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Salvatore Silvestri, Jay G Ladde, James F Brown, Jesus V Roa, Christopher Hunter, George A Ralls, Linda Papa
BACKGROUND: Waveform capnography is considered the gold standard for verification of proper endotracheal tube placement, but current guidelines caution that it is unreliable in low-perfusion states such as cardiac arrest. Recent case reports found that long-deceased cadavers can produce capnographic waveforms. The purpose of this study was to determine the predictive value of waveform capnography for endotracheal tube placement verification and detection of misplacement using a cadaveric experimental model...
January 19, 2017: Resuscitation
Tsukasa Ishiwata, Kenji Tsushima, Mai Fujie, Kenichi Suzuki, Kosuke Hirota, Mitsuhiro Abe, Naoko Kawata, Jiro Terada, Koichiro Tatsumi
BACKGROUND: Apnea developing as a result of oversedation is a potential clinical problem in patients undergoing flexible bronchoscopy (FB) under sedation. However, there are no reports of evaluation using a standardized method of the frequency of occurrence of apnea episodes during FB under sedation. The aim of this study was to investigate the frequency of apnea episodes during FB under sedation in the clinical setting by end-tidal capnography. METHODS: This study was a single-institution retrospective review of a prospectively maintained database and medical records, including capnographic data, from April 2015 to March 2016...
January 7, 2017: BMC Pulmonary Medicine
Justin S Phillips, Lance P Pangilinan, Earl R E Mangalindan, Joseph L Booze, Richard H Kallet
BACKGROUND: Accurately measuring the partial pressure of end-tidal CO2 (PETCO2 ) in non-intubated patients is problematic due to dilution of expired CO2 at high O2 flows and mask designs that may either cause CO2 rebreathing or inadequately capture expired CO2. We evaluated the performance of 2 capnographic O2 masks (Cap-ONE and OxyMask) against a clinically expedient method using a standard O2 mask with a flow-directed nasal cannula used for capnography (CapnoLine) in a spontaneous breathing model of an adult and child under conditions of normal ventilation, hypoventilation, and hyperventilation...
January 2017: Respiratory Care
Mukesh Tripathi, Nilay Tripathi, Mamta Pandey
Modern anesthesia workstations display capnography, flow-time, and pressure-time waveforms in real time. We observed that at certain ventilator settings (10 breaths/min) on Dräger workstations, the expiratory phase of the capnograph overlaps both the inspiratory and the expiratory phases of ventilation. This discrepancy disappears at respiratory rates of 16 breaths/min. This synchronous respiratory monitoring display at respiratory rates 16 breaths/min is not physiologically correct, because it implies a synchronization of waveforms that is not actually present...
December 9, 2016: A & A Case Reports
Jeong-Am Ryu, Kyoungjin Choi, Jeong Hoon Yang, Dae-Sang Lee, Gee Young Suh, Kyeongman Jeon, Joongbum Cho, Chi Ryang Chung, Insuk Sohn, Kiyoun Kim, Chi-Min Park
BACKGROUND: It is not rare for a small-bore feeding tube to be inserted incorrectly into the respiratory system in critically ill patients. Thus, monitoring is necessary to prevent respiratory malplacement of the tube. We investigated the utility of capnographic monitoring to prevent respiratory complications due to feeding tube mispositioning in critically ill patients. METHODS: This study was a pre and post-interventional study, including 445 feeding tube placements events studied retrospectively in the medical and surgical intensive care units of the Samsung Medical Center...
December 9, 2016: BMC Anesthesiology
Cliff Reid, Ian Ferguson, Brian Burns, Karel Habig, Mohammed Shareef
BACKGROUND: Life-like end-tidal capnography (ETCO2) waveforms have been demonstrated in recently deceased and fresh-frozen cadavers following tracheal intubation, offering potential for high fidelity airway simulation training. As the mechanism for carbon dioxide production is not fully understood, it is possible that oesophageal intubation may also generate a capnograph. Our aim was to measure ETCO2 levels following (1) oesophageal and (2) tracheal intubation in fresh-frozen cadavers, and to observe the size, shape and duration of any capnographic waveform...
