in acute lung injury.

    Science.gov (United States)

    Kallet, R H

    2012-11-01

    Several recent studies have advanced our understanding of dead-space ventilation in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). They have demonstrated the utility of measuring physiologic dead-space-to-tidal volume ratio (VD/VT) and related variables in assessing outcomes as well as therapeutic interventions. These studies have included the evaluation of mortality risk, pulmonary perfusion, as well as the effectiveness of drug therapy, prone positioning, positive end-expiratory pressure (PEEP) titration, and inspiratory pattern in improving gas exchange. In patients with ALI/ARDS managed with lung-protective ventilation a significant relationship between elevated VD/VT and increased mortality continues to be reported in both early and intermediate phases of ALI/ARDS. Some clinical evidence now supports the suggestion that elevated VD/VT in part reflects the severity of pulmonary vascular endothelial damage. Monitoring VD/VT also appears useful in assessing alveolar recruitment when titrating PEEP and may be a particularly expedient method for assessing the effectiveness of prone positioning. It also has revealed how subtle manipulations of inspiratory time and pattern can improve CO(2) excretion. Much of this has been accomplished using volumetric capnography. This allows for more sophisticated measurements of pulmonary gas exchange function including: alveolar VD/VT, the volume of CO(2) excretion and the slope of the alveolar plateau which reflects ventilation: perfusion heterogeneity. Many of these measurements now can be made non-invasively which should only increase the research and clinical utility of volumetric capnography in studying and managing patients with ALI/ARDS. PMID:22858884

  2. Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne.

    Science.gov (United States)

    Dyett, J F; Moser, M S; Tobin, A E

    2015-09-01

    The objective of this study is to describe the population of patients receiving emergency airway management outside operating theatres at our institution, a tertiary referral centre in Melbourne. A registry of all patients receiving emergency airway management in the emergency department, ICU and on the wards as part of Medical Emergency Response teams' care, was prospectively collected. There were 128 adults and one paediatric patient requiring emergency airway management recruited to the study. Data for analysis included patient demographics, pre-oxygenation and apnoeic oxygenation, staff, drugs, details of laryngoscopic attempts, adjuncts, airway manoeuvres, complications sustained and method of confirmation of endotracheal tube placement. Over a 12-month period, there were 139 intubations of 129 patients, requiring a total of 169 attempts. Respiratory failure was the most common indication for intubation. Intubation was successful on the first episode of laryngoscopy in 116 (83.5%) patients. Complications occurred in 48 patients. In the cohort of patients without respiratory failure, nasal cannulae apnoeic oxygenation significantly reduced the incidence of hypoxaemia (0 out of 31 [0.0%] versus 10 out of 60 [16.7%], P=0.016; absolute risk reduction 16.7%; number needed to treat: 6). Waveform capnography was used to confirm endotracheal tube placement in 133 patients and there were four episodes of oesophageal intubation, all of which were recognised immediately. In the critical care environment of our institution, emergency airway management is achieved with a first-attempt success rate that is comparable to overseas data. Nasal cannulae apnoeic oxygenation appears to significantly reduce the risk of hypoxaemia in patients without respiratory failure and the use of waveform capnography eliminates episodes of unrecognised oesophageal intubation. PMID:26310407

  3. Use of Microcuff ® endotracheal tubes in paediatric laparoscopic surgeries

    Directory of Open Access Journals (Sweden)

    Rameshwar Mhamane

    2015-01-01

    Full Text Available Background and Aims: Traditionally, uncuffed endotracheal tubes have been used in children. Cuffed tubes may be useful in special situations like laparoscopy. Microcuff ® endotracheal tube is a specifically designed cuffed endotracheal tube for the paediatric airway. We studied the appropriateness of Microcuff ® tube size selection, efficacy of ventilation, and complications, in children undergoing laparoscopy. Methods: In a prospective, observational study, 100 children undergoing elective laparoscopy were intubated with Microcuff ® tube as per recommended size. We studied appropriateness of size selection, sealing pressure, ability to ventilate with low flow, quality of capnography and post-extubation laryngospasm or stridor. Results: Mean age of the patients was 5.44 years (range 8 months 5 days-9 years 11 months. There was no resistance for tube passage during intubation in any patient. Leak on intermittent positive pressure ventilation at airway pressure ≤20 cm H 2 O was present in all patients. Mean sealing pressure was 11.72 (1.9 standard deviation [SD] cm H 2 O. With the creation of pnemoperitoneum, mean intracuff pressure increased to 12.48 (3.12 SD cm H 2 O. With head low positioning, mean cuff pressure recorded was 13.32 (2.92 SD. Ventilation at low flow (mean flow 1 L/min, plateau-type capnography was noted in all patients. Mean duration of intubation was 83.50 min. Coughing at extubation occurred in 6 patients. Partial laryngospasm occurred in 4 patients, which responded to continuous positive airway pressure via face mask. Severe laryngospasm or stridor was not seen in any patient. Conclusion: Microcuff ® tubes can be safely used in children if size selection recommendations are followed and cuff pressure is strictly monitored. Advantages are better airway seal and effective ventilation, permitting use of low flows.

  4. The Diagnostic Value of End-tidal Carbon Dioxide (EtCO2 and Alveolar Dead Space (AVDS in Patients with Suspected Pulmonary Thrombo-embolism (PTE

    Directory of Open Access Journals (Sweden)

    Reza Basiri

    2015-06-01

    Full Text Available Introduction: Capnography, is an easy, fast and practical method which its application in the diagnosis of Pulmonary Thromboendarterectomy (PTE has recently been studied. This study aimed to assess the diagnostic value of end-tidal CO2 (ETCO2 and the alveolar dead space (AVDS in the diagnosis of patients suspected to PTE who have been referred to the emergency department. Materials and Methods: This cross-sectional study was conducted during one year in the emergency department of Ghaem Hospital on patients with suspected PTE who scored less than 4 for the Wells’ criteria during the initial evaluation. After excluding other differential diagnoses, all patients underwent CT pulmonary angiography (CTPA to confirm PTE. Following that, arterial blood gas sampling, ETCO2 and AVDS were requested for all the patients based on capnography. Data analysis was performed using descriptive statistical tests in SPSS software version 11.5. The sensitivity, specificity, and positive and negative predictive values of AVDS and ETCO2 were measured based on (CTPA results. Results: The study was performed on 78 patients (mean age of 47.08± 15.6 years, 43 males/35 females suspected to PTE. According to the results of CTPA, 37 patients did not develop PTE while 41 patients were with PTE. There was no significant difference between the two groups in terms of age and gender (P=0.999, while a statistically significant difference was found between the mean values of ETCO2 and AVDS between the two groups (P

  5. Monitoring during Mechnical Ventilation

    Directory of Open Access Journals (Sweden)

    Dean Hess

    1996-01-01

    Full Text Available Monitoring is a continuous, or nearly continuous, evaluation of the physiological function of a patient in real time to guide management decisions, including when to make therapeutic interventions and assessment of those interventions. Pulse oximeters pass two wavelengths of light through a pulsating vascular bed and determine oxygen saturation. The accuracy of pulse oximetry is about ±4%. Capnography measures carbon dioxide at the airway and displays a waveform called the capnogram. End-tidal PCO2 represents alveolar PCO2 and is determined by the ventilation-perfusion quotient. Use of end-tidal PCO2 as an indication of arterial PCO2 is often deceiving and incorrect in critically ill patients. Because there is normally very little carbon dioxide in the stomach, a useful application of capnography is the detection of esophageal intubation. Intra-arterial blood gas systems are available, but the clinical impact and cost effectiveness of these is unclear. Mixed venous oxygenation (PvO2 or SvO2 is a global indicator of tissue oxygenation and is affected by arterial oxygen content, oxygen consumption and cardiac output. Indirect calorimetry is the calculation of energy expenditure and respiratory quotient by the measurement of oxygen consumption and carbon dioxide production. A variety of mechanics can be determined in mechanically ventilated patients including resistance, compliance, auto-peak end-expiratory pressure (PEEP and work of breathing. The static pressure-volume curve can be used to identify lower and upper infection points, which can be used to determine the appropriate PEEP setting and to avoid alveolar overdistension. Although some forms of monitoring have become a standard of care during mechanical ventilation (eg, pulse oximetry, there is little evidence that use of any monitor affects patient outcome.

  6. Comparison of end-tidal carbon dioxide and arterial blood bicarbonate levels in patients with metabolic acidosis referred to emergency medicine

    Science.gov (United States)

    Taghizadieh, Ali; Pouraghaei, Mahboub; Moharamzadeh, Payman; Ala, Alireza; Rahmani, Farzad; Basiri Sofiani, Karim

    2016-01-01

    Introduction: The routine and gold standard method to diagnose of acid – base disturbance is arterial blood gas (ABG) sampling. Capnography could be used to measure the end-tidal carbon dioxide (ETCO2) levels and ETco2 has a close correlation with the PaCo2. The aim of this study was comparison the ETco2 and arterial blood bicarbonate levels in patients with metabolic acidosis. Methods: In a descriptive-analytical study that performed in Emergency Department of Emam Reza Medical Research and Training Hospital of Tabriz on patients with metabolic acidosis, ETco2 level and blood bicarbonate levels in 262 patients were evaluated. Results: Mean of ETco2 and Hco3 levels in patients with metabolic acidosis were 22.29 ± 4.15 and 12.78 ± 3.83, respectively. In all patients, the significant direct linear relationship was found between ETco2 with Hco3 (r = 0.553, P < 0.001). We had 4 groups of patients with metabolic acidosis, also there is a significant direct linear relationship between the ETCo2 and the Hco3 level of arterial blood in patients with renal failure (P < 0.001 and r = 0.551), sepsis (P < 0.001 and r = 0.431), drug toxicity (P < 0.001 and r = 0.856), and ketoacidosis (DKA) (P < 0.001 and r = 0.559). Conclusion: According to the results of this study, capnography can be used for primary diagnosis of metabolic acidosis in spontaneously breathing patients who referred to the emergency wards, however, the ABG must be considered as the gold standard tool for diagnosis and guiding the treatment. PMID:27777693

  7. Applied value of dead spaces measuring in bronchial asthma%死腔测定在支气管哮喘中应用价值的研究

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 高蓓兰; 储海青; 杨文兰; 郑卫

    2009-01-01

    Objective To investigate the applied value and implications of dead spaces from volumetric capnography(VCap)in bronchial asthma(asthma).Methods The ventilation and volume function together with series dead spaces,which include Langley dead space(VDL),Fowler dead space(VDF)and Wolff dead space(VDW) were measured in 52 patients with asthma exacerbation and 35 controls.Results Compared with healthy group,VDL,VDF and VDW in asthma group showed significant decrease(P<0.01,0.01,0.01).In asthma group,VDL,VDF and VDW were all negative correlated with FEVl%pred,FEV1/FVC%,PEF%pred,FEF25%pred,FEF50%pred,FEF75%pred and MMEF%pred(P<0.05).At the same time,they were positive correlated with RV.TLC and RV/TLC(P<0.05).Conclusions The dead spaces measurement of VCap is easy to be cooperated by patients.And it may have clinical value in diagnosing asthma.%目的 探讨容积二氧化碳图(volumetric capnography,VCap)技术死腔测定在支气管哮喘(简称哮喘)中的应用价值及临床意义.方法 对52例急性发作期哮喘患者及35名健康志愿者的常规肺功能指标及Langley死腔(VDL)、Fowler死腔(VDF)、Wolff死腔(VDW)进行测定分析.结果 本研究显示:哮喘组中VDL、VDF及VDW均较对照组显著减小(P<0.01,0.01,0.01).相关分析显示:VDL、VDF和VDW分别与FEV1占预计值%、FEV1/FVC%、PEF占预计值%、FEF25占预计值%、FEF50占预计值%、FEF75占预计值%、MMEF占预计值%呈负相关(P<0.05),与RV占预计值%、TLC占预计值%、Rv/TLC%呈正相关(P<0.05).结论 VCap死腔测定患者易于配合,对哮喘的辅助诊断及进一步了解其病理生理改变具有一定的临床价值和意义.

  8. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism

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    Marcos Mello Moreira

    2008-11-01

    Full Text Available Marcos Mello Moreira1, Renato G G Terzi1, Carlos Heitor N Carvalho2, Antonio Francisco de Oliveira Neto3, Mônica Corso Pereira4, Ilma Aparecida Paschoal41Department of Surgery, State University of Campinas, School of Medical Sciences; 2Department of Cardiology, State University of Campinas, School of Medical Sciences; 3Intensive Care Unit of the State University of Campinas, School of Medical Sciences; 4Department of Pulmonology, State University of Campinas, School of Medical Sciences, Campinas, BrazilAbstract: Pulmonary embolism (PE is a common condition. The central aim of this study was to describe the use of volumetric capnography (VCap before and after fibrinolytic treatment of major PE. Lung scintigraphy was used as a base of comparison for the results of this treatment. We describe the cases of two conscious and spontaneously breathing patients (20- and 24-year-old women with major PE undergoing thrombolysis. Curves of CO2 were obtained by VCap and associated with arterial blood gas analysis and D-dimer. The pattern of VCap was compared with the VCap of health volunteers. Parameters also calculated were: P(a-etCO2 gradient, alveolar dead space fraction (AVDSf , late dead space fraction (f Dlate, and slope phase III (Slp III. The VCap results before and after thrombolysis for patients 1 and 2 were, respectively, P(a-etCO2: 12.6 to 5.8 and 7.9 to 1.6 (mmHg; AVDSf: 0.46 to 0.18 and 0.25 to 0.05; fDlate: 0.46 to 0.21 and 0.24 to 0.04; Slp III: 1.75 to 5.10 and 1.21 to 5.61 (mmHg/L. Lung scintigraphy was used to compare VCap results from the two subjects with VCap results from healthy volunteers and pigs before and after treatment associated with arterial blood gas, D-dimer, and showed satisfactory agreement.Keywords: pulmonary embolism, capnography, respiratory dead space, thrombolysis, fibrin fibrinogen degradation products/fibrin fragment D

  9. COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients

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    da Silva SMD

    2016-03-01

    Full Text Available Silvia Maria Doria da Silva, Ilma Aparecida Paschoal, Eduardo Mello De Capitani, Marcos Mello Moreira, Luciana Campanatti Palhares, Mônica Corso PereiraPneumology Service, Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP, Campinas, São Paulo, BrazilBackground: Computed tomography (CT phenotypic characterization helps in understanding the clinical diversity of chronic obstructive pulmonary disease (COPD patients, but its clinical relevance and its relationship with functional features are not clarified. Volumetric capnography (VC uses the principle of gas washout and analyzes the pattern of CO2 elimination as a function of expired volume. The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO2, Slope of phase 2 (Slp2, and Slope of phase 3 (Slp3 of capnogram, the curve which represents the total amount of CO2 eliminated by the lungs during each breath.Objective: To investigate, in a group of patients with severe COPD, if the phenotypic analysis by CT could identify different subsets of patients, and if there was an association of CT findings and functional variables.Subjects and methods: Sixty-five patients with COPD Gold III–IV were admitted for clinical evaluation, high-resolution CT, and functional evaluation (spirometry, 6-minute walk test [6MWT], and VC. The presence and profusion of tomography findings were evaluated, and later, the patients were identified as having emphysema (EMP or airway disease (AWD phenotype. EMP and AWD groups were compared; tomography findings scores were evaluated versus spirometric, 6MWT, and VC variables.Results: Bronchiectasis was found in 33.8% and peribronchial thickening in 69.2% of the 65 patients. Structural findings of airways had no significant correlation with spirometric variables. Air trapping and EMP were strongly correlated with VC variables, but in opposite directions. There was some overlap between the EMP and AWD

  10. Carbon dioxide insufflation during colonoscopy in deeply sedated patients

    Institute of Scientific and Technical Information of China (English)

    Rajvinder Singh; Eu Nice Neo; Nazree Nordeen; Ganesananthan Shanmuganathan; Angelie Ashby; Sharon Drummond; Garry Nind

    2012-01-01

    AIM:To compare the impact of carbon dioxide (CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubation rates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air (P =0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively (P =0.012).The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO2) (P =0.0155) and by the patient 0.82 (air) and 0.46 (CO2) (P =0.0228).The level of abdominal bloating was 0.97 (air) and 0.36 (CO2) (P =0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insuffiation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.

