BOX 10.

2 SUMMARY OF AARC CLINICAL PRACTICE GUIDELINE FOR CAPNOGRAPHY/CAPNOMETRY DURING

MECHANICAL VENTILATION
Indications
Based on current evidence, capnography is useful for the following:
1. Monitoring the severity of pulmonary disease and evaluating the response to therapy, especially therapy
intended to improve VD/VT and ventilation/perfusion relationships. It may also provide valuable
information about therapy directed at improving coronary blood flow.
2.Used as a adjunct to verify that tracheal rather than esophageal intubation has taken place.
3.Graphic evaluation of the integrity of the patient-ventilatory interface.
4. Monitoring the adequacy of pulmonary and coronary blood flow.
5. Screening patients for pulmonary embolism.
6.Detection of CO2 rebreathing and the waning effects of neuromuscular blockade.
7.Monitoring CO2 elimination.
8. Optimization of mechanical ventilation.

Contraindications/Complications
There are no absolute contraindications to capnography in mechanically ventilated adult patients.
Mainstream device increase the amount of dead space added to the ventilator circuit. The sampling rate of
respired gases when using sidestream analyzers may be high enough to cause autotriggering when flow
triggering of mechanical breaths is used. The effect is inversely proportional to the size of the patient. The
gas-sampling rate can also diminish delivred tidal volume in neonates and small patients while using
volume-targeted or volume-controlled ventilation.
Monitoring
During capnography, the following should be recorded:
1. Ventilatory variables, including tidal volume, respiratory rate, positive end-expiratory pressure,
inspiratory/expiratory ratios, peak airway pressures, concentrations of respiratory gases.
2. Hmodynamic variables, including systemic and pulmonary pressures, cadiac output, shut and
ventilation/perfusion imbalances.
Limitations
Although capnography can provide valuable information about the efficiency of ventilation, as well as
systemic, pulmonary, and coronary perfusion, PaCO2 should be routinely determined by standard arterial
blood gas analysis. Leaks in the ventilator circuit or leaks around the tracheal tube can lead to inaccurate
measurements of expired CO2. The ability of the contour of the capnogram can also be affected by the
stability of the minute volume, tidal volume, cardiac output, and CO2 nody stores. High breathing
frequencies may exceed the response capabilities of the capnograph and therefore affect the integrity of
the capnogram recorded. Low cardiac output may cause a false-negative result when attempting to verify
the endotracheal tube (ET) position in the trachea. Positioning the ET in the pharynx, as well as the
presence of antacids and carbonated beverage in the stomach, can lead to false-positive results when
assessing ET placement.