End Tidal CO2 Measurements with Non-Invasive Ventilation N · 2010-02-25 · NO SP MC NO SP MC This...
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NO SP MC NO SP MC This second graph shows the relationship between EtCO 2 and minute ventila- tion (solid line) at different patient leak rates. End Tidal CO 2 Measurements with Non-Invasive Ventilation T he protocol included both CPAP and BiPAP modes at different pressures, patient leak rates (PL) and patient interfaces. EtCO 2 was recorded from the following three sites simultaneously: Nasal/oral cannula (NO),mask sample port (SP), mask and ventilator circuit connection (MC). Results for EtCO 2 , minute ventilation, and leak rate were recorded at each ventilator setting as described in the protocol. For each patient interface the fol- lowing protocol was used on a normal subject. Two ventilation modes: CPAP and Spontaneous Timed (BiPAP) Standard pressure settings: CPAP – 5 and 10 cm H 2 O BiPAP – EPAP of 5, IPAP of 10 and 15 cm H 2 O Two leak levels at each pressure setting: Optimal, best clinical setting; High, higher than optimal clinical setting. Methods Results T he sampling site for CO2 in NIV can greatly influence the reliability of the EtCO2 value. The nasal/oral (Smart CapnoLine H Plus) sample line proved to be the most reliable in trending EtCO2 with different ventilator settings and leak rates in the normal patient. n N on-invasive ventilation (NIV) is an emerging application for the use of capnography. Important applications include monitoring the effectiveness of CO 2 removal, maintaining adequate ventila- tion, airway management, and CO 2 re-breathing. NIV is deliv- ered by a nasal or face mask, therefore eliminating the need for intubation or tracheostomy. NIV is frequency given by a bilevel positive airway pressure (BIPAP or bilevel ventilator) device, or a continuous positive airway pressure (CPAP) device. CPAP is primarily used to maintain a patent airway and improve oxygenation, while BiPAP is initiated if CO 2 elimination needs to be improved. The expe- rience is limited in monitoring EtCO 2 during NIV, but there is a clear under- standing that this could offer important clinical information to rapidly maxi- mize CO 2 elimination and decrease work of breathing. To understand the technical aspects of end tidal CO 2 (EtCO 2 ) in the non-inva- sively ventilation (NIV) patient. A laboratory study was conducted to compare simultaneous EtCO 2 data from three different sample sites with commonly used patient interfaces, NIV modes, and varying patient leak rates. Paul F. Nuccio, RRT, FAARC, Michael R. Jackson, RRT-NPS, CPFT Department of Respiratory Care, Brigham and Women’s Hospital, Boston, Massachusetts Conclusion Ventilator: BiPAP Vision® (Respironics) Capnograph: Microcap® (Oridion) Sample Lines: Nasal/oral sampling - Smart CapnoLine® H Plus (Oridion) Mask port - FilterLine® (Oridion) Mask connection - Microstream® Airway Adapter (Oridion) Two commonly used patient interfaces were used. Full face mask with no exhalation ports (NP) in the mask (Respironics). Full face mask with exha- lation ports(EP) in the mask (Fisher Paykel). Equipment As shown in the graph above, there were significant variations in EtCO 2 results at the different sample sites. The nasal/oral sample site (Smart CapnoLine H Plus) was very consistent throughout all settings and patient leak rates. In the BiPAP mode the nasal/oral sample site (Smart CapnoLine H Plus) again was more reliable for appropriate EtCO 2 readings at different ventilator settings and patient leaks. As shown below the EtCO 2 trended appropriately from the nasal/oral (Smart CapnoLine H Plus) site when compared to changes in minute ventilation (solid line). T he data revealed there were significant variations in EtCO 2 results at the different sample sites. The nasal/oral (NO) sample site was very consistent throughout all settings and patient leak rates. In the ST mode the nasal/oral (NO) sample site was more reliable for appropriate EtCO 2 readings at different ventilator settings and patient leaks. Mask port Nasal-oral Mask-ventilator connection
Transcript of End Tidal CO2 Measurements with Non-Invasive Ventilation N · 2010-02-25 · NO SP MC NO SP MC This...
