Accuracy of respiratory rate monitoring by capnometry using the Capnomask(R) in extubated patients receiving supplemental oxygen after surgery (original) (raw)
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A Evaluation of an Oxygen Mask-Based Capnometry Device in Subjects Extubated After Abdominal Surgery
Respiratory care, 2015
For early detection of respiratory and hemodynamic changes during anesthesia, continuous end-tidal carbon dioxide concentration (PETCO2 ) is monitored by capnometry. However, the accuracy of CO2 monitoring during spontaneous breathing in extubated patients remains undetermined. Therefore, we aimed to compare PETCO2 measured by capnometry using an oxygen mask with a carbon dioxide sampling port (capnometry-type oxygen mask) and PCO2 in extubated subjects who had undergone abdominal surgery. Furthermore, we investigated whether spontaneous deep breathing affected dissociation between PaCO2 and PETCO2 . Adult post-abdominal surgery subjects admitted to the ICU were enrolled in this study. After extubation, oxygen was supplied at 6 L/min using the capnometry-type oxygen mask. After 30 min of oxygen supply, PaCO2 blood gas analysis was performed, and PETCO2 was measured under resting and deep-breathing conditions. For both resting and deep-breathing conditions, the correlation between Pa...
Frontiers in Medicine, 2017
Low specificity (80.6%), lagging indication of respiratory abnormality, signal error; measures oxygenation, not ventilation; false alarm reduced signal quality in patients with poor peripheral perfusion Capnography (Medtronic, USA) Can be used in collaboration with SpO2 to reflect oxygenation and ventilation. High sensitivity (98%) and specificity (98%) for trachea intubated patients EtCO2 can be influenced by hemodynamic disturbance, complexity in interpreting CO2 waveforms; maybe unable to detect hypoxemia; no report of sensitivity and specificity for extubated patients PPG (Nonin Medical, USA) Shows the condition of both ventilation and oxygenation with specificity of 91% Low sensitivity (75%), multiple reasons such as motion, vasoconstrictor use, and heart rate change contribute to artifact of PPG RVM (ExSpieon, USA) Real-time detection of hypoventilation, quantitative precise demonstration of RR, TV, and MV for extubated patients, with sensitivity of 93% May not work normally when the patients do not take supine position; with specificity of 86%
Evaluation of Capnography in Nonintubated Emergency Department Patients with Respiratory Distress
Academic Emergency Medicine, 1995
Objective: To evaluate the ability of noninvasive capnographic measurement of end-tidal CO, tension (Petco,) to predict artenal CO, tension (Paco,) in nonintubated ED patients with respiratory distress Methods: A prospective, nonblind study was performed in a level I trauma centerkommunity teaching hospital ED. Participants included all nonintubated adult patients with respiratory distress requiring measurement of arterial blood gases (ABGs): 29 patients were enrolled Petcoz was measured with a capnography monitor. using both baseline tidal volumes and forced expiratory volumes. The bias between Petco? values and simultaneous measurements of Paco, by ABG was assessed Results: Petco,, measured with forced expiration, and Pace? agreed well, with bias (i.e , average difference) = 0 44-c 0.52 bPa (3 3 ? 3.9 torr). Petco, measured with the tidal volume breath produced an unacceptably high bias of 0.82-c 0 70 kPa (6.1 _f 5 2 torr). Levels of agreement between Pacoz and Petco: were similar for smokers and nonsmokers and for men and women. The arterial-end-tidal CO, tension (Pa-etco,) difference was not related to Pace? Pa-etco, correlated with age (r = 0.473; p = 0.01), and was significantly higher in patients with pulmonary disease (1 32 5 0 S6 kPa. 9 9 ? 4 2 torr) than i t was in those without pulmonary disease (0.46 & 0 55 kPa, 3.5 2 4.1 torr, p < 0.001). Conclusions: Noninvasive Petcoz monitoring may adequately predict Paco, in nonintubated ED patients with respiratory distress who ,ire able to produce a forced expiration. Petco? is less accurate for Paco, with tidal volume breathing and in patients with pulmonary disease
Respiratory Care
