12 mainstream sidestream capnpgraphy

Mainstream and Sidestream

CAPNOSTAT® 3 Mainstream CO2 Sensor LoFlo™Sidestream CO2 Module

Capnography

• The standard-of-care – Capnography

• Indicates a ventilatory event faster than any other type of monitoring

• Provides a means for continuous, real-time monitoring of ventilation

• Helps confirm ET tube placement• Enables you to provide the same level of

care during procedural sedation as is required in the O.R.

• Provides a time sensitive picture for the clinician as to the ongoing changes in a patient’s respiratory status during procedural sedation – Immediate and sensitive data regarding a

patient’s respiratory status for assessing the safety of a repeat bolus of medicine in an inadequately sedated patient

Capnography

• Study comparing the CAPNOSTAT mainstream with Microstream® sidestream – Study conducted in a neonatal NICU

concluded that the CAPNOSTAT sensor is more accurate than Microstream at estimating PaCO2.

Kathleen Deakins RRT-NPS Comparison of Microstream and Mainstream Capnography with Arterial CO2 in Neonates; University Hospitals of Cleveland, OH; FAARC 12-03

Clinical Studies

• Procedural Sedation Study in the ED– When the criteria of an ETCO2 >50 mmHg, an

absolute change >10 mm Hg, or an absent waveform were applied, all respiratory distress was detected, not detected by pulse oximetry alone.

– The CO2 monitor represents an additional monitor that can add to the safety of procedural sedation by quickly detecting hypoventilation

Miner JR, Heegaard W, Plummer D. End-tidal carbon dioxide monitoring during procedural sedation.

Academy Emergency Medicine. 2002;9(4):275-80.

Clinical Studies

• Study comparing the CAPNOSTAT mainstream with Microstream sidestream in Emergency Medical Services – Environmental conditions, specifically changes

in ambient temperature: “Under the conditions of low and changing

ambient temperature (-20 degrees C, +22 degrees C), only the Tidal Wave (Respironics; mainstream) remained uninfluenced, whereas deviations of -12% and +15% were found with the NPB-75 (Microstream; sidestream)”.

Biedler A, Wilhelm W, Mertzlufft F. [Portable capnographs in emergency care: a comparison of equipment]

Anaesthesiol Reanim. 1999;24(3):71-8.

Clinical Studies

CAPNOSTAT Mainstream Sensor

• Even under the harshest of airway conditions, the CAPNOSTAT sensor’s true single beam: – Successfully compensates for the

presence of contaminates – Continues to operate – Provides accurate readings

Jaffe, MB. Mainstream or sidestream capnography? Respironics-Novametrix White paper 1012102, August 2002.


• Contaminate-free design– Disposable patient sampling cuvette

ensures analyzer is not exposed to, or contaminated with patient secretions, moisture, etc.

– Unaffected by patient secretions • Microstream sidestream systems are

affected by patient secretions

– Keeps defibrillator in service– Reduces maintenance costs


• Family of Single Patient Use and Reusable Airway Adapters– Adult, pediatric and infant

• CAPNO2mask™ • For use on non-intubated patients

• No sample gas is diverted from the patient– Typical sampling rates in sidestream systems run

from 50cc to 250cc per minute– Because there is no sampling, the CAPNOSTAT

sensor is free from sample line occlusion and waveform distortions

• Heated sensor– The CAPNOSTAT sensor heats the sample cell

windows keeping them dry, minimizing effects from airway moisture


Benefits of Using the CAPNOSTAT Sensor

• Superior solid state design for greater accuracy and robustness

• Instantaneous analysis due to no delay time and 60ms rise time (other devices have greater than 2 second delay time with a rise time of 200-240ms)– Capnogram is displayed in 15 seconds, full specifications

in 60 seconds– “Crisp” waveform faithfully reflects airway ventilation– Better performance at higher respiratory rates

• Relatively lightweight due to miniaturization and newer technologies

• Low deadspace airway adapter is available for infants

• Airway adapter serves as the sample cell and is disposable

• Airway adapter is located in line with the patient– No gas sampling takes place

• Analysis performed at the patient airway and under the same environmental conditions


