Capnography During Sedation呼气末二氧化碳在镇静.pptx

Capnography During Sedation Bhavani Shankar Kodali MD Associate Professor, Harvard Medical School, Vice Chair, Clinical Affairs Brigham and Women’s Hospital New Standards of Monitoring American Society of Anesthesiologists (ASA) and the Association of Anaesthestists of Great Britain and Ireland (AAGBI) have revised standards in 2011 to monitor ventilation with capnography for all procedural sedation cases requiring moderate to deep sedation. Bhavani Shankar Kodali M.D. Why were they introduced? It is difficult to predict how an individual will respond to an administered sedative. Incidence of hypoxia is less if capnography was used to monitor ventilation. Capnography when used in conjunction with pulse oximetry and visual inspection of chest detected respiratory depression 17 times more often than without capnography. Capnography forewarns of impending hypoxia by about 5 to 240 seconds. Capnography triggers early intervention and decreases the incidence of oxygen desaturation. Administration of supplemental oxygen delays the onset of desaturation following apnea and therefore relying on pulse oximetry alone will delay intervention. Bhavani Shankar Kodali M.D. Objectives After reviewing this brief clinical concept, the clinician/nurse will understand the basic physiology of capnography. The clinician/nurse will be able to interpret capnography in monitoring ventilation during sedation more effectively and safely Bhavani Shankar Kodali M.D. Definitions PETCO2: The maximum partial pressure of CO2 at the end of a breath. It is about 36- 40 mm Hg in healthy adults. PACO2: Partial pressure of CO2 in the alveoli. Capnogram: A plot of PCO2 versus time (time capnogram), or expired volume (volume capnogram). Time capnogram is common in clinical practice Bhavani Shankar Kodali M.D. Basic Physiology When you inhale CO2 free air and exhale, and measure partial pressure of CO2 at the mouth, you get the following trace. Normal values of PETCO2 vary between 35 and 40 mm Hg B