The end-tidal capnography

Introduction


End-tidal capnography, also known as PETCO2, ET CO2, is a graphical partial calculation of carbon dioxide through mm Hg during expiration (Galie et al., 2011). Since its inception in 1930, this method has been available since 1950, through the sale and manufacturing of capnography displays. When technology progressed, end-tidal carbon dioxide control became a critical factor in the progression of patient safety in anesthesiology.

The ASA Approval


The ASA immediately approved the end-tidal capnography standards (American Society of Anesthesiologists), it became the standard of care for moderate sedation, general anesthesia, and deep sedation (Galie et al., 2011). Other specialties that later followed included the critical attention and emergency medicine that were frequently used to implement the end-tidal capnography monitoring. In normal circumstances, carbon monoxide monitoring was managed by capillary or arterial blood analysis because it allowed continuous checkups of the alveolar ventilation to intubated patients (Galie et al., 2011). I addition, it is also used as a safety parameter to control the pressure-support level automatically.

Data Collection


The study is done through pure observations and protocols criteria of stabilizing the neurological status of ventilation with pressure support. The method of data collection is through arterial blood samples drawn from the clinical indication and later analyzed for a few minutes through the Copenhagen, Radiometer, as well as the GEM premier 4000 (Galie et al., 2011). After a few minutes, patients are ventilated with the infrared PETCO2 and the smart care system (which is the mainstream sensor) connected to the CO2 cuvette meant for measuring.

Uses of PETCO2


Despite the fact that PETCO2 cannot be used as the primary control parameter, it is also used in low respiratory rate situations to assist the difference between the lead of the central hyperventilation verses the hyperventilation that has hypocapnia (Galie et al., 2011). On the other hand, PETCO2 also improves ventilation with the smart care because of its dedicated software that records the ventilator data every ten seconds. The procedure involves taking samples of the PETCO2, average respiratory rate, VT over two to five minutes at a sampling period of 10 seconds (Galie et al., 2011). In an average, preliminary study, the Vent view compares the PETCO2 data with the Smart Care periods as well as the difference between the smart care and vent view data. In other words, instead of comparing the average PETCO2 values, it compares the smart care's classification to the maximum values of the PETCO2 (Galie et al., 2011).

Statistics and Results


The statistics of this study is to analyze the relationship between the average and maximum PETCO2 and PaCO2 through linear regression. The Pearson test was used to evaluate correlation through the quantitative data expressed as a median and interquartile range. As a result, the linear regression between PaCO2 and PETCO2 had close identities in line with the maximum of PETCO2 because it varied from breath to breath (Galie et al., 2011). In most cases, two-thirds of spontaneous breaths from PETCO2 was greater than of the ventilator breaths. Also, it was discovered that there was a difference between PaCO2 and PETCO2 in patients with pulmonary embolism as compared to the one without. Lastly, patients with emphysema or parenchymal lung disease who underwent through mechanical ventilation showed that PETCO2 was greater as compared to PaCO2.

Conclusion


As elaborated in the essay, the infrared sensor usually under-estimates PaCO2. This is because PETCO2 maximum point tends to be closer to alveolar CO2. As a result, the use of maximum PETCO2 can be used to improve the efficiency and accuracy of Smart care without harming the patient.


Reference

Galia, F., Brimioulle, S., Bonnier, F., & Vandenbergen, N. (2011). RESPIRATORY CARE. Use of Maximum End-Tidal CO2 Values to Improve End-Tidal CO2 Monitoring Accuracy, 56(3), 278-283.

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