  11. Telemedicine and cardiology

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    Jelkić Nikola

    2003-01-01

    Full Text Available Introduction Telecommunications and information technology provide clinical care at distance by means of telemedicine. Hospitals and other health care facilities use medical telemetry devices for monitoring patients' vital signs. These portable devices are used for measuring patient vital signs such as ECG, blood pressure, heart rate, respiration, capnography (CO2 and other important parameters and then transmit these information to a remote location using a nearby receiver. Application of telemetry Eliminating the need for wired connection with the patient, monitors allow, otherwise bedridden patients to be mobile, which shortens the recovery time. Wireless technology is also useful in the emergency care units, because emergency physicians need not leave their patients while consulting a handheld wireless device. This equipment also enables a paramedic to communicate with emergency physicians for early assessment, well before patients' arrive in hospital. Telemedicine Certain types of medical telemetry devices may be used in home conditions. Telemetry can provide monitoring and home health care services at distance, using advanced telecommunications and information technology in patients with reasonably stable, but a severe, chronic, difficult condition and caring home environment. This information can enable health-care providers to effectively manage treatment without need for acute emergency treatment and hospitalization. Conclusion Hospitals worldwide are under constant pressure to decrease healthcare cost and to improve treatment outcome. Telemedicine and home health care may be one of the solutions for the problem.

  12. Time and volume dependence of dead space in healthy and surfactant-depleted rat lungs during spontaneous breathing and mechanical ventilation.

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    Dassow, Constanze; Schwenninger, David; Runck, Hanna; Guttmann, Josef

    2013-11-01

    Volumetric capnography is a standard method to determine pulmonary dead space. Hereby, measured carbon dioxide (CO2) in exhaled gas volume is analyzed using the single-breath diagram for CO2. Unfortunately, most existing CO2 sensors do not work with the low tidal volumes found in small animals. Therefore, in this study, we developed a new mainstream capnograph designed for the utilization in small animals like rats. The sensor was used for determination of dead space volume in healthy and surfactant-depleted rats (n = 62) during spontaneous breathing (SB) and mechanical ventilation (MV) at three different tidal volumes: 5, 8, and 11 ml/kg. Absolute dead space and wasted ventilation (dead space volume in relation to tidal volume) were determined over a period of 1 h. Dead space increase and reversibility of the increase was investigated during MV with different tidal volumes and during SB. During SB, the dead space volume was 0.21 ± 0.14 ml and increased significantly at MV to 0.39 ± 0.03 ml at a tidal volume of 5 ml/kg and to 0.6 ± 0.08 ml at a tidal volume of 8 and 11 ml/kg. Dead space and wasted ventilation during MV increased with tidal volume. This increase was mostly reversible by switching back to SB. Surfactant depletion had no further influence on the dead space increase during MV, but impaired the reversibility of the dead space increase. PMID:23950167

  13. Prehospital airway management: A prospective case study.

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    Wilbers, N E R; Hamaekers, A E W; Jansen, J; Wijering, S C; Thomas, O; Wilbers-van Rens, R; van Zundert, A A J

    2011-01-01

    We conducted a one-year prospective study involving a prehospital Emergency Medical Service in the Netherlands to investigate the incidence of failed or difficult prehospital endotracheal intubation. During the study period the paramedics were asked to fill in a registration questionnaire after every endotracheal intubation. Of the 26,271 patient contacts, 256 endotracheal intubations were performed by paramedics in one year. Endotracheal intubation failed in 12 patients (4.8%). In 12.0% of 249 patients, a Cormack and Lehane grade III laryngoscopy was reported and a grade IV laryngoscopy was reported in 10.4%. The average number of endotracheal intubations per paramedic in one year was 4.2 and varied from zero to a maximum of 12. The median time between arrival on the scene and a positive capnograph was 7 min.38 s in the case of a Cormack and Lehane grade I laryngoscopy and 14 min.58 s in the case of a Cormack and Lehane grade 4 laryngoscopy. The incidence of endotracheal intubations performed by Dutch paramedics in one year was low, but endotracheal intubation was successful in 95.2%, which is comparable with findings in international literature. Early capnography should be used consistently in prehospital airway management. PMID:21612142

  14. Evaluation of bedside pulmonary function in the neonate: From the past to the future.

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    Reiterer, F; Sivieri, E; Abbasi, S

    2015-10-01

    Pulmonary function testing and monitoring plays an important role in the respiratory management of neonates. A noninvasive and complete bedside evaluation of the respiratory status is especially useful in critically ill neonates to assess disease severity and resolution and the response to pharmacological interventions as well as to guide mechanical respiratory support. Besides traditional tools to assess pulmonary gas exchage such as arterial or transcutaenous blood gas analysis, pulse oximetry, and capnography, additional valuable information about global lung function is provided through measurement of pulmonary mechanics and volumes. This has now been aided by commercially available computerized pulmonary function testing systems, respiratory monitors, and modern ventilators with integrated pulmonary function readouts. In an attempt to apply easy-to-use pulmonary function testing methods which do not interfere with the infant́s airflow, other tools have been developed such as respiratory inductance plethysmography, and more recently, electromagnetic and optoelectronic plethysmography, electrical impedance tomography, and electrical impedance segmentography. These alternative technologies allow not only global, but also regional and dynamic evaluations of lung ventilation. Although these methods have proven their usefulness for research applications, they are not yet broadly used in a routine clinical setting. This review will give a historical and clinical overview of different bedside methods to assess and monitor pulmonary function and evaluate the potential clinical usefulness of such methods with an outlook into future directions in neonatal respiratory diagnostics. PMID:26139200

  15. Complementary home mechanical ventilation techniques. SEPAR Year 2014.

    Science.gov (United States)

    Chiner, Eusebi; Sancho-Chust, José N; Landete, Pedro; Senent, Cristina; Gómez-Merino, Elia

    2014-12-01

    This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV. PMID:25138799

  16. Methacholine-Induced Variations in Airway Volume and the Slope of the Alveolar Capnogram Are Distinctly Associated with Airflow Limitation and Airway Closure.

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    Plantier, Laurent; Marchand-Adam, Sylvain; Boyer, Laurent; Taillé, Camille; Delclaux, Christophe

    2015-01-01

    Mechanisms driving alteration of lung function in response to inhalation of a methacholine aerosol are incompletely understood. To explore to what extent large and small airways contribute to airflow limitation and airway closure in this context, volumetric capnography was performed before (n = 93) and after (n = 78) methacholine provocation in subjects with an intermediate clinical probability of asthma. Anatomical dead space (VDaw), reflecting large airway volume, and the slope of the alveolar capnogram (slope3), an index of ventilation heterogeneity linked to small airway dysfunction, were determined. At baseline, VDaw was positively correlated with lung volumes, FEV1 and peak expiratory flow, while slope3 was not correlated with any lung function index. Variations in VDaw and slope3 following methacholine stimulation were correlated to a small degree (R2 = -0.20). Multivariate regression analysis identified independent associations between variation in FEV1 and variations in both VDaw (Standardized Coefficient-SC = 0.66) and Slope3 (SC = 0.35). By contrast, variation in FVC was strongly associated with variations in VDaw (SC = 0.8) but not Slope3. Thus, alterations in the geometry and/or function of large and small airways were weakly correlated and contributed distinctly to airflow limitation. While both large and small airways contributed to airflow limitation as assessed by FEV1, airway closure as assessed by FVC reduction mostly involved the large airways. PMID:26599006

  17. LARYNGEAL CHONDROSARCOMA: SUCCESSFUL USE OF VIDEO LARYNGOSCOPE IN ANTICIPATED DIFFICULT AIRWAY MANAGEMENT.

    Science.gov (United States)

    Dolinaj, Vladimir; Milošev, Sanja; Janjević, Dušanka

    2016-03-01

    Laryngeal chondrosarcoma is a rare mesenchymal tumor, most frequently affecting cricoid cartilage. The objective of this report is to present successful video laryngoscope usage in a patient with anticipated difficult airway who refused awake fiberoptic endotracheal intubation (AFOI). A 59-year-old male patient was admitted in our hospital due to difficulty breathing and swallowing. On clinical examination performed by ENT surgeon, preoperative endoscopic airway examination (PEAE) could not be performed properly due to the patient's uncooperativeness. Computed tomography revealed a spherical tumor that obstructed the subglottic area almost entirely. Due to the narrowed airway, the first choice for the anticipated difficult airway management was AFOI, which the patient refused. Consequently, we decided to perform endotracheal intubation with indirect laryngoscope using a C-MAC video laryngoscope (Karl Storz, Tuttlingen, Germany). Reinforced endotracheal tube (6.0 mm internal diameter) was placed gently between the tumor mass and the posterior wall of the trachea in the first attempt. Confirmation of endotracheal intubation was done by capnography. In a patient with subglottic area chondrosarcoma refusing PEAE and AFOI, video laryngoscope is a particularly helpful device for difficult airway management when difficult airway is anticipated. PMID:27276783

  18. The Effects of Sa-Am Acupuncture Treatment on Respiratory Physiology Parameters in Amyotrophic Lateral Sclerosis Patients: A Pilot Study

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    Sangmi Lee

    2013-01-01

    Full Text Available Respiratory dysfunction and complications are the most common causes of death in amyotrophic lateral sclerosis. This is a pilot study to observe the changes in respiratory physiology parameters after Sa-am acupuncture treatment. Eighteen ALS patients received Sa-am acupuncture treatment twice a day for 5 days. The EtCO2, SpO2, RR, and pulse rate were measured for 15 min before and during treatment, using capnography and oximetry. Correlation of K-ALSFRS-R scores against measured parameters showed that patients who had high K-ALSFRS-R scores had greater changes in pulse rate after acupuncture stimulation; they also showed a decrease in EtCO2, RR, and pulse rate and an increase in SpO2. A comparison of the mean values of these different parameters before and after Sa-am acupuncture stimulation revealed statistically significant differences (P<0.05 in SpO2 and pulse rate, but none in EtCO2 and RR. Sa-am acupuncture treatment on ALS patients seems to be more effective in the early stages of the disease. In light of increased SpO2 values, Sa-am acupuncture appears to have a greater effect on inspiration rather than on expiration. As a pilot study of acupuncture on ALS patients, this study could be used as a basis for future research.

  19. Nocturnal hypoxia in ALS is related to cognitive dysfunction and can occur as clusters of desaturations.

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    Su-Yeon Park

    Full Text Available BACKGROUND: Amyotrophic lateral sclerosis (ALS is a neurodegenerative disease that leads to progressive weakness of the respiratory and limb muscles. Consequently, most patients with ALS exhibit progressive hypoventilation, which worsens during sleep. The aim of this study was to evaluate the relationship between nocturnal hypoxia and cognitive dysfunction and to assess the pattern of nocturnal hypoxia in patients with ALS. METHOD: Twenty-five patients with definite or probable ALS underwent neuropsychologic testing, nocturnal pulse oximetry, and capnography. Patients were grouped according to the presence of nocturnal hypoxia (SpO2<95% for ≥10% of the night and their clinical characteristics and cognitive function were compared. RESULTS: Compared to patients without nocturnal hypoxia, those with nocturnal hypoxia (n = 10, 40% had poor memory retention (p = 0.039 and retrieval efficiency (p = 0.045. A cluster-of-desaturation pattern was identified in 7 patients (70% in the Hypoxia Group. CONCLUSIONS: These results suggest that nocturnal hypoxia can be related to cognitive dysfunction in ALS. In addition, a considerable number of patients with ALS may be exposed to repeated episodes of deoxygenation-reoxygenation (a cluster-of-desaturation pattern during sleep, which could be associated with the generation of reactive oxygen species. Further studies are required to define the exact causal relationships between these phenomena, the exact manifestations of nocturnal cluster-of-desaturation patterns, and the effect of clusters of desaturation on ALS progression.

  20. Application of end-tidal carbon dioxide monitoring to cardiopulmonary resuscitation%呼气末二氧化碳监测在心肺复苏中的应用进展

    Institute of Scientific and Technical Information of China (English)

    赵静静

    2011-01-01

    Carbon dioxide in exhaled air analysis is a noninvasive technology which indicates the lung gas exchange, ventilation/perfusion distribution, and circulation status through PetCO2 measurement. It is widely applied in the field of anaesthesiology, intensive care, and emergency. The 2010 American Heart Association Guidelines for CPR and ECC recommend continuous capnography to confirm correct placement of an endotracheal tube, to monitor CPR quality and conduct ventilation therapy.%分析通过测定呼气末二氧化碳分压(PetCO2)可以反映肺的气体交换状况、通气血流分布情况及循环状态等指标.PetCO2监测广泛应用于麻醉、危重症监护及急救医学等领域.2010年美国AHA心肺复苏(CPR)指南推荐连续PetCO2监测用于CPR整个过程以确认气管插管的位置,监测CPR的质量,并指导通气治疗.

