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120

D. Govil and S. Gupta

 

 

Fig. 15.11 Capnogram showing sedated and inadequately paralyzed patient having spontaneous respiratory efforts

Fig. 15.12 Capnogram showing curare effect after neuromuscular blockade

Fig. 15.13 Capnogram showing return of spontaneous respiration

Conclusion

Capnogram is a very useful tool for ventilated patients, and it gives us a real-time idea of various lung interactions that can have the implications on the outcome of the patient.

15 Pulse Oximetry and Capnography

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Suggested Reading

1.Walsh BK, Crotwell DN, Restrepo RD. Capnography/Capnometry during mechanical ventilation. Respir Care. 2011;56(4):503–9.

This updated clinical practice guideline is based on 234 clinical studies and systematic reviews, 19 review articles investigating the use of capnography/capnometry during mechanical ventilation.

2.Wilson BJ, Cowan HJ, Lord JA. The accuracy of pulse oximetry in emergency department patients with severe sepsis and septic shock: a retrospective cohort study. BMC Emerg Med. 2010;10:9.

Pulse oximetry overestimates ABG-determined SaO2 by a mean of 2.75% in emergency department patients with severe sepsis and septic shock. This overestimation is exacerbated by the

presence of hypoxemia. When SaO2 needs to be determined with a high degree of accuracy, arterial blood gases are recommended.

3.Nagler J, Krauss B. Capnography: a valuable tool for airway management. Emerg Med Clin North Am. 2008;26(4):881–97.

Clinical applications of capnography with regard to ventilation and airway management are discussed.

4.Cheifetz IM, Myers TR. Respiratory therapies in the critical care setting. Should every mechanically ventilated patient be monitored with capnography from intubation to extubation? Respir Care. 2007; 52(4):423–38.

5.Feiner JR, Severinghaus JW. Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology. 2005;102(4):715–9.

Pulse oximeters overestimate arterial oxygen saturation during hypoxia in dark-skinned individuals.

6.Kamat V. Pulse oximetry. Indian J Anaesth. 2002;46(4):261–8.

Despite problems and limitations, pulse oximetry remains the standard of care in all clinical situations, and its use for all patients under anesthesia must be mandated.

7.Van de Louw A, Cracco C. Accuracy of pulse oximetry in the intensive care unit. Intensive Care Med. 2001;27(10):1606–13.

Large SpO2 to SaO2 differences may occur in critically ill patients with poor reproducibility of SpO2. A SpO2 above 94% appears necessary to ensure an SaO2 of 90%.

8.Hampson NB. Pulse oximetry in severe carbon monoxide poisoning. Chest. 1998;114(4): 1036–41.

Presently available pulse oximeters overestimate arterial oxygenation in patients with severe CO poisoning. Accurate assessment of arterial oxygen content in patients with CO poisoning can currently be performed only by analysis of arterial blood with a laboratory CO-oximetry.

Websites

1.www.pulseox.info

Basic information on pulse oximetry

2.www.pulseoximeteronline.com

Industry website to review different types of pulse oximeters

3.www.capnography.com

Website produced by Bhavani Shankar Kodali. An atlas of capnograms

4.www.linxdown.com Downloadable atlas of capnograms

Part II

Cardiovascular System

Jigeeshu V. Divatia, Farhad N. Kapadia, Shyam Sunder Tipparaju and Sheila Nainan Myatra

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