Capnography

[GilaRRT]

I would like to pose a question? How many of you utilize waveform capnography and how many of you make note of the end-tidal CO2? I have both worked and been in many Emerency Rooms and Intensive Care Units that do not utilize capnography on intubated patients.

[Jen2]

We use it for every intubated patient. We are a level 1 trauma center. It is the trauma surgeons that request it.

[Altra, BSN, RN]

We do use it, but not routinely for intubated patients. Level I trauma center.

[ERRNTraveler, RN]

I've not used waveform capnography, but most places at least use those end-tidal CO2 detectors that attach to the end of the ET tube.

[GilaRRT]

Thank you for the replies. I never used any form of C02 monitoring, with the exception of easy cap color devices until I transitioned into the transport and HEMS environment. Now, I cannot imagine life without waveform capnography and ETC02 values.

[runneRN]

We use it and we are a level III...not widely accepted by our RT dept.

[Larry77, RN]

We use it and we are a level III...not widely accepted by our RT dept.

Same as us...if we place it per the MD request and the RT is doing their rounds often times they either silence it or turn it off...they seem to only go by ABG's and O2 sat's and make changes to the vent accordingly. (also trauma III).

[teeituptom, BSN, RN]

not as usefull as you would think it to be. Will soon go by the wayside

[GilaRRT]

I am not sure I understand how it is not useful. A very important QA/QI aspect of intubated patients is verification of tube placement during the actual intubation and following patient movement or activity. C02 is a very effective objective method of verification. Subjective assessment findings such as lung sounds can be quite misleading. Most people would agree that multiple objective and subjective findings are crucial to documenting proer placement. I understand ETCO2 does not always equate to PC02. Conditions that can cause shunting and cardiac arrest conditions can cause problems with interpretation. However, proper education regarding CO2 monitoring could ensure people utilize the findings correctly. In addition, we can potentially anticipate problems with ETCO2 trends. For example, we have an acidotic intubated patient with a low potassium level. The vent settings are changed and the ETCO2 has decreasd from 42 to 22. We can expect a potential change in the patients PH and and anticipate the need for potassium replacement or possible chang in the vent settings. In addition, we can also contrast PCO2 to ETCO2 and identify problems such as shunting.

[jewelcutt]

EtCO2 monitoring on vented patients is crucial, how else will you know you are ventilating the patient adequately? the once every few hours ABG?

[phiposurde]

We use it and we are a level III...not widely accepted by our RT dept.

** Funny, I try to implement the capnograph in our institution after going to a conference. My manager was very excited with it. Until she make the mistake to ask the RT department. They said it was not useful.By the way in the list it can be useful, add the confirmation of a NG tube and help to indirectly find if there a decrease in the CO . Also, some studies can predict the chance of survival by the number on your capnograph.