  1. Monitoring and delivery of sedation.

    Science.gov (United States)

    Sheahan, C G; Mathews, D M

    2014-12-01

    Sedation for medical procedures is provided in a variety of clinical settings by medical personnel with differing levels of education and training. Although generally a safe practice, there is a degree of morbidity and mortality associated with sedation practice. Monitoring standards continue to be refined by professional societies with the goal of improving care. The depth of sedation should be monitored with clinical criteria. Processed electroencephalographic monitors currently do not contribute significantly to sedation care. Monitoring ventilation using pulse oximetry should be abandoned for more direct methods, such as capnography-transcutaneous carbon dioxide, respiratory acoustical and thoracic impedance monitoring could also play a role. Propofol has become widely utilized for sedation, although there are concerns about its margin of safety and synergistic interactions with other agents. Dexmedetomidine and propofol/ketamine also have utility. Patient-controlled sedation pumps and target-controlled infusion devices have been developed to improve patient care and satisfaction. A computer-assisted propofol sedation device to be used by non-anaesthesiologists has been approved in the USA by the Food and Drug Administration. More computer-assisted sedation delivery devices are likely to be developed, but their clinical utility is unclear. PMID:25498581

  2. Methacholine-Induced Variations in Airway Volume and the Slope of the Alveolar Capnogram Are Distinctly Associated with Airflow Limitation and Airway Closure.

    Directory of Open Access Journals (Sweden)

    Laurent Plantier

    Full Text Available Mechanisms driving alteration of lung function in response to inhalation of a methacholine aerosol are incompletely understood. To explore to what extent large and small airways contribute to airflow limitation and airway closure in this context, volumetric capnography was performed before (n = 93 and after (n = 78 methacholine provocation in subjects with an intermediate clinical probability of asthma. Anatomical dead space (VDaw, reflecting large airway volume, and the slope of the alveolar capnogram (slope3, an index of ventilation heterogeneity linked to small airway dysfunction, were determined. At baseline, VDaw was positively correlated with lung volumes, FEV1 and peak expiratory flow, while slope3 was not correlated with any lung function index. Variations in VDaw and slope3 following methacholine stimulation were correlated to a small degree (R2 = -0.20. Multivariate regression analysis identified independent associations between variation in FEV1 and variations in both VDaw (Standardized Coefficient-SC = 0.66 and Slope3 (SC = 0.35. By contrast, variation in FVC was strongly associated with variations in VDaw (SC = 0.8 but not Slope3. Thus, alterations in the geometry and/or function of large and small airways were weakly correlated and contributed distinctly to airflow limitation. While both large and small airways contributed to airflow limitation as assessed by FEV1, airway closure as assessed by FVC reduction mostly involved the large airways.

  3. Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery.

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    Kalava, Arun; Clark, Kirpal; McIntyre, John; Yarmush, Joel M; Lizardo, Teresita

    2015-01-01

    A 64-year-old male had an awake right nasal fiber-optic intubation with an endotracheal tube for open reduction and internal fixation of bilateral displaced mandibular fractures. After induction of anesthesia, an 18 Fr nasogastric tube (NGT) was inserted through the left nostril and was secured. The patient required high flow rates to deliver adequate tidal volumes with the ventilator. A chest x-ray done in the postanesthesia care unit revealed a malpositioned NGT in the left lower lobe bronchus, which was immediately removed. The patient was extubated on postoperative day 2. Various traditional methods, such as aspiration of gastric contents, auscultation of gastric insufflations, and chest x-ray are in use to detect or prevent the misplacement of an NGT. These methods can be unreliable or impractical. Use of capnography to detect an improperly placed NGT should be considered in the operating room as a simple, cost-effective method with high sensitivity to prevent possibly serious sequelae of an NGT placed within the bronchial tree. PMID:26398128

  4. Safe sedation in modern cardiological practice.

    Science.gov (United States)

    Furniss, Stephen S; Sneyd, J Robert

    2015-10-01

    Safe sedation is fundamental to many modern cardiological procedures, and following the publication of the report on safe sedation by the Academy of Medical Royal Colleges, this report discusses sedation specifically in cardiological practice. The major areas within cardiology that use sedation are cardioversion, catheter ablation particularly of atrial fibrillation, transoesophageal echocardiography, implantable device (cardiovascular implantable electronic device) procedures and other procedures such as transcatheter aortic valve replacement. There is increasing demand for cardiological sedation but there is wide geographical variation in its use and there are also growing data to support non-anaesthetists giving sedation. The use of benzodiazepines, particularly for short procedures, is common, but even here good record-keeping and audit together with an understanding of the continuum of sedation and having appropriately trained staff and the necessary facilities are vital. Nurse administration of propofol may be appropriate for some procedures in cardiology that require at least moderate sedation. Appropriate training is essential and the use of capnography and target controlled infusion pumps for propofol administration is recommended. PMID:26085525

  5. Robust remote monitoring of breathing function by using infrared thermography.

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    Pereira, Carina B; Yu, Xinchi; Blazek, Vladimir; Leonhardt, Steffen

    2015-08-01

    An abnormal breathing rate (BR) is one of the strongest markers of physiological distress. Moreover, it plays an important role in early detection of sudden infant death syndrome, as well as in the diagnosis of respiratory disorders. However, the current measuring modalities can cause discomfort to the patient, since attachment to the patient's body is required. This paper proposes a new approach based on infrared thermography to remotely monitor BR. This method allows to (1) detect automatically the nose, (2) track the associate region of interest (ROI), and (3) extract BR. To evaluate the performance of this method, thermal recording of 5 healthy subjects were acquired. Results were compared with BR obtained by capnography. The introduced approach demonstrated an excellent performance. ROIs were precisely segmented and tracked. Furthermore, a Bland-Altman diagram showed a good agreement between estimated BR and gold standard. The mean correlation and mean absolute BR error are 0.92 ± 0.07 and 0.53 bpm, respectively. In summary, infrared thermography seems to be a great, clinically relevant alternative to attached sensors, due to its outstanding characteristics and performance. PMID:26737233

  6. ASPECTOS HEMODINÂMICOS DA CIRCULAÇÃO EXTRACORPÓREA EM CÃES

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    Sheila Nogueira Ribeiro Knupp

    2014-06-01

    Full Text Available The cardiopulmonary bypass (CPB promotes major changes to the body of the patient that needs to be subjected to this procedure, but it can be circumvented or minimized with specific maneuvers for each situation. Despite being an established technique in human medicine, there are still improvements to be achieved. The purposes of this work were to clarify the cardiopulmonary bypass and inform its hemodynamic effects when applied to dogs. Four mongrel healthy dogs were used. The animals were anesthetized and monitored and samples were collected (T0. After that, the animals underwent median sternotomy and cannulation of the aorta and cranial and caudal vena cava and they were kept in CPB for a period of 30 minutes (T1, then disconnected from the CPB machine during 30 minutes in reperfusion process (T2, followed by one hour of reperfusion (T3, and then they were euthanized. The following parameters were evaluated: mean arterial pressure (MAP, central venous pressure (CVP, oxygenation (SaO2 and capnography (ETCO2. MAP, CVP and SaO2 remained within normal limits during the times evaluated. Although the observed average of ETCO2 was low in one of the experimental animals, it maintained the values ​​within the normal range in most experimental animals. We concluded that CPB can be performed in dogs without severe hemodynamic compromise, considering the parameters evaluated in this experiment.

  7. Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery.

    Science.gov (United States)

    Kalava, Arun; Clark, Kirpal; McIntyre, John; Yarmush, Joel M; Lizardo, Teresita

    2015-01-01

    A 64-year-old male had an awake right nasal fiber-optic intubation with an endotracheal tube for open reduction and internal fixation of bilateral displaced mandibular fractures. After induction of anesthesia, an 18 Fr nasogastric tube (NGT) was inserted through the left nostril and was secured. The patient required high flow rates to deliver adequate tidal volumes with the ventilator. A chest x-ray done in the postanesthesia care unit revealed a malpositioned NGT in the left lower lobe bronchus, which was immediately removed. The patient was extubated on postoperative day 2. Various traditional methods, such as aspiration of gastric contents, auscultation of gastric insufflations, and chest x-ray are in use to detect or prevent the misplacement of an NGT. These methods can be unreliable or impractical. Use of capnography to detect an improperly placed NGT should be considered in the operating room as a simple, cost-effective method with high sensitivity to prevent possibly serious sequelae of an NGT placed within the bronchial tree.

  8. Chronic respiratory failure in patients with neuromuscular diseases: diagnosis and treatment.

    Science.gov (United States)

    Paschoal, Ilma Aparecida; Villalba, Wander de Oliveira; Pereira, Mônica Corso

    2007-01-01

    Neuromuscular diseases affect alveolar air exchange and therefore cause chronic respiratory failure. The onset of respiratory failure can be acute, as in traumas, or progressive (slow or rapid), as in amyotrophic lateral sclerosis, muscular dystrophies, diseases of the myoneural junction, etc. Respiratory muscle impairment also affects cough efficiency and, according to the current knowledge regarding the type of treatment available in Brazil to these patients, it can be said that the high rates of morbidity and mortality in these individuals are more often related to the fact that they cough inefficiently rather than to the fact that they ventilate poorly. In this review, with the objective of presenting the options of devices available to support and substitute for natural ventilation in patients with neuromuscular diseases, we have compiled a brief history of the evolution of orthopedic braces and prostheses used to aid respiration since the end of the 19th century. In addition, we highlight the elements that are fundamental to the diagnosis of alveolar hypoventilation and of failure of the protective cough mechanism: taking of a clinical history; determination of peak cough flow; measurement of maximal inspiratory and expiratory pressures; spirometry in two positions (sitting and supine); pulse oximetry; capnography; and polysomnography. Furthermore, the threshold values available in the literature for the use of nocturnal ventilatory support and for the extension of this support through the daytime period are presented. Moreover, the maneuvers used to increase cough efficiency, as well as the proper timing of their introduction, are discussed.

  9. Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

  10. Air-Q laryngeal airway for rescue and tracheal intubation.

    Science.gov (United States)

    Ads, Ayman; Auerbach, Frederic; Ryan, Kelly; El-Ganzouri, Abdel R

    2016-08-01

    We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report. All personal identifiers that could lead to his identification have been removed from this report. A 59-year-old man was scheduled for a flexible and rigid bronchoscopy with possible laser excision of tracheal stenosis. He had a history of hypertension, atrial fibrillation, and diabetes. Assessment of airway revealed a thyromental distance of 6.5 cm, Mallampati class II, and body weight of 110 kg. He had hoarseness and audible inspiratory/expiratory stridor with Spo2 90% breathing room air. After induction and muscle relaxation, tracheal intubation and flexible bronchoscopy were achieved without incident. The patient was then extubated and a rigid bronchoscopy was attempted but failed with Spo2 dropping to 92%; rocuronium 60 mg was given, and reintubation was accomplished with a 7.5-mm endotracheal tube. A second rigid bronchoscopy attempt failed, with Spo2 dropping to 63%. Subsequent direct laryngoscopy revealed a bloody hypopharynx. A size 4.5 Air-Q LA was placed successfully and confirmed with capnography, and Spo2 returned to 100%. The airway was suctioned through the Air-Q LA device, and the airway was secured using a fiberoptic bronchoscope to place an endotracheal tube of 7.5-mm internal diameter. The case was canceled because of edema of the upper airway from multiple attempts with rigid bronchoscopy. The patient was transported

  11. End tidal CO2 versus arterial CO2 monitoring in patients undergoing coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Hassani E

    2009-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Measuring end tidal carbon dioxide (ETCo2 is one of the methods used for estimating arterial carbon dioxide (PaCo2 during general anesthesia. ETCo2 measurements maybe obviate the need for repeating arterial puncture for determination of arterial PaCo2. This study performed to determine the accuracy of ETCo2 levels as a measure of PaCo2 levels in patients undergoing coronary artery bypass graft and also to evaluate variation of the gradient between PaCo2 and ETCo2, peri- cardiopulmonary bypass operation."n"nMethods: In a prospective, cross-sectional study, a total of 40 patients with age 57±11 (35-73 years old undergoing coronary artery bypass graft were enrolled. ETCo2 levels (mmHg were recorded using side stream capnography at the time of arterial blood gas sampling, before (T0 and after (T1 cardiopulmonary bypass."n"nResults: Mean P(a-ETCo2 at T0 was 4.3±4.4mmHg, with the mean PaCo2, 33±6mmHg and mean ETCo2, 29±5mmHg and these values at T1 were 4.5±4.1mmHg, 33±5mmHg and 29±2mmHg respectively. There was no variation of the mean gradient (PaCo2-PETCo2 during, before and after cardiopulmonary bypass (p>0.870. Significant correlation was found between ETCo2 and PaCo2 at T0 and T1 (r=0.754 and 0

  12. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin

    Science.gov (United States)

    Jolley, Caroline J.; Bell, James; Rafferty, Gerrard F.; Moxham, John; Strang, John

    2015-01-01

    Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% 10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression. PMID:26495843

  13. Fração tardia do espaço morto (fDlate antes e após embolectomia pulmonar Late dead space fraction (fDlate before and after pulmonary embolectomy

    Directory of Open Access Journals (Sweden)

    Marcos Mello Moreira

    2005-03-01

    Full Text Available Este relato de caso apresenta os resultados da fDlate (fração tardia de espaço morto em um paciente submetido a embolectomia por tromboembolismo pulmonar (TEP. O TEP foi diagnosticado por ultrassonografia ecodoppler de membros inferiores, cintilografia pulmonar, tomografia helicoidal computadorizada e arteriografia pulmonar. O cálculo da fDlate se baseou na capnografia volumétrica e na gasometria arterial de acordo com ERIKSSON et al. [1]. A fDlate pré-operatória foi de 0,16 e foi considerada positiva por estar acima do valor de corte de 0,12. A fDlate pós-operatória foi de - 0,04, um valor inferior ao valor de corte de 0,12 e foi caracterizada como negativa. A correlação da fDlate com os resultados de imagem confirma a validade desta nova ferramenta diagnóstica não-invasiva.This report presents data on the late dead space fraction (fDlate of a patient submitted to surgical pulmonary embolectomy. Pulmonary thromboembolism (PTE was diagnosed by echo-Doppler ultrasound of the lower limbs, lung scintigraphy, computerized helical tomography and angiography. The fDlate was calculated based on volumetric capnography as well as on arterial blood gases according to ERIKSSON et al. [1]. The preoperative fDlate value was 0.16, which was considered positive for the diagnosis of PTE, as it was higher than the cut-off point of 0.12. The postoperative fDlate value was - 0.04, which was below 0.12 and was characterized as negative. The agreement of fDlate with the imaging results confirms the validity of this new, noninvasive diagnostic tool.

  14. Relationship between Musical Characteristics and Temporal Breathing Pattern in Piano Performance.

    Science.gov (United States)

    Sakaguchi, Yutaka; Aiba, Eriko

    2016-01-01

    Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists. PMID:27516736

  15. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

    Science.gov (United States)

    Jolley, Caroline J; Bell, James; Rafferty, Gerrard F; Moxham, John; Strang, John

    2015-01-01

    Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% 10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.

