Capnography hemodynamic monitoring

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...

INTRODUCTION: Capnography is used to monitor the endtidal carbon dioxide tension (EtCO2) in exhaled gas. Sidestream capnography has great potential to monitor mechanically ventilated pediatric patients, given the continuous sampling from the endotracheal tube into a gas sensor. However, hemodynamic and respiratory impairments may reduce reliability and validity of sidestream capnography to monitor arterial carbon dioxide tension (PaCO2) in critically ill, mechanically ventilated children...

PURPOSE OF REVIEW: To provide an overview on most recent knowledge on methods currently available for monitoring of recruitment maneuvers at the bedside. RECENT FINDINGS: The effects of recruitment maneuvers on clinical outcomes in patients with moderate to severe acute respiratory distress syndrome and in patients with healthy lungs undergoing major surgery were recently assessed. Despite being part of a multifaceted approach of protective ventilation, recruitment maneuvers are supposed to decrease mortality and improve postoperative outcomes...

BACKGROUND: For early detection of respiratory and hemodynamic changes during anesthesia, continuous end-tidal carbon dioxide concentration (PETCO2) is monitored by capnometry. However, the accuracy of CO2 monitoring during spontaneous breathing in extubated patients remains undetermined. Therefore, we aimed to compare P(ETCO2) measured by capnometry using an oxygen mask with a carbon dioxide sampling port (capnometry-type oxygen mask) and P(CO2) in extubated subjects who had undergone abdominal surgery...

The respiratory variations in the plethysmographic (PLET) waveform of the pulse oximeter during mechanical ventilation can be automatically quantified as the PLET variation index (PVI(®)). Like other dynamic variables, the PVI may provide useful information about fluid responsiveness but only when the patient is receiving fully controlled mechanical ventilation with no spontaneous breathing activity. However, a growing number of monitors that automatically measure and display the values of the PVI and other dynamic variables are being introduced into clinical practice...

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...

The aim was to investigate the effect of mechanical pain stimulation at the lower back on hemodynamic and oxygenation changes in the prefrontal cortex (PFC) assessed by functional near-infrared spectroscopy (fNIRS) and on the partial pressure of end-tidal carbon dioxide ( PetCO 2) measured by capnography. 13 healthy subjects underwent three measurements (M) during pain stimulation using pressure pain threshold (PPT) at three locations, i.e., the processus spinosus at the level of L4 (M1) and the lumbar paravertebral muscles at the level of L1 on the left (M2) and the right (M3) side...

BACKGROUND: End-tidal carbon dioxide (ETCO2) correlates with systemic blood flow and resuscitation rate during cardiopulmonary resuscitation (CPR) and may potentially direct chest compression performance. We compared ETCO2-directed chest compressions with chest compressions optimized to pediatric basic life support guidelines in an infant swine model to determine the effect on rate of return of spontaneous circulation (ROSC). METHODS AND RESULTS: Forty 2-kg piglets underwent general anesthesia, tracheostomy, placement of vascular catheters, ventricular fibrillation, and 90 seconds of no-flow before receiving 10 or 12 minutes of pediatric basic life support...

The goal of perioperative monitoring is to aid the clinician in optimizing care to achieve the best possible survival with the lowest possible morbidity. Ideally, we would like to have monitoring that can rapidly and accurately identify perturbations in circulatory well-being that would permit timely intervention and allow for restoration before the patient is damaged. The evidence to support the use of our standard monitoring strategies (continuous electrocardiography, blood pressure, central venous pressure, oxygen saturation and capnography) is based on expert opinion, case series, or at best observational studies...

Hemorrhagic shock (HS) is a setting in which both pulmonary and cutaneous perfusion may be impaired. The goals of this study were to evaluate the relationship between end-tidal (etCO2), transcutaneous (tPCO2), arterial carbon dioxide (PaCO2) and lactate during lethal HS and to assess the effect of progressive HS on those variables and on a new variable, the noninvasive CO2 gradient ([NICO2G] or the difference between tPCO2 and etCO2). Ten consciously sedated swine were hemorrhaged, by means of a computerized exponential protocol, of up to 80% estimated blood volume for 20 min...

