capnometer

カプノメータ

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/06/16 03:15:30」(JST)

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Capnography
Typical capnogram. Expiration phase on the left, inspiration on the right.
MeSH	D019296

Capnography is the monitoring of the concentration or partial pressure of carbon dioxide (CO
₂) in the respiratory gases. Its main development has been as a monitoring tool for use during anesthesia and intensive care. It is usually presented as a graph of expiratory CO
₂ (measured in millimeters of mercury, "mmHg") plotted against time, or, less commonly, but more usefully, expired volume. The plot may also show the inspired CO
₂, which is of interest when rebreathing systems are being used.

The capnogram is a direct monitor of the inhaled and exhaled concentration or partial pressure of CO
₂, and an indirect monitor of the CO
₂ partial pressure in the arterial blood. In healthy individuals, the difference between arterial blood and expired gas CO
₂ partial pressures is very small. In the presence of most forms of lung disease, and some forms of congenital heart disease (the cyanotic lesions) the difference between arterial blood and expired gas increases and can exceed 1 kPa.

Working mechanism

See also: Carbon dioxide sensor

Schematic overview of a capnograph

Capnographs usually work on the principle that CO
₂ absorbs infrared radiation. A beam of infrared light is passed across the gas sample to fall on a sensor. The presence of CO
₂ in the gas leads to a reduction in the amount of light falling on the sensor, which changes the voltage in a circuit. The analysis is rapid and accurate, but the presence of nitrous oxide in the gas mix changes the infrared absorption via the phenomenon of collision broadening. This must be corrected for measuring the CO
₂ in human breath by measuring its infrared absorptive power. This was established as a reliable technique by John Tyndall in 1864, though 19th and early 20th century devices were too cumbersome for everyday clinical use.

Diagnostic usage

Capnography provides information about CO
₂ production, pulmonary (lung) perfusion, alveolar ventilation, respiratory patterns, and elimination of CO
₂ from the anesthesia breathing circuit and ventilator. The shape of the curve is affected by some forms of lung disease; in general there are obstructive conditions such as bronchitis, emphysema and asthma, in which the mixing of gases within the lung is affected.

Conditions such as pulmonary embolism and congenital heart disease, which affect perfusion of the lung, do not, in themselves, affect the shape of the curve, but greatly affect the relationship between expired CO
₂ and arterial blood CO
₂. Capnography can also be used to measure carbon dioxide production, a measure of metabolism. Increased CO
₂ production is seen during fever and shivering. Reduced production is seen during anesthesia and hypothermia.

Capnogram model

The capnogram waveform provides information about various respiratory and cardiac parameters. The capnogram double-exponential model attempts to quantitatively explain the relationship between respiratory parameters and the exhalatory segment of a capnogram waveform. According to the model, each exhalatory segment of capnogram waveform follows the analytical expression:

$$

 
   
     
       
         p
         
           D
         
       
       (
       t
       )
       =
       
         p
         
           A
         
       
       (
       1
       −
       
         e
         
           −
           α
         
       
       
         e
         
           α
           
             e
             
               −
               t
               
                 /
               
               τ
             
           
         
       
       )
     
   
   {\displaystyle p_{D}(t)=p_{A}(1-e^{-\alpha }e^{\alpha e^{-t/\tau }})}
 

where

• $p_{D}(t)$represents the partial pressure of carbon dioxide measured by the capnogram as a function of time $t$ since the beginning of exhalation.
• $p_{A}$represents the alveolar partial pressure of carbon dioxide.
• $\alpha$represents the inverse of the dead space fraction (i.e. the ratio of tidal volume to dead space volume).
• $\tau$represents the pulmonary time constant (i.e. the product of pulmonary resistance and compliance)

In particular, this model explains the rounded "shark-fin" shape of the capnogram observed in patients with obstructive lung disease.

Use in anaesthesia

Capnograph

During anesthesia, there is interplay between two components: the patient and the anesthesia administration device (which is usually a breathing circuit and a ventilator). The critical connection between the two components is either an endotracheal tube or a mask, and CO
₂ is typically monitored at this junction. Capnography directly reflects the elimination of CO
₂ by the lungs to the anesthesia device. Indirectly, it reflects the production of CO
₂ by tissues and the circulatory transport of CO
₂ to the lungs.

When expired CO
₂ is related to expired volume rather than time, the area beneath the curve represents the volume of CO
₂ in the breath, and thus over the course of a minute, this method can yield the CO
₂ per minute elimination, an important measure of metabolism. Sudden changes in CO
₂ elimination during lung or heart surgery usually imply important changes in cardiorespiratory function.

Capnography has been shown to be more effective than clinical judgement alone in the early detection of adverse respiratory events such as hypoventilation, oesophageal intubation and circuit disconnection; thus allowing patient injury to be prevented. During procedures done under sedation, capnography provides more useful information, e.g. on the frequency and regularity of ventilation, than pulse oximetry.