  16. Evaluation of a new side-stream, low dead space, end-tidal carbon dioxide monitoring system in rats.

    Science.gov (United States)

    Beck, Christopher; Barthel, Franziska; Hahn, Anna-Maria; Vollmer, Christian; Bauer, Inge; Picker, Olaf

    2014-01-01

    The aim of this study was to evaluate a newly developed infrared side-stream capnograph with minimal sample volume for the continuous measurement of end-tidal carbon dioxide (CO2) concentrations in small rodents. Thirty-four male Wistar rats (weight 345 ± 70 g) were treated in accordance with the National Institutes of Health (NIH) guidelines for animal care. All experiments were performed with approval of the local animal care and use committee. Sepsis was induced by implanting an 18 gauge stent into the colon 24 h prior to the experiments, allowing a constant fecal leakage into the peritoneal cavity (25 septic and nine control animals). Hemodynamic variables and end-tidal CO2 were recorded continuously and arterial blood (5 × 120 µL) was sampled periodically for arterial blood gas analysis. After baseline controlled mechanical ventilation was randomized and titrated to either normocapnia (35-45 mmHg) or hypercapnia (65-75 mmHg) with exogenous application of CO2. A total of 155 paired CO2 measurements comparing end-tidal and arterial partial pressure were conducted. Side-stream capnography underestimated the CO2 partial pressure with a bias of -6.1 mmHg and a 95% limit of agreement from 6.7 to -19.1 mmHg. Our results suggest that side-stream end-tidal CO2 monitoring with a low dead space could be utilized in rats as a surrogate for the arterial CO2 measurement over a wide range of partial pressures in normal and septic animals. PMID:24072488

  17. Clinical evaluation of an instrument to measure carbon dioxide tension at the oxygenator gas outlet in cardiopulmonary bypass.

    Science.gov (United States)

    Kristiansen, Frode; Høgetveit, Jan Olav; Pedersen, Thore H

    2006-01-01

    This paper presents the clinical testing of a new capnograph designed to measure the carbon dioxide tension at the oxygenator exhaust outlet in cardiopulmonary bypass (CPB). During CPB, there is a need for reliable, accurate and instant estimates of the arterial blood CO2 tension (PaCO2) in the patient. Currently, the standard practice for measuring PaCO2 involves the manual collection of intermittent blood samples, followed by a separate analysis performed by a blood gas analyser. Probes for inline blood gas measurement exist, but they are expensive and, thus, unsuitable for routine use. A well-known method is to measure PexCO2, ie, the partial pressure of CO2 in the exhaust gas output from the oxygenator and use this as an indirect estimate for PaCO2. Based on a commercially available CO2 sensor circuit board, a laminar flow capnograph was developed. A standard sample line with integrated water trap was connected to the oxygenator exhaust port. Fifty patients were divided into six different groups with respect to oxygenator type and temperature range. Both arterial and venous blood gas samples were drawn from the CPB circuit at various temperatures. Alfa-stat corrected pCO2 values were obtained by running a linear regression for each group based on the arterial temperature and then correcting the PexCO2 accordingly. The accuracy of the six groups was found to be (+/- SD): +/- 4.3, +/- 4.8, +/- 5.7, +/- 1.0, +/- 3.7 and +/- 2.1%. These results suggest that oxygenator exhaust capnography is a simple, inexpensive and reliable method of estimating the PaCO2 in both adult and pediatric patients at all relevant-temperatures. PMID:16485695

  18. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

    Science.gov (United States)

    Jolley, Caroline J; Bell, James; Rafferty, Gerrard F; Moxham, John; Strang, John

    2015-01-01

    Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% 10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression. PMID:26495843

  19. Relationship between Musical Characteristics and Temporal Breathing Pattern in Piano Performance

    Science.gov (United States)

    Sakaguchi, Yutaka; Aiba, Eriko

    2016-01-01

    Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists. PMID:27516736

  20. Breath analysis for in vivo detection of pathogens related to ventilator-associated pneumonia in intensive care patients: a prospective pilot study.

    Science.gov (United States)

    Filipiak, Wojciech; Beer, Ronny; Sponring, Andreas; Filipiak, Anna; Ager, Clemens; Schiefecker, Alois; Lanthaler, Simon; Helbok, Raimund; Nagl, Markus; Troppmair, Jakob; Amann, Anton

    2015-03-01

    Existing methods for the early detection of infections in mechanically ventilated (MV) patients at intensive care units (ICUs) are unsatisfactory. Here we present an exploratory study assessing the feasibility of breath VOC analyses for the non-invasive detection of pathogens in the lower respiratory tract of ventilated patients. An open uncontrolled clinical pilot study was performed by enrolling 28 mechanically ventilated (MV) patients with severe intracranial disease, being at risk for the development of or already with confirmed ventilation-associated pneumonia (VAP). The recently developed sampling technique enabled the collection of breath gas with a maximized contribution of alveolar air directly from the respiratory circuit under continuous capnography control, adsorptive preconcentration and final analysis by means of gas chromatography-mass spectrometry (GC-MS).VAP was confirmed in 22/28 preselected patients (78%). The most common microorganisms were Staphylococcus aureus (5/22 VAP patients), Escherichia coli (5/22 VAP patients) and Candida spp. (5/22 VAP patients). 12/32 metabolites released by S. aureus in our previous in vitro studies were also detected in the end-tidal air of VAP patients infected with this pathogen. A similar overlap was seen in Candida albicans infections (8/29 VOCs). Moreover, the concentration profile of selected compounds correlated with the course of the infection.This prospective pilot study provides proof of the concept that the appearance and the concentration profile of pathogen-derived metabolites (elucidated from in vitro experiments) in the breath of ventilated patients during clinically confirmed VAP correlates with the presence of a particular pathogen. PMID:25557917

  1. Estimating instantaneous respiratory rate from the photoplethysmogram.

    Science.gov (United States)

    Dehkordi, Parastoo; Garde, Ainara; Molavi, Behnam; Petersen, Christian L; Ansermino, J Mark; Dumont, Guy A

    2015-08-01

    The photoplethysmogram (PPG) obtained from pulse oximetry shows the local changes of blood volume in tissues. Respiration induces variation in the PPG baseline due to the variation in venous blood return during each breathing cycle. We have proposed an algorithm based on the synchrosqueezing transform (SST) to estimate instantaneous respiratory rate (IRR) from the PPG. The SST is a combination of wavelet analysis and a reallocation method which aims to sharpen the time-frequency representation of the signal and can provide an accurate estimation of instantaneous frequency. In this application, the SST was applied to the PPG and IRR was detected as the predominant ridge in the respiratory band (0.1 Hz - 1 Hz) in the SST plane. The algorithm was tested against the Capnobase benchmark dataset that contains PPG, capnography, and expert labelled reference respiratory rate from 42 subjects. The IRR estimation accuracy was assessed using the root mean square (RMS) error and Bland-Altman plot. The median RMS error was 0.39 breaths/min for all subjects which ranged from the lowest error of 0.18 breaths/min to the highest error of 13.86 breaths/min. A Bland-Altman plot showed an agreement between the IRR obtained from PPG and reference respiratory rate with a bias of -0.32 and limits agreement of -7.72 to 7.07. Extracting IRR from PPG expands the functionality of pulse oximeters and provides additional diagnostic power to this non-invasive monitoring tool. PMID:26737696

  2. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

    Directory of Open Access Journals (Sweden)

    Caroline J Jolley

    Full Text Available Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone (IOT, and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine after 30 minutes. The main outcome measures were pulse oximetry (SpO2%, end-tidal CO2% (ETCO2% and neural respiratory drive (NRD (quantified using parasternal intercostal muscle electromyography. Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% 10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.

  3. Automated quantitative analysis of capnogram shape for COPD-normal and COPD-CHF classification.

    Science.gov (United States)

    Mieloszyk, Rebecca J; Verghese, George C; Deitch, Kenneth; Cooney, Brendan; Khalid, Abdullah; Mirre-Gonzalez, Milciades A; Heldt, Thomas; Krauss, Baruch S

    2014-12-01

    We develop an approach to quantitative analysis of carbon dioxide concentration in exhaled breath, recorded as a function of time by capnography. The generated waveform--or capnogram--is currently used in clinical practice to establish the presence of respiration as well as determine respiratory rate and end-tidal CO 2 concentration. The capnogram shape also has diagnostic value, but is presently assessed qualitatively, by visual inspection. Prior approaches to quantitatively characterizing the capnogram shape have explored the correlation of various geometric parameters with pulmonary function tests. These studies attempted to characterize the capnogram in normal subjects and patients with cardiopulmonary disease, but no consistent progress was made, and no translation into clinical practice was achieved. We apply automated quantitative analysis to discriminate between chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF), and between COPD and normal. Capnograms were collected from 30 normal subjects, 56 COPD patients, and 53 CHF patients. We computationally extract four physiologically based capnogram features. Classification on a hold-out test set was performed by an ensemble of classifiers employing quadratic discriminant analysis, designed through cross validation on a labeled training set. Using 80 exhalations of each capnogram record in the test set, performance analysis with bootstrapping yields areas under the receiver operating characteristic (ROC) curve of 0.89 (95% CI: 0.72-0.96) for COPD/CHF classification, and 0.98 (95% CI: 0.82-1.0) for COPD/normal classification. This classification performance is obtained with a run time sufficiently fast for real-time monitoring. PMID:24967981

  4. Cerebrovascular effects of the thigh cuff maneuver.

    Science.gov (United States)

    Panerai, R B; Saeed, N P; Robinson, T G

    2015-04-01

    Arterial hypotension can be induced by sudden release of inflated thigh cuffs (THC), but its effects on the cerebral circulation have not been fully described. In nine healthy subjects [aged 59 (9) yr], bilateral cerebral blood flow velocity (CBFV) was recorded in the middle cerebral artery (MCA), noninvasive arterial blood pressure (BP) in the finger, and end-tidal CO2 (ETCO2) with nasal capnography. Three THC maneuvers were performed in each subject with cuff inflation 20 mmHg above systolic BP for 3 min before release. Beat-to-beat values were extracted for mean CBFV, BP, ETCO2 , critical closing pressure (CrCP), resistance-area product (RAP), and heart rate (HR). Time-varying estimates of the autoregulation index [ARI(t)] were also obtained using an autoregressive-moving average model. Coherent averages synchronized by the instant of cuff release showed significant drops in mean BP, CBFV, and RAP with rapid return of CBFV to baseline. HR, ETCO2 , and ARI(t) were transiently increased, but CrCP remained relatively constant. Mean values of ARI(t) for the 30 s following cuff release were not significantly different from the classical ARI [right MCA 5.9 (1.1) vs. 5.1 (1.6); left MCA 5.5 (1.4) vs. 4.9 (1.7)]. HR was strongly correlated with the ARI(t) peak after THC release (in 17/22 and 21/24 recordings), and ETCO2 was correlated with the subsequent drop in ARI(t) (19/22 and 20/24 recordings). These results suggest a complex cerebral autoregulatory response to the THC maneuver, dominated by myogenic mechanisms and influenced by concurrent changes in ETCO2 and possible involvement of the autonomic nervous system and baroreflex. PMID:25659488

  5. Effect of Parachlamydia acanthamoebae on pulmonary function parameters in a bovine respiratory model.

    Science.gov (United States)

    Lohr, M; Prohl, A; Ostermann, C; Diller, R; Greub, G; Reinhold, P

    2016-07-01

    The aim of this study was to evaluate pulmonary dysfunction induced by experimental infection with Parachlamydia acanthamoebae in calves. Intrabronchial inoculation with P. acanthamoebae was performed in 31 calves aged 2-3 months old at two different challenge doses of 10(8) and 10(10) inclusion-forming units (IFU) per animal. Control animals received heat inactivated bacteria. The effects on pulmonary gas exchange were determined by arterial blood gas analysis and haemoximetry during the 7 days post inoculation (DPI). For pulmonary function testing (PFT), impulse oscillometry, capnography, and measurement of O2 uptake were undertaken in spontaneously breathing animals 7 and 3 days before inoculation and were repeated until 10 DPI. In the early phase after challenge (1-3 DPI), mild hypoxaemia occurred, which was accompanied by a significant reduction in both tidal and alveolar volumes (each related to bodyweight, BW). In parallel, expiratory flow rate and specific ventilation (i.e. minute ventilation related to O2 uptake) were significantly increased. Minute and alveolar ventilations (each related to metabolic BW) increased significantly due to higher respiratory rates, lasting until 4 and 5 DPI, respectively. Oxygen uptake was slightly reduced during the first 2 days after challenge, but increased significantly during the recovery phase, from 4 to 8 DPI. No deterioration in respiratory mechanics or acid-base balance was observed. Respiratory infection with 10(10) IFU P. acanthamoebae per calf induced mild respiratory dysfunction, mainly characterised by hypoxaemia. The study's findings do not indicate severe pathophysiological consequences of P. acanthamoebae infection on pulmonary function in the bovine host. PMID:27240907

  6. Impact of Post-Intubation Interventions on Mortality in Patients Boarding in the Emergency Department

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    Rahul Bhat

    2014-09-01

    Full Text Available Introduction: Emergency physicians frequently perform endotracheal intubation and mechanical ventilation. The impact of instituting early post-intubation interventions on patients boarding in the emergency department (ED is not well studied. We sought to determine the impact of postintubation interventions (arterial blood gas sampling, obtaining a chest x-ray (CXR, gastric decompression, early sedation, appropriate initial tidal volume, and quantitative capnography on outcomes of mortality, ventilator-associated pneumonia (VAP, ventilator days, and intensive care unit (ICU length-of-stay (LOS. Methods: This was an observational, retrospective study of patients intubated in the ED at a large tertiary-care teaching hospital and included patients in the ED for greater than two hours postintubation. We excluded them if they had incomplete data, were designated “do not resuscitate,” were managed primarily by the trauma team, or had surgery within six hours after intubation. Results: Of 169 patients meeting criteria, 15 died and 10 developed VAP. The mortality odds ratio (OR in patients receiving CXR was 0.10 (95% CI 0.01 to 0.98, and 0.11 (95% CI 0.03 to 0.46 in patients receiving early sedation. The mortality OR for patients with 3 or fewer interventions was 4.25 (95% CI 1.15 to 15.75 when compared to patients with 5 or more interventions. There was no significant relationship between VAP rate, ventilator days, or ICU LOS and any of the intervention groups. Conclusion: The performance of a CXR and early sedation as well as performing five or more vs. three or fewer post-intubation interventions in boarding adult ED patients was associated with decreased mortality. [West J Emerg Med. 2014;15(6:708-711

