Dr Ajmal Eusuf

ICU Monitoring Standards and Capnography

Current Monitoring

• Personnel

• Patient monitoring

• Equipment monitoring

Current Monitoring-patient

• Saturations and gases

• ECG

• Blood pressure

• Respirations

• Heart and lungs should have clinical monitoring intermittently

Current monitoring-equipment

• Ventilator failures and supply

• Oxygen analysis

• Disconnection alarms

• Volume and pressure alarms

• Temperature

Rational for capnography

• Would you put a patient to sleep in theatre without capnography being present?

• Would you keep them asleep without capnography?

• Must of our theatre patients are fit and well• ICU patients are sicker • One set of equipment for all the unit which

takes a few minutes to set up

Capnographic analysis

• Primarily used for correct intubation

• Can also be used for 1)tidal volume

• 2) dead space

• 3) partial obstruction

• 4) breath stacking

• 5) analysis of chronic airway disease

• Examples:

• Normal

• Capnograph breating around tube

• CPR capnograph

• Disconnection

• Oesophageal intubation

• Hyperventilation

• Hypoventilation

• Rising baseline

• ROSC

• Sharkfin

• Phase 1- anatomical and apparatus dead space

• Phase 2- mixing of dead space and alveolar CO2

• Phase 3- alveolar plateau

• Phase 4- start of inspiration

Critical incidents

• In theatre! Australian study showed endobronchial intubation was most common incident at 42%

• Oesophageal intubation was 18%

• 58% of these incidents were picked up via CO2 and SpO2, 25% picked up clinically

• Was calculated that 93% of all incidents should be picked up via CO2, SpO2 and BP.

Comparisons

• Anaesthetic and recovery guidelines are roughly the same

• American ICS specifies capnography as mandatory monitoring

• UK ICS still debating this

• Most units now have capnography as mandatory for intubation purposes, but only 50% use this!

• Comparisons of theatre and ICU patients

Conclusion

• Capnography has a wide range of uses

• For better compliance of UK unit protocols, probably need it as bedside monitoring

• Lagging behind other world-wide practises

• Probably needed more by ICU than theatres?

Any Questions?