A novel application of capnography during controlled human exposure to air pollution (original) (raw)
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Capnographic Monitoring in Respiratory Emergencies
Clinical Pediatric Emergency Medicine, 2009
Children with respiratory diseases present commonly to the emergency department. As a continuous, dynamic measure of the ventilatory status, capnography can provide valuable information in the assessment and management of these patients. After a review of the relevant physiology and technology of carbon dioxide monitoring, clinical applications for the use of capnography in patients with respiratory illnesses are discussed. Characteristic waveforms are provided, and their interpretation and clinical significance are discussed. A focus on the current literature investigating the noninvasive monitoring of patients with obstructive lung disease is included. Practical tips for successfully using capnography are also presented. Clin Ped Emerg Med 10:82-89
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.
The Journal of Emergency Medicine, 2011
e Abstract-Study Objective: To determine if the slope of Phase II and Phase III, and the alpha angle of the expiratory capnographic waveform, as measured via computerrecognizable algorithms, can reflect changes in bronchospasm in acute asthmatic non-intubated patients presenting to the emergency department (ED). Methods: In this prospective study carried out in a university hospital ED, 30 patients with acute asthma were monitored with clinical severity scoring and peak flow measurements, and then had a nasal cannula attached for sidestream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a personal computer card for analysis. The patients were treated according to departmental protocols. After treatment, when they had improved enough for discharge, a second set of results was obtained for capnographic waveform recording. The pre-treatment and posttreatment results were then compared with paired-samples t-test analysis. Results: On the capnographic waveform preand post-treatment, there was a significant difference in the slope of Phase III (p < 0.001) and alpha angle (p < 0.001), but not in the Phase II slope (p ؍ 0.35). There was significant change in peak flow meter reading, but it was poorly correlated with all the capnographic indices. Conclusion: The study provides some preliminary data showing that capnographic waveform indices can indicate improvement in airway diameter in acute asthmatics in the ED. Capnographic waveform analysis presents several advantages in that it is effort-independent, and provides continuous monitoring of normal tidal respiration. With further refined studies, it may serve as a new method of monitoring nonintubated asthmatics in the ED.
Occupational and Environmental Medicine, 2002
Aims: To investigate the relation between personal exposures to nitrogen dioxide, carbon monoxide, and PM 10 , and exposures estimated from static concentrations of these pollutants measured within the same microenvironments, for healthy individuals and members of susceptible groups. Methods: Eleven healthy adult subjects and 18 members of groups more susceptible to adverse health changes in response to a given level of exposure to nitrogen dioxide, carbon monoxide, and/or PM 10 than the general population (six schoolchildren, six elderly subjects, and six with pre-existing diseasetwo with chronic obstructive pulmonary disease (COPD), two with left ventricular failure (LVF), and two with severe asthma) were recruited. Daytime personal exposures were determined either directly or through shadowing. Relations between personal exposures and simultaneously measured microenvironment concentrations were examined. Results: Correlations between personal exposures and microenvironment concentration were frequently weak for individual subjects because of the small range in measured concentrations. However, when all subjects were pooled, excellent relations between measured personal exposure and microenvironment concentration were found for both carbon monoxide and nitrogen dioxide, with slopes of close to one and near zero intercepts. For PM 10 , a good correlation was also found with an intercept of personal exposure (personal cloud) of 16.7 (SD 10.4) µg/m 3 . Modelled and measured personal exposures were generally in reasonably good agreement, but modelling with generic mean microenvironment data was unable to represent the full range of measured concentrations. Conclusions: Microenvironment measurements of carbon monoxide and nitrogen dioxide can well represent the personal exposures of individuals within that microenvironment. The same is true for PM 10 with the addition of a personal cloud increment. Elderly subjects and those with pre-existing disease received generally lower PM 10 exposures than the healthy adult subjects and schoolchildren by virtue of their less active lifestyles.
Capnography: A Feasible Tool in Clinical and Experimental Settings
Respiratory care, 2015
Capnography is the monitoring of the partial pressure of alveolar carbon dioxide (CO2) in the respiratory gases. It is a useful noninvasive clinical tool for assessing efficiency and optimizing mechanical ventilation.1 The use of capnography for monitoring surgical patients during anesthesia and in the emergency department to confirm artificial airway placement is well-established and recommended.2 Capnography’s importance as a standard of monitoring and patient safety in the ICU has been confirmed in recent years.1,3 Clinical uses of capnography in the ICU also include indirect assessment of cardiac output during weaning from cardiopulmonary bypass in patients without significant lung disease, monitoring of patients during changes in bed positioning, prognostic indicator of outcome in cardiac arrest, adjustment of the trigger sensitivity, and assessment of pulmonary circulation, recognizing the presence of pulmonary embolism as well as the effectiveness of chemical thrombolysis.4-8.........
A review of capnography in asthma: A new approach on assessment of capnogram
Asthma is a chronic inflammatory disease of the bronchial tubes that occurs in about 3 to 5% of all people and continues to be a significant cause of morbidity and mortality. Traditionally, peak flow meter and spirometer is used to monitor the asthmatic patients which have lots of limitation. Nowadays, capnography is a new method used to monitor the asthmatic condition. It is able to show the different respiratory situation of patient including asthma. Unlike traditional methods, it is taken while the patient is breathing as comfortable as possible. Previous studies have shown significant correlation between the capnogram and asthmatic patient. However, all of them are just manual studies conducted through the conventional method. Manual analysis of capnogram is, however, time-consuming and led to erroneous due to human factor such as tiredness and lack of proficiency. Therefore, it is proposed here to develop a computerized system to detect the severity of airway obstruction by pro...
Forced expiratory capnography and chronic obstructive pulmonary disease (COPD)
Journal of Breath Research, 2013
This report proposes a potentially sensitive and simple physiological method to detect early changes and to follow disease progression in obstructive pulmonary disease (COPD) based upon the usual pulmonary function test. Pulmonary function testing is a simple, although relatively insensitive, method to detect and follow COPD. As a proof-of-concept, we have examined the slope of the plateau for carbon dioxide during forced expiratory capnography in healthy (n=10) and COPD subjects (n=10). We compared the change in the rate of exhalation of carbon dioxide over time as a marker of heterogeneous ventilation of the lung. All subjects underwent pulmonary function testing, body-plethysmography, and forced exhalation capnography. The subjects with COPD also underwent high-resolution computed tomography of the chest. Regression lines were fitted to the slopes of the forced exhalation capnogram curves. There was no difference in the mean levels of exhaled carbon dioxide between the COPD and the healthy groups (p>0.48). We found a significant difference in the mean slope of the forced exhalation capnogram for the COPD subjects compared to the healthy subjects (p=0.01). Most important, for the COPD subjects, there was a significant positive correlation between the slope of the forced exhaled capnogram and a defined radiodensity measurement of the lung by high-resolution computed tomography (r 2 =0.49, p=0.02). The slope of the forced exhalation capnogram may be a simple way to determine physiological changes in the lungs in patients with COPD that are not obtainable with standard pulmonary function tests. Forced exhalation capnography would be of great clinical benefit if it can identify early disease changes and at-risk individuals.