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Dr Ajmal Eusuf ICU Monitoring Standards and Capnography
Current Monitoring <ul><li>Personnel </li></ul><ul><li>Patient monitoring </li></ul><ul><li>Equipment monitoring </li></ul>
Current Monitoring-patient <ul><li>Saturations and gases </li></ul><ul><li>ECG </li></ul><ul><li>Blood pressure </li></ul>...
Current monitoring-equipment <ul><li>Ventilator failures and supply </li></ul><ul><li>Oxygen analysis </li></ul><ul><li>Di...
Rational for capnography <ul><li>Would you put a patient to sleep in theatre without capnography being present? </li></ul>...
Capnographic analysis <ul><li>Primarily used for correct intubation </li></ul><ul><li>Can also be used for 1)tidal volume ...
<ul><li>Normal </li></ul>
<ul><li>Capnograph breating around tube </li></ul>
<ul><li>CPR capnograph </li></ul>
<ul><li>Disconnection </li></ul>
<ul><li>Oesophageal intubation </li></ul>
<ul><li>Hyperventilation </li></ul>
<ul><li>Hypoventilation </li></ul>
<ul><li>Rising baseline </li></ul>
<ul><li>ROSC </li></ul>
<ul><li>Sharkfin </li></ul>
<ul><li>Phase 1- anatomical and apparatus dead space </li></ul><ul><li>Phase 2- mixing of dead space and alveolar CO2 </li...
 
 
Critical incidents <ul><li>In theatre! Australian study showed endobronchial intubation was most common incident at 42% </...
Comparisons  <ul><li>Anaesthetic and recovery guidelines are roughly the same </li></ul><ul><li>American ICS specifies cap...
Conclusion <ul><li>Capnography has a wide range of uses </li></ul><ul><li>For better compliance of UK unit protocols, prob...
Any Questions?
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13 icu monitoring standards and capnography

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Transcript of "13 icu monitoring standards and capnography"

  1. 1. Dr Ajmal Eusuf ICU Monitoring Standards and Capnography
  2. 2. Current Monitoring <ul><li>Personnel </li></ul><ul><li>Patient monitoring </li></ul><ul><li>Equipment monitoring </li></ul>
  3. 3. Current Monitoring-patient <ul><li>Saturations and gases </li></ul><ul><li>ECG </li></ul><ul><li>Blood pressure </li></ul><ul><li>Respirations </li></ul><ul><li>Heart and lungs should have clinical monitoring intermittently </li></ul>
  4. 4. Current monitoring-equipment <ul><li>Ventilator failures and supply </li></ul><ul><li>Oxygen analysis </li></ul><ul><li>Disconnection alarms </li></ul><ul><li>Volume and pressure alarms </li></ul><ul><li>Temperature </li></ul>
  5. 5. Rational for capnography <ul><li>Would you put a patient to sleep in theatre without capnography being present? </li></ul><ul><li>Would you keep them asleep without capnography? </li></ul><ul><li>Must of our theatre patients are fit and well </li></ul><ul><li>ICU patients are sicker </li></ul><ul><li>One set of equipment for all the unit which takes a few minutes to set up </li></ul>
  6. 6. Capnographic analysis <ul><li>Primarily used for correct intubation </li></ul><ul><li>Can also be used for 1)tidal volume </li></ul><ul><li>2) dead space </li></ul><ul><li>3) partial obstruction </li></ul><ul><li>4) breath stacking </li></ul><ul><li>5) analysis of chronic airway disease </li></ul><ul><li>Examples: </li></ul>
  7. 7. <ul><li>Normal </li></ul>
  8. 8. <ul><li>Capnograph breating around tube </li></ul>
  9. 9. <ul><li>CPR capnograph </li></ul>
  10. 10. <ul><li>Disconnection </li></ul>
  11. 11. <ul><li>Oesophageal intubation </li></ul>
  12. 12. <ul><li>Hyperventilation </li></ul>
  13. 13. <ul><li>Hypoventilation </li></ul>
  14. 14. <ul><li>Rising baseline </li></ul>
  15. 15. <ul><li>ROSC </li></ul>
  16. 16. <ul><li>Sharkfin </li></ul>
  17. 17. <ul><li>Phase 1- anatomical and apparatus dead space </li></ul><ul><li>Phase 2- mixing of dead space and alveolar CO2 </li></ul><ul><li>Phase 3- alveolar plateau </li></ul><ul><li>Phase 4- start of inspiration </li></ul>
  18. 20. Critical incidents <ul><li>In theatre! Australian study showed endobronchial intubation was most common incident at 42% </li></ul><ul><li>Oesophageal intubation was 18% </li></ul><ul><li>58% of these incidents were picked up via CO2 and SpO2, 25% picked up clinically </li></ul><ul><li>Was calculated that 93% of all incidents should be picked up via CO2, SpO2 and BP. </li></ul>
  19. 21. Comparisons <ul><li>Anaesthetic and recovery guidelines are roughly the same </li></ul><ul><li>American ICS specifies capnography as mandatory monitoring </li></ul><ul><li>UK ICS still debating this </li></ul><ul><li>Most units now have capnography as mandatory for intubation purposes, but only 50% use this! </li></ul><ul><li>Comparisons of theatre and ICU patients </li></ul>
  20. 22. Conclusion <ul><li>Capnography has a wide range of uses </li></ul><ul><li>For better compliance of UK unit protocols, probably need it as bedside monitoring </li></ul><ul><li>Lagging behind other world-wide practises </li></ul><ul><li>Probably needed more by ICU than theatres? </li></ul>
  21. 23. Any Questions?
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