• Immediate response for emergency situations– No delay in measurement

• Variety of airway adapters allows use on intubated or nonintubated neonatal, pediatric, and adult patients

• Heated sensor keeps sample cell windows dry


• Uses the same proven analyzer and electronic technology as the CAPNOSTAT 3 Mainstream CO2 sensor

• Users can seamlessly switch between the LoFlo Sidestream CO2 Module or CAPNOSTAT 3 Mainstream CO2 Sensor, to

allow selection of the technology most suited for the application

LoFlo Sidestream Module - Features

• Innovative disposable patent pending sample cell and filter • Eliminates the possibility of contamination of the

analyzer, thereby protecting your investment

• Sampling rate of 50ml/minute


• Complete family of:• Adult, pediatric, and infant nasal cannula kits• Oral/nasal cannula kits• Sampling kits with oxygen delivery• Adult/pediatric and infant/neonatal on airway

adapter kits for intubated patients• Patents pending


• Innovative, patents pending, low deadspace neonatal on-airway adapter with less than 1 ml deadspace


• Sample pump rated for 24,000 hours of continuous use– No routine changing of the sample pump– Typical sidestream systems sample pump rated at

7,000 hours or less• Patent pending CAPflow™, Respironics capillary

based flow control system permits tight control of flow, independent of barometric pressure

• Pump is activated automatically when the disposable sample cell is connected and turns off automatically when sample cell is removed


• Measurement of End Tidal Carbon Dioxide (ETCO2) and respiration rate

• Delivers a crisp, accurate capnogram at all respiratory rates up to 150 breaths per minute

• Waveforms and ETCO2 readings in 15

seconds, warm up in less than 80 seconds,• Full accuracy in 3 minutes• Routine gas calibration is not required


• 50 ml/min flowrate • Ideal for non-intubated and intubated patients • Interchangeable with the CAPNOSTAT 3

Mainstream CO2 Sensor

• No calibration required


• LoFlo Module plugs into the M Series and is interchangeable (and backward compatible) with the CAPNOSTAT sensor

• Care giver has the choice of using the CAPNOSTAT sensor or the LoFlo module

• Superior solid state design for accuracy and robustness

• Immediate response for emergency situations• Integrated filter keeps sample cell windows dry

Benefits of Using the LoFlo Sidestream Module

• Analyzer CANNOT be contaminated due to our Removable Sample Cell

• Family of adult, pediatric and infant sampling cannulas and on-airway adapter kits allows LoFlo to be used on intubated or non-intubated patients

• 24,000 hour rated sample pump @ 50 ml/min sample rate

• No routine service is required

Benefits of Using the LoFlo Sidestream Module

Product Summary

• ZOLL offers you the choice of using mainstream or sidestream ETCO2 that best fits your applications -

• “Plug and play”• Both technologies are robust, proven solid state • Lifetime warranty• Analyzer in both systems CANNOT be contaminated by

patient secretions or water• The CAPNOSTAT sensor and LoFlo module are for use in

all clinical areas where ETCO2 monitoring is required• No routine calibration

Clinical Summary

• Of equal importance to the ETCO2 value is

the waveform which faithfully reflects what’s occurring. – Subtle changes in waveforms can indicate

actual or impending problems with setup, airway mechanics, respiratory drive, cardiovascular systems, and other important conditions.

– The shape and trends of the CO2 waveforms

contain valuable information that is not available from any other source.

Clinical Summary

• Capnography affords the clinician breath by breath trending of ETCO2 and thus a

noninvasive look at ventilation– Trending provides information on changes in

ventilation and perfusion

Thank you for visiting the ZOLL web site. If you

have any questions or need additional information,

please call 1 (800) 348-9011 or (978) 421-9655

ZOLL Medical Corporation

269 Mill Road

Chelmsford, MA 01824

This material is presented with the consent of Respironics Inc. Wallingford CT.CAPNOSTAT is a registered trademark and LoFlo is a trademark of Respironics, Inc.Microstream is a registered trademark of Oridion

12 mainstream sidestream capnpgraphy

Health & Medicine

Transcript of 12 mainstream sidestream capnpgraphy