  7. MRI of ventilated neonates and infants: respiratory pressure as trigger signal; MR-Untersuchung bei beatmeten Saeuglingen und Kleinkindern: Der Atermwegdruck als Triggersignal

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    Lotz, J. [Diagnostische Radiologie (Germany); Reiffen, H.P. [Klinik fuer Anaesthesiologie, Medizinische Hochschule Hannover (Germany)

    2004-02-01

    Introduction: motivated by the difficulties often encountered in the setup of respiratory trigger in MR imaging of mechanical ventilated pediatric patients, a simplified approach in terms of time and reliability was sought. Method: with the help of a male-to-male Luer-Lock adapter in combination with a 3-way adapter the tube of the respiratory compensation bellow was fixed to the output channel for capnography of the airway filter. Ten patients (age 4 months to 6 years) were tested with spin echo imaging and either respiration compensation (T1-weighted imaging) or respiratory triggered (T2-weighted imaging). Results: a clear trigger signal was achieved in all cases. No negative influence on the quality or security of the mechanical ventilation of the patients was observed. Summary: the proposed adapter is safe, efficient and fast to install in patients undergoing MR imaging in general anaesthesia. (orig.) [German] Einleitung: Bei beatmeten Patienten, insbesondere bei Saeuglingen und Kleinkindern, kann es schwierig sein, ein geeignetes Atemsignal fuer die Triggerung der MR-Bildgebung zu erhalten. Eine einfache und schnell zu installierende technische Modifikation wurde gesucht, um ein verlaessliches Atemsignal fuer die atemgetriggerte Untersuchung zu erreichen. Material, Methoden, Ergebnisse: Mithilfe eines handelsueblichen Adapters wurde der Atemwegsdruck bei beatmeten Patienten als Triggersignal fuer atemkompensierte oder atemgetriggerte Sequenzen in der MRT abgeleitet. Dafuer wurde der Schlauch des am MRT vorhandenen Atemgurtes ueber einen Dreiwegehahn und einen Luer-Lock maennlich-maennlich Adapter mit dem fuer die Kapnographie vorgesehenen Filteranschluss verbunden. Die sehr rasch zu montierende Technik wurde bei 10 Patienten im Alter von 4 Monaten bis 6 Jahren erfolgreich getestet. In allen Faellen wurde ein verlaessliches, klares Signal gewonnen. Es kam zu keiner Beeintraechtigung der Beatmung. Schlussfolgerung: Der vorgestellte Aufbau ist eine praktische

  8. PETCO2 measured by a new lightweight mainstream capnometer with very low dead space volume offers accurate and reliable noninvasive estimation of PaCO2

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    Takahashi D

    2011-10-01

    Full Text Available Daijiro Takahashi, Takehiko Hiroma, Tomohiko NakamuraDivision of Neonatology, Nagano Children’s Hospital, Nagano, JapanObjective: Although capnometers are widely used in adult and pediatric intensive care units, they are not widely used in neonatal intensive care units due to issues such as the weight of sensors, dead space, and leakage from tracheal intubation tubes. These authors developed a light and low dead space airway adaptor of end-tidal carbon dioxide pressure (PETCO2 and evaluated the correlations between PETCO2 and partial CO2 pressure (PaCO2 in rabbits while changing tidal volume and leakage volume.Methods: Firstly, Japanese rabbits weighing 2 kg were divided into three tidal volumes (6 mL/kg, 10 mL/kg, or 15 mL/kg, and PETCO2 and PaCO2 were measured. Secondly, the respiratory apparatus was set to a tidal volume/body weight ratio of 10 mL/kg, leakage rates were divided into seven groups, and PETCO2  and PaCO2 were measured.Results: PETCO2 and PaCO2 were significantly correlated (r2 = 0.9099, P < 0.0001 when there was no leakage in the tracheal intubation tubes. No significant differences were observed between PaCO2 and PETCO2 (Pa-ETCO2 in the three tidal volume/body weight groups or for groups in which leakage rate was <60%, but significant deviations in Pa-ETCO2 were noted in groups with leakage rate 60%.Conclusion: There was a strong correlation between PETCO2 and PaCO2 when tidal volume/body weight ratio was 6–15 mL/kg with leakage rate <60%. Lightweight mainstream capnometer with a low amount of dead space airway adaptor might be useful in very low birth weight infants with small tidal volume.Keywords: capnography, mainstream, neonate

  9. The use of a volatile anesthetic regimen protects against acute normovolemic hemodilution induced myocardial depression in patients with coronary artery disease

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    Lorsomradee Sratwadee

    2009-01-01

    Full Text Available Background: Previous studies indicated that acute normovolemic hemodilution (ANH was associated with a depression of myocardial function in coronary surgery patients with baseline heart rate faster than 90 bpm. It was suggested that this phenomenon could be explained by the occurrence of myocardial ischemia. In the present study, we hypothesized that the cardioprotective properties of a volatile anesthetic regimen might protect against the ANH related myocardial functional impairment. Materials and Methods: Forty elective coronary surgery patients with baseline heart rate faster than 90 bpm were randomly allocated to receive different anesthetic regimens. Group A (n = 20 received midazolam-based anesthesia. Group B (n = 20 received a sevoflurane-based anesthesia. Five-lead electrocardiogram, pulse oximetry, capnography, radial arterial pressure, and Swan Ganz continuous thermodilution cardiac output via right internal jugular vein were monitored. Measurements were obtained before and after ANH. Data were compared using paired t test. All data were expressed as mean ± SD. Data were considered significant if P < 0.05. Results: After ANH, systemic vascular resistance was slightly decreased in group A while there was a significant decrease in group B. In group A, cardiac output was slightly decreased from 5.07±1.17 l/min to 5.02±1.28 l/min after ANH, whereas in group B, cardiac output was significantly increased from 4.84±1.21 l/min to 6.02±1.28 l/min after ANH. Conclusion: In coronary surgery patients, with baseline heart rate faster than 90 bpm, anesthesia with sevoflurane during ANH was associated with an improvement in myocardial function after ANH, which was not present in patients anesthetized with midazolam.

  10. Applied value of dead spaces measuring in bronchial asthma%死腔测定在支气管哮喘中应用价值的研究

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 高蓓兰; 储海青; 杨文兰; 郑卫

    2009-01-01

    目的 探讨容积二氧化碳图(volumetric capnography,VCap)技术死腔测定在支气管哮喘(简称哮喘)中的应用价值及临床意义.方法 对52例急性发作期哮喘患者及35名健康志愿者的常规肺功能指标及Langley 死腔(VDL)、Fowler死腔(VDF)、Wolff死腔(VDW)进行测定分析.结果 本研究显示:哮喘组中VDL、VDF及VDW均较对照组显著减小(P<0.01,0.01,0.01).相关分析显示:VDL、VDF和VDW分别与FEV1占预计值%、FEV1/FVC%、PEF占预计值%、FEF25占预计值%、FEF50占预计值%、FEF75占预计值%、MMEF占预计值%呈负相关(P<0.05),与RV占预计值%、TLC占预计值%、RV/TLC%呈正相关(P<0.05).结论 VCap死腔测定患者易于配合,对哮喘的辅助诊断及进一步了解其病理生理改变具有一定的临床价值和意义.

  11. Relationship between Musical Characteristics and Temporal Breathing Pattern in Piano Performance.

    Science.gov (United States)

    Sakaguchi, Yutaka; Aiba, Eriko

    2016-01-01

    Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists.

  12. Effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Boentert, Matthias; Brenscheidt, Inga; Glatz, Christian; Young, Peter

    2015-09-01

    In amyotrophic lateral sclerosis (ALS), non-invasive ventilation (NIV) is indicated if sleep-disordered breathing (SDB), daytime hypercapnia, or significant diaphragmatic weakness is present. We investigated both short-term and long-term effects of NIV on objective measures of sleep and nocturnal respiration in patients with ALS. Polysomnography (PSG) and transcutaneous capnography were conducted for diagnosis of SDB (T0), for treatment initiation (T1), and follow-up 3, 9, and 15 months later (T2, T3, and T4, respectively). Records from 65 patients were retrospectively analyzed at T0 and T1. At subsequent timepoints, the number of full data sets decreased since follow-up sleep studies frequently included polygraphy rather than PSG (T2, 38 patients, T3, 17 patients, T4, 11 patients). At T0, mean age was 63.2 years, 29 patients were female, and 22 patients had bulbar ALS. Immediate sequelae of NIV initiation included significant increases of slow wave sleep, rapid eye movement sleep, and oxygen saturation. Mean apnea-hypopnea index, respiratory rate, and the maximum transcutaneous carbon dioxide tension were reduced. At T2-T4, normoxia and normocapnia were preserved. Sleep quality measures showed no alteration as diurnal use of NIV gradually increased reflecting disease progression. In contrast to previous reports, improvement of sleep and respiratory outcomes was found in both non-bulbar and bulbar patients. NIV significantly improves objective sleep quality and SDB in the first night of treatment in patients with bulbar and non-bulbar ALS. NIV warrants nocturnal normoventilation without deterioration of sleep quality in the long run with only minor changes to ventilator settings. PMID:26076745

  13. Relationship between Musical Characteristics and Temporal Breathing Pattern in Piano Performance

    Science.gov (United States)

    Sakaguchi, Yutaka; Aiba, Eriko

    2016-01-01

    Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists.

  14. Preparation, premedication, and surveillance.

    Science.gov (United States)

    Lazzaroni, M; Bianchi Porro, G

    2005-02-01

    expert peer groups have issued practice guidelines for sedation and analgesia that call for continuous monitoring of the patient's hemodynamic and ventilatory status and consciousness. Direct observation is facilitated by electronic devices (pulse oximetry, capnography), directly indicating the patient's ventilatory status and the depth of sedation. Recently, it has been proposed that the bispectral index (BIS), an electroencephalography-based technique, can be used to monitor the depth of sedation during gastrointestinal endoscopy. However, the results of a recent study cast some doubt on the usefulness of the BIS, in its current version, for titrating boluses of propofol to an adequate level of sedation. Further data therefore appear to be needed to assess whether or not BIS values can help avoid unnecessary propofol dosage and can replace continuous assessment of the ventilatory effort. PMID:15692924

  15. Effects of concurrent intravenous morphine sulfate and naltrexone hydrochloride on end-tidal carbon dioxide

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    Goli Veeraindar

    2012-03-01

    Full Text Available Abstract Background Respiratory depression, a potentially fatal side-effect of opioid-overdose, may be reversed by timely administration of an opioid antagonist, such as naloxone or naltrexone. Tampering with a formulation of morphine sulfate and sequestered naltrexone hydrochloride extended release capsules (MS-sNT releases both the opioid morphine and the antagonist naltrexone. A study in recreational opioid-users indicated that morphine and naltrexone injected in the 25:1 ratio (duplicating the ratio of the formulation found MS-sNT reduced morphine-induced euphoric effects vs intravenous (IV morphine alone. In the same study, the effects of morphine + naltrexone on end-tidal carbon dioxide (EtCO2, a measure of respiratory-depression, were evaluated and these data are reported here. Methods Single-center, placebo-controlled, double-blind crossover study. Non-dependent male opioid users were randomized to receive single IV doses of placebo, 30 mg morphine alone, and 30 mg morphine + 1.2 mg naltrexone. EtCO2 was measured by noninvasive capnography. Results Significant differences in EtCO2 least-squares means across all treatments for maximal effect (Emax and area under the effect curve (AUE0-2, AUE0-8, AUE0-24 were detected (all p ≤ 0.0011. EtCO2 Emax values for morphine + naltrexone were significantly reduced vs morphine alone (42.9 mm Hg vs 47.1 mm Hg, p max was delayed for morphine + naltrexone vs morphine alone (5.0 h vs 1.0 h. Conclusions Results provide preliminary evidence that the naltrexone:morphine ratio within MS-sNT is sufficient to significantly reduce EtCO2 when administered intravenously to non-dependent male recreational opioid-users. Further studies with multiple measures of respiratory-function are warranted to determine if risk of respiratory depression is also reduced by naltrexone in the tampered formulation.

  16. Pulmonary function responses to ozone in smokers with a limited smoking history

    Energy Technology Data Exchange (ETDEWEB)

    Bates, Melissa L., E-mail: mlbates@pediatrics.wisc.edu [Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802 (United States); Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); Brenza, Timothy M. [Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802 (United States); Ben-Jebria, Abdellaziz [Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802 (United States); Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802 (United States); Bascom, Rebecca [Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA 17033 (United States); Eldridge, Marlowe W. [Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53792 (United States); Department of Bioengineering, University of Wisconsin-Madison, Madison, WI 53792 (United States); Ultman, James S. [Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802 (United States); Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802 (United States)

    2014-07-01

    In non-smokers, ozone (O{sub 3}) inhalation causes decreases in forced expiratory volume (FEV{sub 1}) and dead space (V{sub D}) and increases the slope of the alveolar plateau (S{sub N}). We previously described a population of smokers with a limited smoking history that had enhanced responsiveness to brief O{sub 3} boluses and aimed to determine if responsiveness to continuous exposure was also enhanced. Thirty smokers (19 M, 11 F, 24 ± 4 years, 6 ± 4 total years smoking,4 ± 2 packs/week) and 30 non-smokers (17 M, 13 F, 25 ± 6 years) exercised for 1 h on a cycle ergometer while breathing 0.30 ppm O{sub 3}. Smokers and non-smokers were equally responsive in terms of FEV{sub 1} (− 9.5 ± 1.8% vs − 8.7 ± 1.9%). Smokers alone were responsive in terms of V{sub D} (− 6.1 ± 1.2%) and S{sub N} (9.1 ± 3.4%). There was no difference in total delivered dose. Dead space ventilation (V{sub D}/V{sub T}) was not initially different between the two groups, but increased in the non-smokers (16.4 ± 2.8%) during the exposure, suggesting that the inhaled dose may be distributed more peripherally in smokers. We also conclude that these cigarette smokers retain their airway responsiveness to O{sub 3} and, uniquely, experience changes in V{sub D} that lead to heterogeneity in airway morphometry and an increase in S{sub N}. - Highlights: • We previously found lung function responses to O{sub 3} bolus exposure in smokers. • Here, we describe their responsiveness to continuous O{sub 3} exposure with exercise. • Spirometry and capnography were used to assess pulmonary function changes. • Enhanced bronchoconstriction in smokers increases parenchymal delivery of O{sub 3}.