BACKGROUND: Capnometry detects hypoventilation earlier than pulse oximetry while supplemental oxygen is being administered. We compared the end-tidal CO 2 (P ETCO 2) measured using a newly developed oxygen nasal cannula with a CO 2-sampling port and the P aCO 2 in extubated subjects after abdominal surgery. We also investigated whether the difference between P aCO 2 and P ETCO 2 is affected by resting, by spontaneous breathing with the mouth consciously closed, and by deep breathing with the mouth closed. METHODS: Adult post-abdominal surgery subjects admitted to the ICU were enrolled. After extubation, oxygen was supplied at 4 L/min using a capnometrytype oxygen cannula. The breathing frequency, P ETCO 2 , and P aCO 2 were measured after 30 min of oxygen supplementation. P ETCO 2 was continuously measured during rest, during breathing with the mouth consciously closed, and during deep breathing with the mouth closed. The difference between P ETCO 2 and P aCO 2 during various breathing patterns was analyzed using the Bland-Altman method. RESULTS: Twenty subjects were included. The bias ؎ SD (limits of agreement) for breathing frequency measured by capnometry compared with those obtained by direct measurement was 0.4 ؎ 3.6 (؊6.7 to 7.4). In P ETCO 2 compared with P aCO 2 , the biases (limits of agreement) were 14.8 ؎ 8.2 (؊1.3 to 30.9) at rest, 10.2 ؎ 6.4 (؊2.3 to 22.7) with the mouth closed, and 7.7 ؎ 5.6 (؊3.2 to 18.6) for deep breathing with the mouth closed. P ETCO 2 determined using the capnometry device yielded unreliable and widely ranging values under various breathing patterns. However, deep breathing with the mouth closed decreased the difference between P ETCO 2 and P aCO 2 , as compared with other breathing patterns. CONCLUSIONS: P ETCO 2 measurements under deep breathing with mouth closed with a capnometry-type oxygen cannula improved the prediction of the absolute value of P aCO 2 in extubated post-abdominal surgical subjects without respiratory dysfunction.
British Journal of Anaesthesia, 2012
† The RRa TM is a new acoustic monitoring device which can monitor respiratory rate. † This study compared the RRa TM with capnometry in extubated patients after surgery. † There was close correlation and reasonable limits of agreement between the two devices. Background. Respiratory rate should be monitored continuously in the post-anaesthesia care unit (PACU) to avoid any delay in the detection of respiratory depression. Capnometry is the standard of care but in extubated patients requires a nasal cannula or a face mask that may be poorly tolerated or can be dislodged, leading to errors in data acquisition and false alarms. The value of a new non-invasive acoustic monitor in this setting has not been fully investigated. Methods. Adult patients admitted to the PACU after general anaesthesia were included. After tracheal extubation, an adhesive sensor with an integrated acoustic transducer (RRa TM) was placed on the patient's throat and connected to its monitor while the patient breathed through a face mask with a carbon dioxide sampling port (Capnomask TM) connected to a capnometer. Both the acoustic monitor and the capnometer were connected to a computer to record one pair of data per second for up to 60 min. Results. Fifty-two patients, mean (range) age 54 (22-84) yr and BMI 26 (19-39) kg m 22 , were studied. Compared with capnometry, the bias and limits of agreement of the acoustic method were 0 (21.4-1.4) bpm. The acoustic sensor was well tolerated while the face mask was removed by eight patients, leading to study discontinuation in two patients. Conclusions. In extubated patients, continuous assessment of respiration rate with an acoustic monitor correlated well with capnometry.
Capnography: a valuable tool for airway management
Emergency medicine clinics of North America, 2008
Capnography provides continuous, dynamic assessment of the ventilatory status of patients. Carbon dioxide physiology and the technology utilized in end-tidal carbon dioxide monitor devices are reviewed. Clinical applications with regard to ventilation and airway management are discussed, including: verification of endotracheal tube placement, continuous monitoring of tube position, monitoring during procedural sedation and in the obtunded patient, and assessment of patients with respiratory illnesses. Current guidelines for use of capnography within emergency medicine are included. Potential future applications are also presented.
