He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. air / oxygen dilution during mask sampling of spontaneously breathing patientsĬhris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne.mandatory versus spontaneously triggered breaths.sometimes see reverse phase 3 slope seen in patients with emphysema (alveolar destruction leads to rapid delivery of CO2 to airways).Dilution of expiratory gases by the forward flow of fresh gases during the later part of expiration when expiratory flow rate decreases below the forward gas flow rate.Rebreathing capnogram of Mapleson D circuit.camel hump (seen in patients in lateral position).curare cleft (partially paralysed patient on mechanical ventilation).right main bronchus intubation (ETCO2 can increase, decrease or stay the same, can also cause a bifid capnogram).esophageal intubation (See Figure 2 of Kodali 2013 and Interpret your capnogram at Inspiratory valve malfunction (elevation of the base line, prolongation of down stroke, prolongation of phase III).Contamination of CO2 monitor (sudden elevation of base line and top line).Water drops in analyzer or condensation in airway adapter.CO2 absorber saturated (check capnograph with room air).Circuit disconnection (note low airway pressures).Total airway obstruction (note high airway pressures).Apnoea test in brain death dead patient.Airway misplaced – extubation, oesophageal intubation.an additional phase IV (terminal upstroke before phase 0) may be seen in pregnancyĮTCO2 only represents alveolar CO2 when a relatively horizontal plateau phase (phase III) is seen.the beta angle is the transition from Phase III to Phase I (the start of inspiration).the alpha angle is the transition from Phase II to Phase III.Normal end-tidal PCO2 is approximately: 38 mmHg or 5%.Phase 0 is the inspiratory downstroke, the beginning of the next inspiration.Traditionally, PCO 2 of the last alveolar gas sampled at the airway opening is called the PETCO 2.

Phase II (expiratory upstroke) is the transition between VD ana, which does not participate in gas exchange, and alveolar gas from the respiratory bronchioles and alveoli.Phase I (inspiratory baseline) reflects inspired gas, which is normally devoid of carbon dioxide.The CO2 waveform can be analyzed for 5 characteristics:–Height–Frequency–Rhythm–Baseline–Shape.Capnography waveform interpretation can be used for diagnosis and ventilator-trouble shooting.Such a prognostic indicator could be used for a more rational approach to prolonged CPR. Initial, minimal, and maximal end-tidal CO2 values were significantly (p 90%) in predicting return of spontaneous circulation is prospectively demonstrated using the maximal end-tidal CO2 during the first 20 mins after tracheal intubation, with a cutoff value of 10 torr. Return of spontaneous circulation occurred in eight patients. Presenting rhythm was asystole in 22 of the first 24 patients. One hundred twenty patients, during nontraumatic cardiac arrest.Įnd-tidal CO2 values were measured continuously after tracheal intubation, and were categorized as the initial value, and as minimal and maximal values during the first 20 mins. To determine whether continuous semiquantitative assessment of end-tidal CO2 could provide a highly sensitive predictor of return of spontaneous circulation during cardiopulmonary resuscitation (CPR).

Entitled co2