  17. The effect of a peptide-containing synthetic lung surfactant on gas exchange and lung mechanics in a rabbit model of surfactant depletion

    Directory of Open Access Journals (Sweden)

    van Zyl JM

    2013-03-01

    Full Text Available Johann M van Zyl,1 Johan Smith,2 Arthur Hawtrey1 1Division of Pharmacology, 2Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa Background: Currently, a new generation of synthetic pulmonary surfactants is being developed that may eventually replace animal-derived surfactants used in the treatment of respiratory distress syndrome. Enlightened by this, we prepared a synthetic peptide-containing surfactant (Synsurf consisting of phospholipids and poly-L-lysine electrostatically bonded to poly-L-glutamic acid. Our objective in this study was to investigate if bronchoalveolar lavage (BAL-induced acute lung injury and surfactant deficiency with accompanying hypoxemia and increased alveolar and physiological dead space is restored to its prelavage condition by surfactant replacement with Synsurf, a generic prepared Exosurf, and a generic Exosurf containing Ca2+. Methods: Twelve adult New Zealand white rabbits receiving conventional mechanical ventilation underwent repeated BAL to create acute lung injury and surfactant-deficient lung disease. Synthetic surfactants were then administered and their effects assessed at specified time points over 5 hours. The variables assessed before and after lavage and surfactant treatment included alveolar and physiological dead space, dead space/tidal volume ratio, arterial end-tidal carbon dioxide tension (PCO2 difference (mainstream capnography, arterial blood gas analysis, calculated shunt, and oxygen ratios. Results: BAL led to acute lung injury characterized by an increasing arterial PCO2 and a simultaneous increase of alveolar and physiological dead space/tidal volume ratio with no intergroup differences. Arterial end-tidal PCO2 and dead space/tidal volume ratio correlated in the Synsurf, generic Exosurf and generic Exosurf containing Ca2+ groups. A significant and sustained improvement in systemic oxygenation occurred from time point 180 minutes onward in animals

  18. Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism

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    J.H.T. Ferreira

    2006-09-01

    Full Text Available The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 ± 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 ± 8.64 to 39.14 ± 6.77 mmHg and alveolar air (from 92.97 ± 2.14 to 63.91 ± 8.27 mmHg. The effective alveolar ventilation exhibited a significant reduction (from 199.62 ± 42.01 to 84.34 ± 44.13 consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio also presented a significant reduction after embolization (from 0.96 ± 0.34 to 0.33 ± 0.17 fraction. The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 ± 1.71 to 60.76 ± 6.62 mmHg, but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 ± 1.22 to 23.15 ± 8.24 mmHg. Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 ± 1.36 to 37.61 ± 12.79 mmHg, as also did the calculated alveolar (from 56.38 ± 22.47 to 178.09 ± 37.46 mL and physiological (from 0.37 ± 0.05 to 0.75 ± 0.10 fraction dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution

  19. Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study

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    Golzari Samad EJ

    2011-06-01

    Full Text Available Abstract Background Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum. Methods A prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1 were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo2 to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H2O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software. Results Before the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49 and 16.6% (CI 0-0.34 respectively. After the additional training program in the

  20. Effects of cerebral ischemia on human neurovascular coupling, CO2 reactivity, and dynamic cerebral autoregulation.

    Science.gov (United States)

    Salinet, Angela S M; Robinson, Thompson G; Panerai, Ronney B

    2015-01-15

    Cerebral blood flow (CBF) regulation can be impaired in acute ischemic stroke but the combined effects of dynamic cerebral autoregulation (CA), CO2 cerebrovascular reactivity (CVR), and neurovascular coupling (NVC), obtained from simultaneous measurements, have not been described. CBF velocity in the middle cerebral artery (MCA) (CBFv, transcranial Doppler), blood pressure (BP, Finometer), and end-tidal Pco2 (PetCO2 , infrared capnography) were recorded during a 1-min passive movement of the arm in 27 healthy controls [mean age (SD) 61.4 (6.0) yr] and 27 acute stroke patients [age 63 (11.7) yr]. A multivariate autoregressive-moving average model was used to separate the contributions of BP, arterial Pco2 (PaCO2 ), and the neural activation to the CBFv responses. CBFv step responses for the BP, CO2, and stimulus inputs were also obtained. The contribution of the stimulus to the CBFv response was highly significant for the difference between the affected side [area under the curve (AUC) 104.5 (4.5)%] and controls [AUC 106.9 (4.3)%; P = 0.008]. CBFv step responses to CO2 [affected hemisphere 0.39 (0.7), unaffected 0.55 (0.8), controls 1.39 (0.9)%/mmHg; P = 0.01, affected vs. controls; P = 0.025, unaffected vs. controls] and motor stimulus inputs [affected hemisphere 0.20 (0.1), unaffected 0.22 (0.2), controls 0.37 (0.2) arbitrary units; P = 0.009, affected vs. controls; P = 0.02, unaffected vs. controls] were reduced in the stroke group compared with controls. The CBFv step responses to the BP input at baseline and during the paradigm were not different between groups (P = 0.07), but PetCO2 was lower in the stroke group (P < 0.05). These results provide new insights into the interaction of CA, CVR, and NVC in both health and disease states. PMID:25593216

  1. The respiratory monitoring of preventing respiratory complications during auxiliary oxygen%预防辅助吸氧呼吸并发症的呼吸监测

    Institute of Scientific and Technical Information of China (English)

    严艳; 高伟; 崔晓光

    2014-01-01

    背景 辅助吸氧有利于预防和治疗自主呼吸患者的低氧血症,却增加了对患者呼吸监测的难度.若呼吸抑制未及时监测、早期发现和处理,可引起呼吸暂停甚至呼吸停止等从而危及患者生命. 目的 综述目前临床上应用的几种监测患者自主呼吸功能的方法. 内容 目前监测呼吸功能的方法包括临床体征观察、脉搏血氧饱和度(oxygen saturation with pulseoximetry,SpO2)监测、二氧化碳描记图、经皮氧分压/二氧化碳分压仪监测.介绍这些方法在临床上应用原理、有效性和优、缺点. 趋向 了解这些监测方法,用于患者呼吸监测及管理,确保患者安全.%Background Auxiliary oxygen is advantageous to the prevention and treatment of hypoxemia in patients with spontaneous breathing,but increase the difficulty of respiratory function monitoring on the patients.If respiratory depression do not timely monitor,discover and treat,it can lead to apnea or even stop breathing,etc,accordingly endanger the patients' life.Objective To review the several methods of monitoring patients spontaneous breathing in clinic at present.Content Methods which monitor respiratory function at present include clinical signs observasion,oxygen saturation with pulse oximetry (SpO2)monitoring,capnography,and percutaneous oxygen partial pressure/carbon dioxide partial pressure instrument monitoring.In this paper,it is introduced that the principle and effectiveness of these methods which were used clinically and their advantages and disadvantages.Trend To understand and use these monitoring methods for respiratory monitoring and management of patients,in order to ensure patient safety.

  2. A quest to increase safety of anesthetics by advancements in anesthesia monitoring: scientometric analysis

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    Vlassakov KV

    2015-05-01

    Full Text Available Kamen V Vlassakov, Igor Kissin Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Abstract: The aim of this study was to assess progress in the field of anesthesia monitoring over the past 40 years using scientometric analysis. The following scientometric indexes were used: popularity indexes (general and specific, representing the proportion of articles on either a topic relative to all articles in the field of anesthetics (general popularity index, GPI or the subfield of anesthesia monitoring (specific popularity index, SPI; index of change (IC, representing the degree of growth in publications on a topic from one period to the next; and index of expectations (IE, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000 biomedical journals covered by PubMed. Publications on 33 anesthesia-monitoring topics were assessed. Our analysis showed that over the past 40 years, the rate of rise in the number of articles on anesthesia monitoring was exponential, with an increase of more than eleven-fold, from 296 articles over the 5-year period 1974–1978 to 3,394 articles for 2009–2013. This rise profoundly exceeded the rate of rise of the number of articles on general anesthetics. The difference was especially evident with the comparison of the related GPIs: stable growth of the GPI for anesthesia monitoring vs constant decline in the GPI for general anesthetics. By the 2009–2013 period, among specific monitoring topics introduced after 1980, the SPI index had a meaningful magnitude (≥1.5 in 9 of 24 topics: Bispectral Index (7.8, Transesophageal Echocardiography (4.2, Electromyo­graphy (2.8, Pulse Oximetry (2.4, Entropy (2.3, Train-of-four (2.3, Capnography (1.9, Pulse Contour (1.9, and Electrical Nerve Stimulation for neuromuscular monitoring (1.6. Only one of these topics (Pulse

  3. Excessive variations in the plethysmographic waveform during spontaneous ventilation: an important sign of upper airway obstruction.

    Science.gov (United States)

    Perel, Azriel

    2014-12-01

    signals of impedance plethysmography and capnography persisted, despite the presence of clinically significant UAO. It is, therefore, suggested that monitoring the sPVI may be of great clinical importance in spontaneously breathing patients who are susceptible to develop UAO. PMID:25405690

  4. A quest to increase safety of anesthetics by advancements in anesthesia monitoring: scientometric analysis.

    Science.gov (United States)

    Vlassakov, Kamen V; Kissin, Igor

    2015-01-01

    The aim of this study was to assess progress in the field of anesthesia monitoring over the past 40 years using scientometric analysis. The following scientometric indexes were used: popularity indexes (general and specific), representing the proportion of articles on either a topic relative to all articles in the field of anesthetics (general popularity index, GPI) or the subfield of anesthesia monitoring (specific popularity index, SPI); index of change (IC), representing the degree of growth in publications on a topic from one period to the next; and index of expectations (IE), representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed. Publications on 33 anesthesia-monitoring topics were assessed. Our analysis showed that over the past 40 years, the rate of rise in the number of articles on anesthesia monitoring was exponential, with an increase of more than eleven-fold, from 296 articles over the 5-year period 1974-1978 to 3,394 articles for 2009-2013. This rise profoundly exceeded the rate of rise of the number of articles on general anesthetics. The difference was especially evident with the comparison of the related GPIs: stable growth of the GPI for anesthesia monitoring vs constant decline in the GPI for general anesthetics. By the 2009-2013 period, among specific monitoring topics introduced after 1980, the SPI index had a meaningful magnitude (≥1.5) in 9 of 24 topics: Bispectral Index (7.8), Transesophageal Echocardiography (4.2), Electromyography (2.8), Pulse Oximetry (2.4), Entropy (2.3), Train-of-four (2.3), Capnography (1.9), Pulse Contour (1.9), and Electrical Nerve Stimulation for neuromuscular monitoring (1.6). Only one of these topics (Pulse Contour) demonstrated (in 2009-2013) high values for both IC and IE indexes (76 and 16.9, respectively), indicating significant recent progress. We suggest that rapid growth in the field of

  5. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.

    Science.gov (United States)

    Jarzyna, Donna; Jungquist, Carla R; Pasero, Chris; Willens, Joyce S; Nisbet, Allison; Oakes, Linda; Dempsey, Susan J; Santangelo, Diane; Polomano, Rosemary C

    2011-09-01

    As the complexity of analgesic therapies increases, priorities of care must be established to balance aggressive pain management with measures to prevent or minimize adverse events and to ensure high quality and safe care. Opioid analgesia remains the primary pharmacologic intervention for managing pain in hospitalized patients. Unintended advancing sedation and respiratory depression are two of the most serious opioid-related adverse events. Multiple factors, including opioid dosage, route of administration, duration of therapy, patient-specific factors, and desired goals of therapy, can influence the occurrence of these adverse events. Furthermore, there is an urgent need to educate all members of the health care team about the dangers and potential attributes of administration of sedating medications concomitant with opioid analgesia and the importance of initiating rational multimodal analgesic plans to help avoid adverse events. Nurses play an important role in: 1) identifying patients at risk for unintended advancing sedation and respiratory depression from opioid therapy; 2) implementing plans of care to assess and monitor patients; and 3) intervening to prevent the worsening of adverse events. Despite the frequency of opioid-induced sedation, there are no universally accepted guidelines to direct effective and safe assessment and monitoring practices for patients receiving opioid analgesia. Moreover, there is a paucity of information and no consensus about the benefits of technology-supported monitoring, such as pulse oximetry (measuring oxygen saturation) and capnography (measuring end-tidal carbon dioxide), in hospitalized patients receiving opioids for pain therapy. To date, there have not been any randomized clinical trials to establish the value of technologic monitoring in preventing adverse respiratory events. Additionally, the use of technology-supported monitoring is costly, with far-reaching implications for hospital and nursing practices. As a

  6. Carbon dioxide accumulation during analgosedated colonoscopy: Comparison of propofol and midazolam

    Institute of Scientific and Technical Information of China (English)

    Ludwig T Heuss; Shajan Peter Sugandha; Christoph Beglinger

    2012-01-01

    AIM:To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol.METHODS:Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme.All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen.Oxygen saturation (SpO2) was measured by pulse oximetry (POX),and capnography (PcCO2) was continuously measured using a combined dedicated sensor at the ear lobe.Instances of apnea resulting in measures such as stimulation of the patient,a chin lift,a mask maneuver,or withholding of sedation were recorded.PcCO2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points:baseline,maximal rise,termination of the procedure and 5 min after termination of the procedure.The number of patients in both study groups who regained baseline PcCO2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS:A total of 97 patients entered this study.The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems.Therefore,83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n =42) or midazolam (n =41) for sedation.Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups,respectively].A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms.The mean SpO2 at baseline (%) was 99± 1 for the midazolam group and 99 ± 1 for the propofol group.No cases of hypoxemia (SpO2 < 85%) or apnea were

  7. The cardiovascular and respiratory effects of medetomidine and thiopentone anaesthesia in dogs breathing at an altitude of 1486 m

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    K. E. Joubert

    2002-07-01

    Full Text Available The purpose of this study was to evaluate the cardio-respiratory effects of the combination of medetomidine and thiopentone followed by reversal with atipamezole as a combination for anaesthesia in 10 healthy German Shepherd dogs breathing spontaneously in a room at an altitude of 1486 m above sea level with an ambient air pressure of 651 mmHg. After the placement of intravenous and intra-arterial catheters, baseline samples were collected. Medetomidine (0.010 mg/kg was administered intravenously and blood pressure and heart rate were recorded every minute for 5 minutes. Thiopentone was then slowly administered until intubation conditions were ideal. An endotracheal tube was placed and the dogs breathed room air spontaneously. Blood pressure, pulse oximetry, respiratory and heart rate, capnography, blood gas analysis and arterial lactate were performed or recorded every 10 minutes for the duration of the trial. Thiopentone was administered to maintain anaesthesia. After 60 minutes, atipamezole (0.025 mg/kg was given intramuscularly. Data were recorded for the next 30 minutes. A dose of 8.7 mg/kg of thiopentone was required to anaesthetise the dogs after the administration of 0.010 mg/kg of medetomidine. Heart rate decreased from 96.7 at baseline to 38.5 5 minutes after the administration of medetomidine (P < 0.05. Heart rate then increased with the administration of thiopentone to 103.2 (P < 0.05. Blood pressure increased from 169.4/86.2 mmHg to 253.2/143.0 mmHg 5 minutes after the administration of medetomidine (P < 0.05. Blood pressure then slowly returned towards normal. Heart rate and blood pressure returned to baseline values after the administration of atipamezole. Arterial oxygen tension decreased from baseline levels (84.1 mmHg to 57.8 mmHg after the administration of medetomidine and thiopentone (P < 0.05. This was accompanied by arterial desaturation from 94.7 to 79.7 % (P < 0.05. A decrease in respiratory rate from 71.8 bpm to 12