Volumetric capnography: reliability and reproducibility in spontaneously breathing patients
Clinical Physiology and Functional Imaging, 2005
Volumetric capnography provides a breath-by-breath analysis of ventilationperfusion imbalances and deadspace volumes. The technique has been best described in intubated and ventilated patients, but promising clinical applications also concern spontaneously breathing patients. The objective of the study was to verify the reliability and reproducibility of a new capnographic program in various types of clinical conditions. In a first step, 56 patients, either healthy or with acute respiratory disorders, were connected to a sidestream gas sampler and flow sensor through a mouthpiece. An acquisition software synchronized expired CO 2 and flow data to create volumetric capnographic curves. Mixed expired CO 2 partial pressure, corresponding to the exhaled CO 2 of the effective tidal volume, was simultaneously collected in a neoprene bag for comparison. In a second step, changes in airway deadspace before and after the adjunction of known spacer volumes were compared in six healthy volunteers. The mean difference between both methods in measuring mixed expired CO 2 partial pressure was )0AE9 mmHg (SE 0AE2 mmHg, P<0AE001). The limits of agreement extended from )4AE4 to 2AE5 mmHg. The interobserver correlation coefficient for reproducibility was 0AE98. Airway deadspace volume, after correction for extra volumes, was not statistically different than the basic value (P ¼ 0AE89). In conclusion, volumetric capnography can be compared with references when used in spontaneously breathing patients. Future developments and clinical applications should clarify its role as a non-invasive method for deadspace and ventilation-perfusion imbalances analysis.
Journal of Clinical Monitoring and Computing, 2014
Continuous respiratory assessment is especially important during post-operative care following extubation. Respiratory depression and subsequent adverse outcomes can arise due to opioid administration and/or residual anesthetics. A non-invasive respiratory volume monitor (RVM) has been developed that provides continuous, real-time, measurements of minute ventilation (MV), tidal volume (TV), and respiratory rate (RR) via a standardized set of thoracic electrodes. Previous work demonstrated accuracy of the RVM versus standard spirometry and its utility in demonstrating response to opioids in postoperative patients. This study evaluated the correlation between RVM measurements of MV, TV and RR to ventilator measurements during general anesthesia (GA). Continuous digital RVM and ventilator traces, as well as RVM measurements of MV, TV and RR, were analyzed from ten patients (mean 62.6 ± 7.4 years; body mass index 28.6 ± 5.2 kg/m 2) undergoing surgery with GA. RVM data were compared to ventilator data and bias, precision and accuracy were calculated. The average MV difference between the RVM and ventilator was-0.10 L/min (bias:-1.3 %, precision: 6.6 %, accuracy: 9.0 %. The average TV difference was 40 mL (bias: 0.4 %, precision: 7.3 %, accuracy: 9.1 %). The average RR difference was-0.22 breaths/ minute (bias:-1.8 %, precision: 3.7 % accuracy: 4.1 %). Correlations between the RVM traces and the ventilator were compared at various points with correlations[0.90 throughout. Pairing the close correlation to ventilator measurements in intubated patients demonstrated by this study with previously described accuracy compared to spirometry in nonintubated patients, the RVM can be considered to have the capability to provide continuity of ventilation monitoring post-extubation This supports the use of real-time continuous
Anesthesia and analgesia, 2017
Intermittent measurement of respiratory rate via observation is routine in many patient care settings. This approach has several inherent limitations that diminish the clinical utility of these measurements because it is intermittent, susceptible to human error, and requires clinical resources. As an alternative, a software application that derives continuous respiratory rate measurement from a standard pulse oximeter has been developed. We sought to determine the performance characteristics of this new technology by comparison with clinician-reviewed capnography waveforms in both healthy subjects and hospitalized patients in a low-acuity care setting. Two independent observational studies were conducted to validate the performance of the Medtronic Nellcor Respiration Rate Software application. One study enrolled 26 healthy volunteer subjects in a clinical laboratory, and a second multicenter study enrolled 53 hospitalized patients. During a 30-minute study period taking place while...