BACKGROUND: It is important to be able to accurately monitor cardiac output (CO) during high-risk surgery and in critically ill patients. The invasiveness of the pulmonary artery catheter (PAC) limits its use, and therefore, new minimally invasive methods for CO monitoring are needed. A potential method is estimation of CO from endogenous carbon dioxide measurements, using a differentiated Fick's principle to determine effective pulmonary blood flow (EPBF). In this study, we aimed to validate a novel capnodynamic method (COEPBF) in a wide range of clinically relevant haemodynamic conditions...

BACKGROUND: In the acute respiratory distress syndrome (ARDS), lung-protective ventilation strategies combine the delivery of small tidal volumes (VT) with sufficient positive end-expiratory pressure (PEEP). However, an optimal approach guiding the setting of PEEP has not been defined. Monitoring volumetric capnography is useful to detect changes in lung aeration. OBJECTIVES: The aim of this study was to determine whether volumetric capnography may be a useful method to determine the optimal PEEP in ARDS...

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)...

SESSION TYPE: Heart Failure PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: A recently developed algorithm (RRoxi) provides continuous non-invasive respiratory rate from a pulse oximeter waveform. This approach is based on modulations in the photoplehtysmogram secondary to hemodynamic and autonomic changes during the respiratory cycle. Medical conditions characterized by abnormal cardiorespiratory interactions, such as congestive heart failure (CHF), may influence the fundamental modulations used by RRoxi to extract respiratory rate...

SESSION TYPE: COPD Posters IIPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: A new method of analyzing a pulse oximeter waveform (RRoxi algorithm) allows continuous non-invasive respiratory rate monitoring. The RRoxi algorithm uses respiratory-induced modulations in the photoplethysmogram secondary to changes in hemodynamic and autonomic activity throughout the respiratory cycle. Patients with chronic obstructive pulmonary disease (COPD) may exhibit abnormal cardiorespiratory interactions that could influence the modulations used by RRoxi to extract respiratory rate...

In critically ill intubated patients, assessment of adequacy of ventilation relies on measuring partial pressure of arterial carbon dioxide (PaCO2), which requires invasive arterial blood gas analysis. Alternative noninvasive technologies include transcutaneous CO2 (tPCO2) and end-tidal CO2 (EtCO2) monitoring. We evaluated accuracy of tPCO2 and EtCO2 monitoring in a porcine model of acute lung injury (ALI) due to smoke inhalation and burns. Eight anesthetized Yorkshire pigs underwent mechanical ventilation, wood-bark smoke inhalation injury, and 40% total body surface area thermal injury...

OBJECTIVE: Systemic effects of carbon dioxide (CO2) insufflation during left-sided cardiac surgery were evaluated in a prospective randomized study, with regard to acid-base status, gas exchange, cerebral hemodynamics, and red blood cell morphology. METHODS: Twenty patients undergoing elective left-sided cardiac surgery were randomized to de-airing procedure either by CO2 insufflation technique (CO2 group, n = 10) or by Lund technique without CO2 insufflation (Lund group, n = 10)...

OBJECTIVE: The purpose of this study was to determine whether changes in PETCO2 and exhaled CO2 (VCO2) can predict fluid responsiveness after a preload challenge. DESIGN: A retrospective review of prospectively recorded data. SETTING: A medical intensive care unit of a university-affiliated tertiary care hospital. PARTICIPANTS: Mechanically ventilated patients undergoing a preload challenge. INTERVENTIONS: In the authors' intensive care unit, fluid responsiveness is determined by a passive leg raising (PLR) maneuver and/or a 500-mL crystalloid challenge...

Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate  < 6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)  < 90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)  < 9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)  < 90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate  > 29/min)...

The goals of monitoring are to improve the safety of perioperative care and to improve patient's outcome. Various invasive and non-invasive monitors are currently used. Minimum monitoring standards including blood pressure monitoring, electrocardiogram, pulse oximetry, capnography, temperature monitoring, and neuromuscular monitoring are essential but not enough to achieve the goals. Although emerging technologies have made it possible to monitor cardiac, cerebral and spinal functions in the perioperative period, there is limited evidence that those monitors can improve patient's outcome...