Capnography provides a rapid and reliable method to detect life-threatening conditions (malposition of tracheal tubes, unsuspected ventilatory failure, circulatory failure and defective breathing circuits) and to circumvent potentially irreversible patient injury.

Capnography and pulse oximetry together could have helped in the prevention of 93% of avoidable anesthesia mishaps according to an ASA (American Society of Anesthesiologists) closed claim study.

Use in emergency medical services

Capnography is increasingly being used by EMS personnel to aid in their assessment and treatment of patients in the prehospital environment. These uses include verifying and monitoring the position of an endotracheal tube or a blind insertion airway device. A properly positioned tube in the trachea guards the patient's airway and enables the paramedic to breathe for the patient. A misplaced tube in the esophagus will lead to the patient's death if it goes undetected.

A study in the March 2005 Annals of Emergency Medicine, comparing field intubations that used continuous capnography to confirm intubations versus non-use showed zero unrecognized misplaced intubations in the monitoring group versus 23% misplaced tubes in the unmonitored group. The American Heart Association (AHA) affirmed the importance of using capnography to verify tube placement in their 2005 CPR and Emergency Cardiovascular Care Guidelines.

The AHA also notes in their new guidelines that capnography, which indirectly measures cardiac output, can also be used to monitor the effectiveness of CPR and as an early indication of return of spontaneous circulation (ROSC). Studies have shown that when a person doing CPR tires, the patient's end-tidal CO
₂ (ETCO2, the level of carbon dioxide released at the end of expiration) falls, and then rises when a fresh rescuer takes over. Other studies have shown when a patient experiences return of spontaneous circulation, the first indication is often a sudden rise in the ETCO2 as the rush of circulation washes untransported CO
₂ from the tissues. Likewise, a sudden drop in ETCO2 may indicate the patient has lost pulses and CPR may need to be initiated.

Paramedics are also now beginning to monitor the ETCO2 status of nonintubated patients by using a special nasal cannula that collects the carbon dioxide. A high ETCO2 reading in a patient with altered mental status or severe difficulty breathing may indicate hypoventilation and a possible need for the patient to be intubated. Low ETCO2 readings on patients may indicate hyperventilation.

Capnography, because it provides a breath by breath measurement of a patient's ventilation, can quickly reveal a worsening trend in a patient's condition by providing paramedics with an early warning system into a patient's respiratory status. Clinical studies are expected into the uses of capnography in asthma, congestive heart failure, diabetes, circulatory shock, pulmonary embolus, acidosis, and other conditions, with potential implications for the prehospital use of capnography.

Use by registered nurses

Registered nurses in critical care settings may use capnography to determine if a nasogastric tube, which is used for feeding, has been placed in the trachea as opposed to the esophagus. Usually a patient will cough or gag if the tube is misplaced, but most patients in critical care settings are sedated or comatose. If a nasogastric tube is accidentally placed in the trachea instead of the esophagus, the tube feedings will go into the lungs, which is a life-threatening situation.

Bibliography

• Silvestri S, Ralls GA, Krauss B, et al. (May 2005). "The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system". Ann Emerg Med. 45 (5): 497–503. doi:10.1016/j.annemergmed.2004.09.014. PMID 15855946.
• Lightdale JR, Goldmann DA, Feldman HA, Newburg AR, DiNardo JA, Fox VL (June 2006). "Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial". Pediatrics. 117 (6): e1170–8. doi:10.1542/peds.2005-1709. PMID 16702250.
• Burton JH, Harrah JD, Germann CA, Dillon DC (May 2006). "Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?". Acad Emerg Med. 13 (5): 500–4. doi:10.1197/j.aem.2005.12.017. PMID 16569750.

See also

Internal links

• Integrated Pulmonary Index
• Medical equipment
• Medical test
• Respiratory monitoring

External links

• Physical principles used in capnography graphically explained
• Capnography.com
• Capnography for Paramedics
• CapnoBase.org: Respiratory signal database that contains clinical and simulated capnogram recordings
• Research project on capnography

UpToDate Contents

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• 1. 麻酔器：故障の防止・診断・管理anesthesia machines prevention diagnosis and management of malfunctions [show details]
  …patient effort . Prevention – Basic function of the capnometer can be confirmed during the pre-use check by blowing into the sample line. Capnometers and multigas analyzers require periodic recalibration …
• 2. 経皮的気管穿刺換気法による針輪状甲状軟骨間膜切開needle cricothyroidotomy with percutaneous transtracheal ventilation [show details]
  …properly. Fix the catheter in place with a suture or a tracheostomy tie, as possible. Interpose a capnometer in the circuit to monitor end tidal CO₂, if possible. Begin regular ventilation by intermittently…
• 3. 民間航空機内で発生した急病のマネージメントmanagement of inflight medical events on commercial airlines [show details]
  …Such devices usually include an electronic sphygmomanometer, pulse oximeter, digital thermometer, capnometer, glucometer, and 12-lead electrocardiogram. The ability to obtain ECGs makes the management of…

English Journal

• Continuous monitoring of membrane lung carbon dioxide removal during ECMO: experimental testing of a new volumetric capnometer.