  8. 呼吸末二氧化碳在危重病患者代谢性紊乱中预测价值%ETCO2 :The predicative value of metabolic disturbances in critical patients

    Institute of Scientific and Technical Information of China (English)

    刘亚凤; 李文强; 陈阵; 胡念丹

    2012-01-01

    目的:探讨呼吸末二氧化碳( ETCO2)在急危重患者代谢性紊乱中的预测价值.方法:分析2011-06-2011 09急诊入住武汉大学人民医院重症医学科的100例患者,入院后使用碳酸波形图监测初始ETCO2值,ETCO2监测完毕以后迅速抽血做血气分析监测HCO3值.统计数据并分析ETCO2和HCO3值的关系,同时比较分析存活组和死亡组以及HCO3≤21 mmol/L和HCO3>21 mmol/L的病例ETCO2和HCO3值的关系.结果:ETCO2和HCO3中度相关(R=0.593),死亡组ETCO2和HCO3值较存活组均明显减低,HCO3≤21 mmol/L组ETCO2较HCO3>21 mmol/L组低,差异有统计学意义.ETCO2可反映HCO3的水平,ROC曲线下面积是0.754(95% CI:0.659~0.850),ETCO2=32.5 mmHg时,灵敏度=0.65,特异度=0.85,Youden指数=0.5,阳性似然比=4.3,阴性似然比=0.5,ETCO2 36.5 mmHg时,特异度均在95%以上,甚至等于1.结论:碳酸波形图监测的ETCO2值作为一种无创的诊断工具,可有效预测危重症患者代谢性紊乱的发生,为临床评估患者的危重程度提供有力的证据,并为临床治疗的时机提供及时性的指导.%Objectives To discuss ETCOz's predictive value of metabolic disturbances in critical patients. Methods 100 patients admitted in ICU of People's Hospital of Wuhan University from 2011-6 to 2011-9 were analyzed in this study. After admission, every critical patient had a simultaneous ETCO; measurement using capnography. Then, blood gas analysis monitoring HCO3 value was taken quickly. The relationship between ETCOz and HCOs in survival and dead group, HCO3≤21 tnmol/1 and HCO3 >21 mmol/1 group was comparative analyzed. Result: There was a moderate correlation between the value of ETCO2 and HCO3 levels (r = 0. 593). The mean ETCO2 and HCOj level were significantly lower in patients who died. The value of ETCO2 measurement for detecting low bicarbonate level was found to be significant. The area under the receiver operating characteristic curve was 0. 754 (95% CI, 0. 659~O

  9. Comparative study among acepromazine, chlorpromazine and methotrimeprazine in different doses, through bispectral index, term and pressure algimetry, in dogs / Estudo comparativo entre a acepromazina, clorpromazina e levomepromazina em diferentes doses, através do exame bispectral, termo e pressoalgimetria, em cães

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    Lidia Mitsuko Matsubara

    2009-12-01

    Full Text Available The study’s objective was to realize comparisons among different acepromazine, chlorpromazine and methotrimeprazine doses, evaluate parametric changes, test analgesia using press and term algimetry, and evaluate bispectral condition. 90 mongrel dogs were used, male and female, adult, weighting 10 to 15 Kg as a rule, distributed in 9 groups with 10 animals each. At first, second and third groups acepromazine was used at 0,1; 0,05 e 0,025 mg/Kg, respectively. At forth, fifth and sixth groups, chlorpromazine was used at 1,0; 0,5 and 0,25 mg/Kg, respectively. At seventh, eighth and ninth groups, methotrimeprazine at 1,0; 0,5 and 0,25 mg/Kg was used, respectively. All drugs were administered intravenously. Objects of study: heart rate (HR, non invasive blood pressure (SAP, MAP, DAP, respiratory rate (f, capnography (ETCO2, pulse oxymetry (SatO2, mouth and rectal temperature, bispectral index (BIS, electromyography (EMG%, press and term algimetry. Somatic analgesia was evaluated by animal’s response to nociceptives stimulus. We concluded that chlorpromazine had more hypotension. Dogs showed higher hypnosis level at chlorpromazine group, with evident myorelaxation. All groups showed analgesia to thermic and mechanic stimulus. Acepromazine group showed high duration to both pain stimuli. Bispectral index was shorten at chlorpromazine group at 1,0 mg/kg doses, showing higher hypnosis index, and acepromazine was the less depressing considering the bispectral index.Objetivou-se comparar, em diferentes doses, a acepromazina, a clorpromazina e a levomepromazina com relação às alterações paramétricas, à analgesia avaliada através da presso e termoalgimetria e a condição bispectral em 90 cães sem raça definida alocados em nove grupos. No primeiro, segundo e terceiro grupo foi empregada a acepromazina nas doses de 0,1; 0,05 e 0,025 mg/kg, respectivamente. No quarto, quinto e sexto grupo foi empregada a clorpromazina nas doses de 1,0; 0,5 e 0

  10. Variáveis capnográficas pré e pós-tromboendarterectomias pulmonares Pre and post-pulmonary thromboendarterectomies campnographic variables

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    Marcos Mello Moreira

    2007-12-01

    Full Text Available Este relato de dois casos com os resultados da fração tardia de espaço morto (fDlate, fração do espaço morto alveolar end-tidal (AVDSf, gradiente artério-alveolar de CO2 [P(a-etCO2] e slope da fase 3 do espirograma, submetidos à tromboendarterectomia pulmonar por tromboembolismo pulmonar (TEP. O TEP foi diagnosticado pela cintilografia pulmonar, tomografia helicoidal computadorizada e por arteriografia pulmonar. O cálculo da fDlate, AVDSf e P(a-etCO2 baseou-se na capnografia volumétrica associada à gasometria arterial. A fDlate préoperatória do primeiro paciente foi de 0,16 (cutoff de 0,12 e a AVDSf = 0,30 (cutoff de 0,15. Já a fDlate do segundo paciente resultou falso-negativa (0,01, embora a AVDSf resultasse positiva (0,28. A fDlate pós-operatória do primeiro paciente foi de -0,04 e a AVDSf de 0,16; a fDlate do segundo paciente foi de 0,07 e a AVDSf = 0,28. A associação destas variáveis com os exames por imagem reforça a importância deste método como ferramenta diagnóstica não-invasiva no diagnóstico de TEP.In these case report, the results of late dead space fraction (fDlate, end-tidal alveolar dead space fraction (AVDSf, arterial-alveolar gradient CO2 [P(a-etCO2], and slope phase 3 of spirogram of two patients who underwent thromboendarterectomy for pulmonary embolism (PE are shown. PE was diagnosed by pulmonary scintigraphy, helical tomography, and pulmonary angiography. The calculation of fDlate, AVDSf and P(a-etCO2 was based on volumetric capnography associated with arterial blood gas analysis. The pre-operative fDlate of the first patient was 0.16 (cutoff 0.12 and AVDSf was 0.30 (cutoff 0.15. However, the fDlate of the second patient was false-negative (0.01 but, the AVDSf was positive (0.28. Postoperative fDlate of the first patient was -0.04 and AVDSf was 0.16; for the second patient, the values were 0.07 and 0.28, respectively. The association of these capnographic variables with image exams reinforces the

  11. Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol Comparación entre la insuflación con aire ambiente o con dióxido de carbono durante la colonoscopia en pacientes sedados con propofol

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    Pilar Díez-Redondo

    2012-08-01

    Full Text Available Objectives: compare the intensity of pain experienced after colonoscopy with air or with CO2 and evaluate the safety of CO2 in colonoscopies performed with moderate/deep sedation. Materials and methods: individuals undergoing ambulatory colonoscopy without exclusion criteria (severe respiratory disease, morbid obesity were randomized in air or CO2 group. We recorded different variables prior to, during and upon completion of the colonoscopy, performing monitoring using pulse oximetry and capnography. Each patient rated, using a visual numeric scale, the intensity of post-colonoscopy pain at different moments. Results: 141 individuals in the air group (sex M/F 63/78, age 24-83 and 129 in the CO2 group (sex M/F 59/70, age 24-82. No significant differences existed in the recorded variables in both groups except for the greater number of explorations performed by an endoscopist in training (TE in the air group compared to those by a more experienced endoscopist (SE. CO2 in expired air, episodes of oxygen desaturation and of apnoea and dose of propofol, of midazolam were similar in both groups. No episodes of hypercapnea or any complication requiring cardiopulmonary resuscitation measures were recorded. The pain in the air group was significantly higher at 15 minutes and at 1, 3 and 6 hours after the endoscopy, equalising at 24 hours. After multivariant adjustment for type of doctor (TE vs. SE the differences observed in pain intensity for each group were maintained. Conclusions: a the use of CO2 in colonoscopy causes significantly less pain in the first 6 hours after the procedure; b its use in patients with moderate/deep sedation is safe; and c performance of the endoscopic technique is not modified, nor are times reduced.Objetivos: comparar la intensidad del dolor experimentado tras una colonoscopia con aire ambiente o con dióxido de carbono (CO2 y evaluar la seguridad del CO2 en pacientes con sedación moderada o profunda. Materiales y m

  12. Associação entre índice de ventilação e tempo de ventilação mecânica em lactentes com bronquiolite viral aguda Association between ventilation index and time on mechanical ventilation in infants with acute viral bronchiolitis

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    Armando A. Almeida-Júnior

    2005-12-01

    of variables with significant correlations. METHODS: Twenty-nine infants admitted to the pediatric intensive care unit of UNICAMP university hospital were studied. Acute viral bronchiolitis was defined according to clinical and radiological criteria. Children with chronic diseases and those that were hemodynamically unstable were excluded. All measurements were taken after 24 to 72 hours' mechanical ventilation, using volumetric capnography and blood gas analysis. Mechanical ventilation time was divided into: 7 days. Association between time on mechanical ventilation and the variables analyzed was determined by Spearman's Correlation Coefficient (r s. RESULTS: Time on mechanical ventilation showed a significant positive correlation with PaCO2 (r s = 0.45, p = 0.01 and ventilation index (r s = 0.51, p = 0.005, and a negative correlation with pH (r s = -0.40, p = 0.03. Ventilation indices of 37, measured between day one and day five, was associated with a progressively increased risk of more than 7 days on mechanical ventilation (OR = 4.2 on the first day to 15.71 on the fourth day. CONCLUSION: Ventilation index, PaCO2 and pH, measured early, were associated with prolonged mechanical ventilation, reflecting the severity of ventilatory disturbance and the need for support.

  13. P ET CO2 e SpO2 permitem ajuste ventilatório adequado em pacientes obesos mórbidos P ET CO2 y SpO2 permiten ajuste de ventilación adecuada en pacientes obesos mórbidos P ET CO2 and SpO2 allow adequate ventilatory adjustment in morbidly obese patients

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    Fábio Ely Martins Benseñor

    2004-08-01

    O2 mayor que 95%. No se utilizó PEEP. A través de monitor respiratorio CO2SMO Plus, se midió espacios muertos fisiológico, alveolar y de vías aéreas (VD phy, VD alv y VD aw y el volumen corriente alveolar (VT alv. Muestras de sangre arterial y venoso central permitieron calcular PaO2/FIO2 y VD phy/VT. Los datos fueron comparados y analizados por ANOVA (p BACKGROUND AND OBJECTIVES: Ventilation strategies for anesthesia in morbidly obese patients have been investigated, but an agreement has not been achieved yet. This study aimed at clinically evaluating ventilation adjustments based on oximetry and capnography readings in these patients during anesthesia. METHODS: Consent was obtained from the Institutional Ethics Committee and from patients. Smokers and respiratory or cardiac disease patients were excluded. Eleven patients with Body Mass Index (BMI of 59.2 ± 8.3 undergoing gastroplasty under general anesthesia were studied (Group O, with a control group (NO composed of 8 non-obese patients (BMI 20.2 ± 3.9 submitted to gastrectomy. Ventilator was adjusted to keep P ET CO2 below 40 mmHg and SpO2 above 95%. PEEP was not used. Through a CO2SMO Plus respiratory monitor, airway, alveolar and physiologic dead spaces (respectively VD aw, VD phy and VD alv, as well as alveolar tidal volume (TV alv were measured. Arterial and central venous blood samples were used to calculate PaO2/FIO2 and VD phy/TV relationships. Data were compared and evaluated by ANOVA (p < 0.05. RESULTS: Tidal volume was 4.2 ± 0.4 mL.kg-1 in Group O and 7.9 ± 2.3 mL.kg-1 in Group NO for measured weight, and 11.5 ± 1.8 mL.kg-1 in Group O and 6.6 ± 1.1 mL.kg-1 in Group NO for ideal weight. PaO2 was lower and TV alv was higher in Group O (p < 0.008 and 0.0001, respectively. No difference was found in PaCO2, VD phy, VD alv and VD aw. CONCLUSIONS: SpO2 and P ET CO2 seem to assure adequate ventilation, which can be achieved in morbidly obese patients with tidal volumes adjusted to ideal weight.