September 23, 2016: Emergency Medicine Journal: EMJ
Florent Baudin, Pierre Bourgoin, David Brossier, Sandrine Essouri, Guillaume Emeriaud, Marc Wysocki, Philippe Jouvet
OBJECTIVES: The aim of our pilot study was to develop a model to better predict Paco2 in mechanically ventilated children using noninvasive parameters including volumetric capnography. DESIGN: Prospective clinical pilot study. SETTING: Level III PICU. PATIENTS: Sixty-five mechanically ventilated children. INTERVENTIONS: None. MATERIALS AND METHODS: We conducted a prospective clinical pilot study that included all children admitted to the PICU (< 18 yr; weight, > 3 kg; mechanically ventilated, > 6 hr; with an arterial line)...
December 2016: Pediatric Critical Care Medicine
Gerd Schmalisch
Although capnography is a standard tool in mechanically ventilated adult and pediatric patients, it has physiological and technical limitations in neonates. Gas exchange differs between small and adult lungs due to the greater impact of small airways on gas exchange, the higher impact of the apparatus dead space on measurements due to lower tidal volume and the occurrence of air leaks in intubated patients. The high respiratory rate and low tidal volume in newborns, especially those with stiff lungs, require main-stream sensors with fast response times and minimal dead-space or low suction flow when using side-stream measurements...
August 30, 2016: Biomedical Engineering Online
George W Williams, Christy A George, Brian C Harvey, Jenny E Freeman
BACKGROUND: Current respiratory monitoring technologies such as pulse oximetry and capnography have been insufficient to identify early signs of respiratory compromise in nonintubated patients. Pulse oximetry, when used appropriately, will alert the caregiver to an episode of dangerous hypoxemia. However, desaturation lags significantly behind hypoventilation and alarm fatigue due to false alarms poses an additional problem. Capnography, which measures end-tidal CO2 (EtCO2) and respiratory rate (RR), has not been universally used for nonintubated patients for multiple reasons, including the inability to reliably relate EtCO2 to the level of impending respiratory compromise and lack of patient compliance...
January 2017: Anesthesia and Analgesia
Spence Madsen, Jordan Baczuk, Kurt Thorup, Richard Barton, Neal Patwari, John T Langell
BACKGROUND: Respiratory rate (RR) is a critical vital signs monitored in health care setting. Current monitors suffer from sensor-contact failure, inaccurate data, and limited patient mobility. There is a critical need for an accurate and reliable and noncontact system to monitor RR. We developed a contact-free radio frequency (RF)-based system that measures movement using WiFi signal diffraction, which is converted into interpretable data using a Fourier transform. Here, we investigate the system's ability to measure fine movements associated with human respiration...
June 1, 2016: Journal of Surgical Research
Melissa K Brown, Danielle V Lazarus, Sarah R Gonzales, Wade D Rich, Madeline J Wozniak, Debra M Poeltler, Anup C Katheria
BACKGROUND: Colorimetric end-tidal carbon dioxide (ETCO2) detectors can identify airway obstruction during noninvasive ventilation and successful intubation during newborn resuscitation. The resistance of these devices is not well described, and the information provided by manufacturers is incomplete. METHODS: We compared the resistance of 3 colorimetric ETCO2 detectors (Neo-StatCO2, Pedi-Cap, and Mini StatCO2,) and 2 mainstream capnograph sensors (EMMA infant airway adapter 17449 and neonatal/infant airway adapter YG-213T)...
August 2016: Respiratory Care
Zsofia Csorba, Ferenc Petak, Kitti Nevery, Jozsef Tolnai, Adam L Balogh, Ferenc Rarosi, Gergely H Fodor, Barna Babik
BACKGROUND: Although the mechanical status of the lungs affects the shape of the capnogram, the relations between the capnographic parameters and those reflecting the airway and lung tissue mechanics have not been established in mechanically ventilated patients. We, therefore, set out to characterize how the mechanical properties of the airways and lung tissues modify the indices obtained from the different phases of the time and volumetric capnograms and how the lung mechanical changes are reflected in the altered capnographic parameters after a cardiopulmonary bypass (CPB)...
May 2016: Anesthesia and Analgesia
Paresh P Mehta, Gursimran Kochhar, Mazen Albeldawi, Brian Kirsh, Maged Rizk, Brian Putka, Binu John, Yinghong Wang, Nicole Breslaw, Rocio Lopez, John J Vargo
OBJECTIVES: Regulatory changes requiring the use of capnographic monitoring for endoscopic procedures using moderate sedation have placed financial challenges on ambulatory and hospital endoscopy centers across the United States due to the increased cost of training endoscopy personnel and purchasing both capnography-monitoring devices and specialized sampling ports. To date, there has been no published data supporting the use of capnographic monitoring in adult patients undergoing routine endoscopic procedures with moderate sedation...