• Montalti A, Belliato M, Gelsomino S, Nalon S, Matteucci F, Parise O, de Jong M, Makhoul M, Johnson DM, Lorusso R.
• Perfusion. 2019 Mar;()267659119833233.
• Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient-machine interactions. We tested a new volumetric capnometer w
• PMID 30868943

• Novel mainstream capnometer system is safe and feasible even under CO insufflation during ERCP-related procedure: a pilot study.

• Takimoto Y, Iwasaki E, Masaoka T, Fukuhara S, Kawasaki S, Seino T, Katayama T, Minami K, Tamagawa H, Machida Y, Ogata H, Kanai T.
• BMJ open gastroenterology. 2019 ;6(1)e000266.
• There is a need to safely achieve conscious sedation during endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the safety and feasibility of a mainstream capnometer system to monitor apnoea during ERCP under CO insufflation. Non-intubated adult patients undergoing ERCP-related proce
• PMID 30899539

• Effect of mild hypercapnia on outcome and histological injury in a porcine post cardiac arrest model.

• Babini G, Ristagno G, Boccardo A, De Giorgio D, De Maglie M, Affatato R, Ceriani S, Zani D, Novelli D, Staszewsky L, Masson S, Pravettoni D, Latini R, Belloli A, Scanziani E, Skrifvars M.
• Resuscitation. 2019 Feb;135()110-117.
• To evaluate in an established porcine post cardiac arrest model the effect of a mild hypercapnic ventilatory strategy on outcome. The left anterior descending coronary artery was occluded in 14 pigs and ventricular fibrillation induced and left untreated for 12 min. Cardiopulmonary resuscitation w
• PMID 30612967

Japanese Journal

• ドクターヘリ活動時の気管挿管における携帯型カプノメータの有用性

• 岡野 雄一,高橋 大介,加藤 陽一,山家 純一,田代 尊久,奥本 克己,桑原 謙
• 日本航空医療学会雑誌 = Journal of Japanese Society for Aeromedical Services 19(3), 10-14, 2019-02
• NAID 40021832008

• 肥満を伴った知的障害者に対し静脈内鎮静法と固定器具によるコントロール下で核磁気共鳴画像法（MRI）検査を行った1症例

• 小田 綾,入舩 正浩,吉田 啓太,向井 友宏,高橋 珠世,好中 大雅,大植 香菜,向井 明里,神田 拓,尾田 友紀
• 日本障害者歯科学会雑誌 38(1), 47-52, 2017
• <p>核磁気共鳴画像法検査は，診断上必要とされることもあるが，検査に時間がかかり，激しい騒音を伴う．そのため，検査中に安静を保つことが難しい患者ではプレパレーションを行った後に検査を行うこともあるが，知的障害者では行えない場合も多い．診断価値のある画像を得るため，深鎮静下で検査を行うことがあるが，撮影中に呼吸停止を起こすことも考えられる．さらに患者が肥満を伴っている場合は重篤な合併症に …
• NAID 130006832741

• 呼気二酸化炭素モニター (特集 モニタリング : 病態把握の指標・ヒント) -- (臓器別編;呼吸器疾患診療におけるモニタリング)

• 坂口 嘉郎
• 救急医学 = The Japanese journal of acute medicine 40(1), 11-15, 2016-01
• NAID 40020708908

Related Links

• Capnometer | definition of capnometer by Medical dictionary

1) In any event patients treated with propofol have to be treated precisely and monitored continuously with an ECG monitor, a pulse oximeter and capnometer that contain alarms that detect changes quickly--something that Dr Murray ...

• Capnometer | Definition of Capnometer by Merriam-Webster

Comments on capnometer What made you want to look up capnometer? Please tell us where you read or heard it (including the quote, if possible).

• Masimo - EMMA Capnometer

EMMA Mainstream Capnometer, Portable Real-time Capnometry with immediate results. A small, portable capnometer that is designed to fit easily onto a breathing circuit that sports a rugged design and is easy to maintain.

Related Pictures

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★リンクテーブル★

リンク元

「カプノメータ」

「カプノメータ」

　　[★]

英

capnometer

関

カプノグラフィ、呼気終末二酸化炭素分圧 ETCO2

概念

• 吸気中の二酸化炭素の濃度を測定する装置

参考

• http://worldka.blog.shinobi.jp/Entry/34/
• http://akimichi.homeunix.net/~emile/aki/html/medical/anesthesia/node27.html