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This second graph shows the relationship between EtCO2 and minute ventila-tion (solid line) at different patient leak rates.
End Tidal CO2 Measurements with Non-Invasive Ventilation
The protocol included both CPAP and BiPAP modes at different pressures, patient leak rates
(PL) and patient interfaces. EtCO2 was recorded from the following three sites simultaneously: Nasal/oral cannula (NO),mask sample port (SP), mask and ventilator circuit connection (MC).
Results for EtCO2, minute ventilation, and leak rate were recorded at each ventilator setting as described in the protocol. For each patient interface the fol-lowing protocol was used on a normal subject.
Two ventilation modes: CPAP and Spontaneous Timed (BiPAP)
Standard pressure settings: CPAP – 5 and 10 cm H2O BiPAP – EPAP of 5, IPAP of 10 and 15 cm H2O
Two leak levels at each pressure setting: Optimal, best clinical setting; High, higher than optimal clinical setting.
Methods
Results
The sampling site for CO2 in NIV can greatly influence the reliability of the EtCO2 value. The
nasal/oral (Smart CapnoLine H Plus) sample line proved to be the most reliable in trending EtCO2 with different ventilator settings and leak rates in the normal patient. n
Non-invasive ventilation (NIV) is an emerging application for the use of capnography. Important applications include monitoring the effectiveness of CO2 removal, maintaining adequate ventila-tion, airway management, and CO2 re-breathing. NIV is deliv-
ered by a nasal or face mask, therefore eliminating the need for intubation or tracheostomy.
NIV is frequency given by a bilevel positive airway pressure (BIPAP or bilevel ventilator) device, or a continuous positive airway pressure (CPAP) device. CPAP is primarily used to maintain a patent airway and improve oxygenation, while BiPAP is initiated if CO2 elimination needs to be improved. The expe-rience is limited in monitoring EtCO2 during NIV, but there is a clear under-standing that this could offer important clinical information to rapidly maxi-mize CO2 elimination and decrease work of breathing.
To understand the technical aspects of end tidal CO2 (EtCO2) in the non-inva-sively ventilation (NIV) patient. A laboratory study was conducted to compare simultaneous EtCO2 data from three different sample sites with commonly used patient interfaces, NIV modes, and varying patient leak rates.
Paul F. Nuccio, RRT, FAARC, Michael R. Jackson, RRT-NPS, CPFT
Department of Respiratory Care, Brigham and Women’s Hospital, Boston, Massachusetts
Conclusion
Ventilator: BiPAP Vision® (Respironics)
Capnograph: Microcap® (Oridion)
Sample Lines: Nasal/oral sampling - Smart CapnoLine® H Plus (Oridion)
Mask port - FilterLine® (Oridion)
Mask connection - Microstream® Airway Adapter (Oridion)
Two commonly used patient interfaces were used.
Full face mask with no exhalation ports (NP) in the mask (Respironics).
Full face mask with exha-lation ports(EP) in the mask (Fisher Paykel).
Equipment
As shown in the graph above, there were significant variations in EtCO2 results at the different sample sites. The nasal/oral sample site (Smart CapnoLine H Plus) was very consistent throughout all settings and patient leak rates.
In the BiPAP mode the nasal/oral sample site (Smart CapnoLine H Plus) again was more reliable for appropriate EtCO2 readings at different ventilator settings and patient leaks. As shown below the EtCO2 trended appropriately from the nasal/oral (Smart CapnoLine H Plus) site when compared to changes in minute ventilation (solid line).
The data revealed there were significant variations in EtCO2 results at the different sample sites.
The nasal/oral (NO) sample site was very consistent throughout all settings and patient leak rates. In the ST mode the nasal/oral (NO) sample site was more reliable for appropriate EtCO2 readings at different ventilator settings and patient leaks.
Mask port
Nasal-oral
Mask-ventilator connection
