![]() ![]() For example, if you see a troublesome oxygen saturation reading, you may simply choose to increase the oxygen flow without considering the potential causes for the change, such as a medication that might be relaxing the patient's airway. It still useful, but it also has its limitations. I began my healthcare career when pulse oximetry was considered a wonderful new monitoring tool. If the square becomes a flat line, the patient is not breathing. If the square waveform starts to collapse, there's an airway obstruction. If respiration decreases (hypoventilation), the waveform becomes taller and less frequent, and the numeric reading rises above the normal range. If the patient's respiratory rate increases (hyperventilation), the CO 2 waveform becomes smaller than the baseline and more frequent, and the numeric reading falls below the normal range. "Normal" end tidal CO 2 is in the range of 35 to 45 mmHg. On a capnography monitor, you see a real-time waveform (capnogram) - a normal waveform appears as a square-shaped or rectangular box - and a numeric reading (capnometry) showing the measurement of exhaled CO 2. ![]() Continuous capnography should be seen as a trending tool that provides a complete picture of a patient's ventilation, perfusion and metabolism. The word continuous is important, because a respiratory depression can occur when you're away from the patient's bedside. Nothing beats the close observation of expert nurses and anesthesia providers, but even your most attentive caregivers would benefit from being backed up by capnography.Ĭontinuous capnography is a breath-to-breath measurement of exhaled carbon dioxide at each phase of the respiratory cycle, gathered either through an advanced airway device (intubated) or a nasal cannula-type device (non-intubated). Without the monitoring modality, critical minutes may pass before you notice the patient is experiencing hypoventilation, airway obstruction or obstructive sleep apnea that could lead to respiratory arrest, cardiac arrest, hypoxic brain injury and even death. His one great achievement is being the father of three amazing children.BIG PICTURE Continuous capnography offers a complete analysis of a patient's ventilation, perfusion and metabolism.Ĭapnography identifies potential respiratory events well before you have the sneaking suspicion that something seems amiss. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of , the RAGE podcast, the Resuscitology course, and the SMACC conference. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.Īfter finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. ![]() He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. ![]()
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