March 2016: American Journal of Gastroenterology
Sheila Barnett, Adelina Hung, Roy Tsao, Julie Sheehan, Bolanle Bukoye, Sunil G Sheth, Daniel A Leffler
OBJECTIVES: Appropriate monitoring during sedation has been recognized as vital to patient safety in procedures outside of the operating room. Capnography can identify hypoventilation prior to hypoxemia; however, it is not clear whether the addition of capnography improves safety or is cost effective during routine colonoscopy, a high volume, low-risk procedure. Our aim was to evaluate the value of EtCO2 monitoring during colonoscopy with moderate sedation. METHODS: We conducted a prospective study of sedation safety and patient satisfaction before and after the introduction of EtCO2 monitoring during outpatient colonoscopy with midazolam and fentanyl using the validated PROcedural Sedation Assessment Survey (PROSAS)...
March 2016: American Journal of Gastroenterology
J Mikhail Kellawan, John W Harrell, Eric M Schrauben, Carson A Hoffman, Alejandro Roldan-Alzate, William G Schrage, Oliver Wieben
UNLABELLED: Non-invasive measurement of cerebral blood flow (CBF) in humans is fraught with technologic, anatomic, and accessibility issues, which has hindered multi-vessel hemodynamic analysis of the cranial vasculature. Recent developments in cardiovascular MRI have allowed for the measurement of cine velocity vector fields over large imaging volumes in a single acquisition with 4D flow MRI. The purpose of this study was to develop an imaging protocol to simultaneously measure pulsatile flow in the circle of Willis as well as the carotid and vertebrate arteries at rest and during increased CO2 (hypercapnia)...
May 2016: Magnetic Resonance Imaging
Srikiran Ramarapu
A 70-year-old man was scheduled for open reduction and internal fixation of his right knee fracture. When the tourniquet was deflated after 150 minutes, his arterial blood pressure and heart rate decreased precipitously. The patient was deemed to exhibit pulseless electrical activity. Cardiopulmonary resuscitation was initiated. The bispectral index reading improved to 25 to 30, but his end-tidal carbon dioxide was still very low (5 mm Hg). Transesophageal echocardiography showed a pulmonary embolism. Feedback from echo imaging improved the quality of chest compressions and motivated the resuscitation team to maintain the diastolic blood pressure>25 mm Hg...
December 1, 2015: A & A Case Reports
Jeong-Am Ryu, Joongbum Cho, Dae Sang Lee, Gee Young Suh, Jeong Hoon Yang, Kyeongman Jeon, Chi Ryang Chung, Chi-Min Park
No abstract text is available yet for this article.
December 2015: Critical Care Medicine
Jean-Marc Dumonceau, Andrea Riphaus, Florian Schreiber, Peter Vilmann, Ulrike Beilenhoff, Jose R Aparicio, John J Vargo, Maria Manolaraki, Caroline Wientjes, István Rácz, Cesare Hassan, Gregorios Paspatis
No abstract text is available yet for this article.
December 2015: Endoscopy
Julia Fuzak Freeman, Christopher Ciarallo, Lara Rappaport, Maria Mandt, Lalit Bajaj
OBJECTIVES: Prehospital pediatric airway management is difficult and controversial. Options include bag-mask ventilation (BMV), endotracheal tube (ETT), and laryngeal mask airway (LMA). Emergency Medical Services personnel report difficulty assessing adequacy of BMV during transport. Capnography, and capnograph tracings in particular, provide a measure of real-time ventilation currently used in prehospital medicine but have not been well studied in pediatric patients or with BMV. Our objective was to compare pediatric capnographs created with 3 airway modalities...
January 2016: American Journal of Emergency Medicine
Amir Kugelman, Agenta Golan, Arieh Riskin, Irit Shoris, Michal Ronen, Nelly Qumqam, David Bader, Ruben Bromiker
OBJECTIVE: To compare the time spent within a predefined safe range of CO2 (30-60 mmHg) during conventional ventilation between infants who were monitored with distal end-tidal CO2 (dETCO2, or capnography) and those who were not. STUDY DESIGN: For this randomized, controlled multicenter study, ventilated infants with a double-lumen endotracheal tube were randomized to 1 of 2 groups: the open (monitored) group, in which data from the capnograph were recorded, displayed to the medical team, and used for patient care, and the masked group, in which data from the capnograph were recorded...
January 2016: Journal of Pediatrics
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