  14. Correlation of end-tidal carbon dioxide and arterial partial pressure of carbon dioxide during robotic cardiac surgery%机器人心脏手术中呼气末二氧化碳分压与动脉二氧化碳分压的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王刚; 肖赛松; 高长青; 陈婷婷; 周琪; 李佳春; 王加利; 王瑶

    2011-01-01

    目的 探讨机器人心脏手术中体外循环前后及单肺通气条件下呼气末二氧化碳分压(PETCO2)与动脉二氧化碳分压(PaCO2)的相关性.方法 80例行机器人心脏手术的患者,按疾病种类分为三组:先天性心脏病组35例(A组),二尖瓣疾病组27例(B组),冠心病组18例(C组),分别在诱导后双肺通气(TLV)30 min(T1),单肺通气(OLV)30 min(T2),OLV+二氧化碳气胸30 min(T3),OLV+二氧化碳气胸60 min(T4),OLV+二氧化碳气胸90 min(T5),停体外循环后OLV 30 min(T6),恢复TLV 30 min(T7)等时刻抽取动脉血做血气分析,比较PaCO2与PETCO2.结果 三组患者的PETCO2与 PaCO2除了在T2时刻没有相关性外(P>0.05),其余时刻均有相关性(P<0.05);A组和B组的PETCO2、PaCO2和PETCO2与PaCO2的差值(Pa-ETCO2)在体外循环后均增加(P<0.05);C组PETCO2与PaCO2在T3、T4、T5时刻逐渐升高,Pa-ETCO2也逐渐增大(P<0.05).结论 在机器人心脏手术的各类心脏疾病中的PETCO2与PaCO2有良好的相关性,随着二氧化碳气胸时间的延长,两者的差值逐渐增大;在体外循环后两者的差异也比体外循环前明显增大,所以PETCO2监测不能完全替代机器人心脏手术中的PaCO2测定.%Objective This study was performed to estimate the relationship between end - tidal carbon dioxide ( PETCO2 ) and arterial PCO2( PaCO2 ) during robotic cardiac surgery. Methods Eighty patients were divided into three groups: congenital heart disease group ( Group A, n = 35 ), mitral valve disease group ( Group B, n = 27 ), and coronary heart disease group ( Group C, n = 18 ). The premedication were subcutaneous morphine 0. 1 mg/kg and intramuscular scopolamine 0. 15 - 0. 3 mg. Anesthesia was induced with midazolam 1 -5 mg, etomidate 0. 3 mg/kg, lidocaine 1.0 -1.5 mg/kg, pipecuronium 0. 15 mg/kg and sulfentanyl 1.0-1.5 μg/kg. Measurements of PETCO2 from capnography values and PaCO2 from arterial blood gases were registered at seven time points: 30 min after anesthesia

  15. Insuficiência respiratória crônica nas doenças neuromusculares: diagnóstico e tratamento Chronic respiratory failure in patients with neuromuscular diseases: diagnosis and treatment

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    Ilma Aparecida Paschoal

    2007-02-01

    . Respiratory muscle impairment also affects cough efficiency and, according to the current knowledge regarding the type of treatment available in Brazil to these patients, it can be said that the high rates of morbidity and mortality in these individuals are more often related to the fact that they cough inefficiently rather than to the fact that they ventilate poorly. In this review, with the objective of presenting the options of devices available to support and substitute for natural ventilation in patients with neuromuscular diseases, we have compiled a brief history of the evolution of orthopedic braces and prostheses used to aid respiration since the end of the 19th century. In addition, we highlight the elements that are fundamental to the diagnosis of alveolar hypoventilation and of failure of the protective cough mechanism: taking of a clinical history; determination of peak cough flow; measurement of maximal inspiratory and expiratory pressures; spirometry in two positions (sitting and supine; pulse oximetry; capnography; and polysomnography. Furthermore, the threshold values available in the literature for the use of nocturnal ventilatory support and for the extension of this support through the daytime period are presented. Moreover, the maneuvers used to increase cough efficiency, as well as the proper timing of their introduction, are discussed.

  16. Manejo anestésico e complicações no implante percutâneo de válvula aórtica Manejo anestésico y complicaciones en el implante percutáneo de válvula aórtica Anesthetic management and complications of percutaneous aortic valve implantation

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    Tailur Alberto Grando

    2013-06-01

    monitorizada con una presión arterial promedio (PAP, electrocardiograma (ECG, oximetría, capnografía, ecocardiograma transesofágico, termometría y marcapaso transvenoso. RESULTADOS: Fueron sometidos con éxito al implante valvular 28 pacientes, con una edad promedio de 82,46 años, EuroScore medio de 20,98%, clase funcional III/IV. Nueve pacientes necesitaron implante de marcapaso definitivo. En el seguimiento de los pacientes hubo dos decesos, uno en el transoperatorio por perforación del VI y uno al tercer día por causa desconocida. En 24 meses un paciente falleció con diagnóstico de mieloma múltiple. La técnica anestésica fue segura. CONCLUSIONES: La experiencia inicial con implante valvular aórtico percutáneo bajo anestesia general ha sido segura y eficaz sin complicaciones anestésicas importantes para ese procedimiento.BACKGROUND AND OBJECTIVE: Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia. METHOD: Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM, electrocardiogram (ECG, pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. RESULTS: Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe

  17. Instabilidade hemodinâmica grave durante o uso de isoflurano em paciente portador de escoliose idiopática: relato de caso Severe hemodynamic instability during the use of isoflurane in a patient with idiopathic scoliosis: case report

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    Adriano Bechara de Souza Hobaika

    2007-04-01

    ámica grave causada por isoflurano en pacientes previamente saludables. Anafilaxia, taquicardia supraventricular con repercusión hemodinámica y sensibilidad cardiaca aumentada al isoflurano son discutidas como posibles causas de la inestabilidad hemodinámica. Actualmente, existen evidencias de que el isoflurano pude interferir en el sistema de acoplamiento y desacoplamiento de la contratilidad miocárdica a través de la reducción del Ca2+ citosólico y/o deprimiendo la función de las proteínas contráctiles. Los mecanismos moleculares fundamentales de este proceso deben ser elucidados todavía. El relato sugiere que la administración del isoflurano fue la causa de las alteraciones hemodinámicas presentadas por el paciente y que este, probablemente, presentó una sensibilidad cardiovascular no común al fármaco.BACKGROUND AND OBJECTIVES: Isoflurane is considered a safe inhalational anesthetic. It has a low level of biotransformation, and low hepatic and renal toxicity. In clinical concentrations, it has minimal negative inotropic effect, causes a small reduction in systemic vascular resistance, and, rarely, can cause cardiac arrhythmias. The objective of this report was to present a case of severe hemodynamic instability in a patient with idiopathic scoliosis. CASE REPORT: Male patient, 13 years old, ASA physical status I, with no prior history of allergy to medications, scheduled for surgical repair of idiopathic scoliosis. After anesthetic induction with fentanyl, midazolam, propofol, and atracurium, 1% isoflurane with 100% oxygen was initiated for anesthesia maintenance. After five minutes, the patient presented severe hypotension (MAP = 26 mmHg associated with sinus tachycardia (HR = 166 bpm that did not respond to the administration of vasopressors and fluids. Lung and heart auscultation, pulse oxymetry, capnography, nasopharyngeal temperature, and arterial blood gases did not change. The patient was treated for anaphylaxis and the surgery was cancelled. The

  18. Intubação nasotraqueal às cegas em paciente acordada candidata à hemimandibulectomia: relato de caso Intubación nasotraqueal a ciegas en paciente despierta candidata a la hemimandibulectomía: relato de caso Blind nasotracheal intubation in awaken patient scheduled for hemimandibulectomy: case report

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    Daniel de Carli

    2008-02-01

    old patient, weighing 56 kg, was scheduled for hemimandibulectomy; she presented cervical immobility secondary to arthrodesis, mouth opening of 2.2 cm, moderate retrognatism, voluntary protrusion of the mandible was absent, mentosternal distance of 11 cm and mento-thyroid distance of 6 cm, therefore receiving a score of 5 on the Wilson scale. The patient signed an informed consent after being informed about the procedure. After monitoring and oxygenation, continuous infusion of dexmedetomidine was initiated. Superior and inferior laryngeal nerve block was performed with 2.0% lidocaine without vasoconstrictor and the hypopharinx was anesthetized with a lidocaine spray. Before NTI, ondansetron, midazolam, fentanyl, and droperidol were administered and the patient remained awake and cooperative. Nasal insertion of the tracheal tube was oriented by its opacification and respiratory sounds and the placement was confirmed by pulmonary auscultation and capnography. Continuous infusion of propofol and remifentanil was instituted, vecuronium was administered and controlled ventilation was initiated. The surgery lasted 60 minutes without intercurrences. At the end, the patient was breathing spontaneously, so she was extubated and transferred to the recovery room from where she was discharged without any complaints. CONCLUSION: Nasotracheal intubation is an alternative to fiberoptic endoscopy when safety and control of the airways is uncertain. Informing the patient about the procedure was essential. Safety was assured and respiratory depression and hemodynamic instability was not observed.

  19. Remifentanil versus dexmedetomidina como coadjuvantes de técnica anestésica padronizada em pacientes com obesidade mórbida Remifentanil versus dexmedetomidina como coadyuvantes de técnica anestésica de modelo en pacientes con obesidad mórbida Remifentanil versus dexmedetomidine as coadjutants of standardized anesthetic technique in morbidly obese patients

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    Eliana Cristina Murari Sudré

    2004-04-01

    ás 30% para ambas luego después de la intubación traqueal. Los pacientes fueron monitorizados con presión arterial media invasiva, oximetría de pulso, BIS, capnografia, estimulador de nervio periférico y electrocardiograma. Fueron evaluados: 1 diferentes tiempos de recuperación anestésica (abertura de los ojos, reinicio de la respiración espontanea, tiempo de extubación traqueal, tiempo para el alta de la sala de recuperación pos-anestésica y hospitalar, 2 la evolución de la gasometria arterial, y 3 analgesia pos-operatoria. RESULTADOS: Ochenta y ocho pacientes fueron evaluados. Los pacientes del grupo R presentaron abertura ocular mas precoz (9,49 ± 5,61 min versus 18,25 ± 10,24 min, p BACKGROUND AND OBJECTIVES: Two coadjuvant anesthetic drugs - remifentanil and dexmedetomidine - were compared in terms of anesthetic recovery, arterial pH and PaCO2 evolution, in morbidly obese patients submitted to Capella's surgery. METHODS: Participated in this prospective, randomized and double blind study 92 patients divided in two groups and submitted to standardized anesthetic technique (general/epidural. Remifentanil Group (Group R and Dexmedetomidine Group (Group D received continuous intravenous infusion of these drugs (0.1 µg.kg-1.min-1 and 0.5 µg.kg-1.h-1, ideal body weight plus 30% for both immediately after tracheal intubation. Monitoring consisted of invasive mean blood pressure, pulse oximetry, BIS EEG, capnography, peripheral nerve stimulator and EKG. The following parameters were evaluated: 1 different anesthetic recovery times (eye opening, return to spontaneous ventilation, tracheal extubation time, time for post anesthetic recovery unit and hospital discharge; 2 arterial blood gas analysis evolution; and 3 postoperative analgesia. RESULTS: Evaluation was possible in 88 patients. Patients group R had earlier eye opening (9.49 ± 5.61 min versus 18.25 ± 10.24 min, p < 0.0001, faster return to spontaneous ventilation (9.78 ± 5.80 min versus 16.58 ± 6

  20. Analgesia pós-toracotomia com associação de morfina por via peridural e venosa Analgesia pós-toracotomia con asociación de morfina por vía peridural y venosa Comparison of intravenous and epidural morphine analgesia after thoracotomy

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    Neuber Martins Fonseca

    2002-09-01

    bolus de 25 µg.kg-1, por 30 horas. Análisis de gases arteriales, frecuencias cardíaca y respiratoria, presencia de prurito, náuseas y vómitos y analgesia pós-operatoria fueron evaluados a cada 6 horas, hasta un total de 30 horas del pós-operatorio. La analgesia fue evaluada por escala de graduación numérica (EGN de 0 a 10. RESULTADOS: A EGN presentó reducción en el grupo I apenas en el momento M2 no ocurriendo en los demás intervalos. Nos grupos II y III ocurrieron reducción del dolor a partir de 18 horas en relación a los valores iniciales y en relación al grupo I. Hubo mayor necesidad de analgesia complementar en el grupo I de que en los otros grupos. CONCLUSIONES: Se observó mejor efecto analgésico con morfina venosa o con la asociación de vías venosa y peridural utilizando menos dosis de morfina. Esta diferencia fue expresiva cuando menos cantidades de analgésicos complementares fueron utilizados en estos grupos, ofreciendo un efectivo método de analgesia para el pós-operatorio de cirugía de tórax con menores efectos depresivos respiratorios e emetogénicos.BACKGROUND AND OBJECTIVES: Patients undergoing thoracotomy experience severe postoperative pain. This study aimed at evaluating postoperative analgesia with the association of intravenous and epidural morphine as compared to a single route. METHODS: Participated in this study 20 patients of both genders, physical status ASA I, II or III, scheduled for thoracotomy. Patients were premedicated with intravenous midazolam (3 to 3.5 mg in the OR. Monitoring consisted of continuous ECG, invasive blood pressure, pulse oximetry, capnography, CVP, diuresis and temperature. Continuous epidural anesthesia was induced in T7-T8 with 10 ml of 0.25% bupivacaine followed by fentanyl (5 µg.kg-1, etomidate(0.2 to 0.3 mg.kg-1 and succinylcholine (1 mg.kg-1. Tracheal intubation was performed with a double lumen tube and complemented with pancuronium(0.08 to 0.1 mg.kg-1 and mechanically controlled ventilation

  1. Hipercapnia acentuada durante circulação extracorpórea em cirurgia para revascularização do miocárdio: relato de caso Hipercapnia acentuada durante circulación extracorpórea en cirugía para revascularización del miocárdio: relato de caso Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization: case report

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    Maurício Serrano Nascimento

    2002-04-01

    ía estar conectado al cilindro de aire comprimido. CONCLUSIONES: Fallas mecánicas de los componentes del circuito de extracorpórea pueden ocurrir en el per-operatorio y exigen correcciones rápidas. Los avanzos tecnológicos en los equipamientos de anestesia, monitorización y normatizaciones de seguridad atenuaron la posibilidad de que casos como ese se repitan, más jamás substituirán la presencia vigilante del anestesiólogo.BACKGROUND AND OBJECTIVES: Bypassing heart blood and returning it oxygenated to systemic circulation is achieved at the expenses of major cardiopulmonary physiologic changes. The aim of this report was to present an anesthetic complication during CPB and to warn for the need of interaction of the whole anesthetic-surgical team to prevent adverse perioperative events. CASE REPORT: A brown female patient, 56 years old, 95 kg, height 1.65 m, physical status ASA IV, with chronic renal failure under hemodialysis was admitted for myocardial revascularization. Monitoring consisted of ECG, invasive blood pressure, pulse oximetry, capnography, esophageal temperature, central venous pressure and anesthetic gases analysis. Patient was premedicated with intravenous midazolam (0.05 mg.kg-1. Anesthesia was induced with fentanyl (16 µg.kg-1, etomidate (0.3 mg.kg-1 and pancuronium (0.1 mg.kg-1, and was maintained with O2, isoflurane (0.5 - 1 MAC and fentanyl continuous infusion. Blood gas analysis after induction has shown: pH: 7.41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol.L-1; BE: 0 mmol.L-1; SatO2 100%. A second blood gases analysis, sampled soon after CPB, returned in 30 minutes, showing: pH 7.15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol.L-1; BE: -3 mmol.L-1; SatO2 99%. Thorough and urgent checking of anesthetic and perfusion equipment was performed and revealed that the gas blender was connected to the O2 line and to a CO2 cylinder, when it should be connected to the compressed air cylinder. CONCLUSIONS: Bypass circuit mechanical problems may