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Monitoring during mechanical ventilation: CAPNOGRAPHY (4)

A useful application of capnography is the detection of esophageal intubation. Because there is normally very little carbon dioxide in the stomach, intubation of the esophagus and ventilation of the stomach result in a near-zero PetCO2. A potential problem with the use of capnography to confirm endotracheal intubation occurs during cardiac arrest, with false negative results occurring because of very low PetCO2 values related to decreased pulmonary bloodflow. Relatively inexpensive disposable devices that produce a colour change in the presence of expired carbon dioxide are available to detect esophageal intubation. During resuscitation, changes in pulmonary bloodflow are reflected by changes in PetCO2. However, the use of PetCO2 as a real-time objective indicator of bloodflow during resuscitation is not practical.

Although capnography has become a standard of care in the operating room, its use in the critical care unit cannot be enthusiastically supported. PetCO2 is often an imprecise predictor of PaCO2, particularly in patients with lung disease -precisely those in whom its use might be most desirable. Although the use of capnography has been advocated as a backup ventilator disconnect alarm, there is no evidence that it is any better than the alarms currently available on ventilators. You can shop with the best pharmacy there is and finally have a chance to buy levaquin online for treatment paying less for high quality medications that you need, getting them delivered to your door in no time at all.

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