Capnography

It is usually presented as a graph of CO2 (measured in kilopascals, "kPa" or millimeters of mercury, "mmHg") plotted against time, or, less commonly, but more usefully, expired volume (known as volumetric capnography).

Therefore the monitoring of end tidal CO2 can provide vital information on the integrity of the cardiovascular system, specifically how well the heart is able to pump blood.

[5] The amount of CO2 that is measured during each breath requires an intact cardiovascular system to delivery the CO2 to the alveoli which is the functional unit of the lungs.

These three phases are important to understand in clinical scenarios since a change in the shape and absolute values can indicate respiratory and/or cardiovascular compromise.

[8] Capnography has been shown to be more effective than clinical judgement alone in the early detection of adverse respiratory events such as hypoventilation, esophageal intubation and circuit disconnection; thus allowing patient injury to be prevented.

During procedures done under sedation, capnography provides more useful information, e.g. on the frequency and regularity of ventilation, than pulse oximetry.

Capnography and pulse oximetry together could have helped in the prevention of 93% of avoidable anesthesia mishaps according to an ASA (American Society of Anesthesiologists) closed claim study.

[11] Capnography is increasingly being used by EMS personnel to aid in their assessment and treatment of patients in the prehospital environment.

[13] The American Heart Association (AHA) affirmed the importance of using capnography to verify tube placement in their 2005 CPR and Emergency Cardiovascular Care Guidelines.

[14] The AHA also notes in their new guidelines that capnography, which indirectly measures cardiac output, can also be used to monitor the effectiveness of CPR and as an early indication of return of spontaneous circulation (ROSC).

Studies have shown that when a person doing CPR tires, the patient's end-tidal CO2 (PETCO2, the level of carbon dioxide released at the end of expiration) falls, and then rises when a fresh rescuer takes over.

[15] Paramedics are also now beginning to monitor the PETCO2 status of nonintubated patients by using a special nasal cannula that collects the carbon dioxide.

When compared to oxygenation which is measured by pulse oximetry, there are several disadvantages that capnography can help address to provide a more accurate reflection of cardiovascular integrity.

The analysis is rapid and accurate, but the presence of nitrous oxide in the gas mix changes the infrared absorption via the phenomenon of collision broadening.

This was established as a reliable technique by John Tyndall in 1864, though 19th and early 20th century devices were too cumbersome for everyday clinical use.

Source of CO2 Content During Exhalation
Capnograph
Schematic overview of a capnograph