etco2 linkedin
TRANSCRIPT
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End-Tidal CO2 (EtCO2)
The Wave Of The Future
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EtCO2 Basics
EtCO2 measures ventilation
SAo2 measures oxygenation
Uses infra-red light to measure exhaled air
Vacuum in LP15 draws 50mL/min
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EtCO2 Basics
Tachypnea - abnormally rapid breathing
Hyperventilation - Increased minute ventilation that results in decreased EtCO2 levels (hypocapnea)
Hypoventilation - Decreased minute ventilation that results in increased EtCO2 levels (hypercapnea)
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Cellular Ventilation
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Alveolar Ventilation
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EtCO2 BasicsEtCO2 monitoring is continuous - changes are immediately seen (CO2 diffuses across membranes < 0.5 sec)
SAo2 monitoring relies on trending
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EtCO2 Basics
Normal Values 35-45mmHg <35 = hyperventilation decreased metabolic state >45 = hypoventilation increased metabolic state
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EtCO2 Basics< 35mmHg (Hyperventilation) Increased CO2 clearance (tachypnea) Decreased CO2 production (hypothermia, sedation, paralysis) Decreased delivery to lungs (decreased cardiac output) V/Q mismatch (ventilating non-perfused lungs - Pulmonary embolism)
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EtCO2 Basics
> 45mmHg (Hypoventilation) Decreased central drive, muscle weakness, diffusion problems Increased CO2 production (Fever, burns, Hyperthyroidism, sz, Bicarb, ROSC, reperfusion)
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EtCO2 Basics
Normal Capnogram
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EtCO2 Basics
Baseline - CO2-free air in dead spaces
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EtCO2 Basics
Expiratory Upstroke (exhalation)
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EtCO2 Basics
Expiratory plateau (exhalation of mostly alveolar gases)
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EtCO2 Basics
Inspiration (inhalation of CO2-free gases)
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Bronchospasm
Normal Bronchospasm(Uneven alveolar emptying)
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Emphysema
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Pulmonary Edema
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Poor Plateau
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Differential Lung Emptying
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Curare Cleft
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Carbonated Beverages
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Esophageal Intubation
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Ineffective Respirations
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Pain Management/Sedation
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Hypothermia/Low Metabolic Demand
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Malignant Hyperthermia
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Metabolic StatesDiabetes/Dehydration EtCO2 tracks serum HCO3 & degree of acidosis ↓EtCO2 = metabolic acidosis
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Metabolic States
Sepsis
EtCO2 inversely related to Lactate
The lower the EtCO2, the higher the lactate levels
Lactate levels >4 = sepsis
EtCO2 levels <25 = sepsis alert
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Cardiac Output
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Cardiac
CHF/Heart Failure
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Cardiac Arrest