CMYK

END-TIDAL CO2
Normal and Abnormal Capnogram Waveforms

Normal Capnogram Waveform

A-B: Baseline
B-C: Expiratory Upstroke
Indications: C-D: Expiratory Plateau
• ET tube is correctly positioned D: End-tidal Concentration
• Proper ventilation is occurring D-E: Inspiration

Abnormal Capnogram Waveforms

Esophageal Intubation
Observations:
• No CO2 sensed
Airway Obstruction
• Small transient waveforms Possible Causes:
• Partially kinked or occluded artificial airway
• Presence of foreign body in the airway
• Bronchospasm
Increasing EtCO2 Level - Elevated end-tidal CO2 valve
Time
- Loss of alveolar plateau
Possible Causes:
• Decrease in • Increase in
metabolic rate
respiratory rate
and/or tidal volume • Rapid rise in Decreasing EtCO2 Level
(hypoventilation) body temperature
(malignant Possible Causes:
Time • Decrease in
hyperthermia) • Increase in
metabolic rate
Leak respiratory rate
and/or tidal volume • Fall in body
(hyperventilation) temperature
Possible Causes:
Time
• ET tube cuff • Mask or Bag Mask
may be deflated Valve leak
or ruptured • Artificial airway is
• ET tube in the too small for patient
vocal cords Time
EtCO2 During Cardiac Arrest
Rebreathing EtCO2 increases significantly with
the return of effective heart function.
Possible Causes:
• Mechanical dead space Observations:
• Mechanical ventilator failure • EtCO2 drops during cardiac arrest
• As rescuer tires, a decrease in
EtCO2 is observed
Time • Increases with effective chest
compressions and heart function
Muscle Relaxants (Curare Cleft)
Possible Causes: Curare Cleft

• Patient is mechanically ventilated Real-Time Trend

Observations:
• Depth of cleft is proportional to degree
of drug activity
Time