Dr. Ajmal Eusuf discusses the importance and benefits of capnography monitoring in the ICU. Capnography can be used to confirm proper endotracheal tube placement, monitor ventilation, and detect various respiratory issues. While capnography is standard practice in operating rooms and recommended by guidelines, only about half of UK ICUs currently use it as a mandatory monitoring tool. Adopting capnography as routine bedside monitoring in the ICU would help compliance with protocols and better patient care, especially for critically ill patients who are sicker than those in operating rooms.

1. Dr Ajmal Eusuf ICU Monitoring Standards and Capnography

2. Current Monitoring Personnel Patient monitoring Equipment monitoring

3. Current Monitoring-patient Saturations and gases ECG Blood pressure Respirations Heart and lungs should have clinical monitoring intermittently

4. Current monitoring-equipment Ventilator failures and supply Oxygen analysis Disconnection alarms Volume and pressure alarms Temperature

5. Rational for capnography Would you put a patient to sleep in theatre without capnography being present? Would you keep them asleep without capnography? Must of our theatre patients are fit and well ICU patients are sicker One set of equipment for all the unit which takes a few minutes to set up

6. Capnographic analysis Primarily used for correct intubation Can also be used for 1)tidal volume 2) dead space 3) partial obstruction 4) breath stacking 5) analysis of chronic airway disease Examples:

7. Normal

8. Capnograph breating around tube

9. CPR capnograph

10. Disconnection

11. Oesophageal intubation

12. Hyperventilation

13. Hypoventilation

14. Rising baseline

15. ROSC

16. Sharkfin

17. Phase 1- anatomical and apparatus dead space Phase 2- mixing of dead space and alveolar CO2 Phase 3- alveolar plateau Phase 4- start of inspiration

20. Critical incidents In theatre! Australian study showed endobronchial intubation was most common incident at 42% Oesophageal intubation was 18% 58% of these incidents were picked up via CO2 and SpO2, 25% picked up clinically Was calculated that 93% of all incidents should be picked up via CO2, SpO2 and BP.

21. Comparisons Anaesthetic and recovery guidelines are roughly the same American ICS specifies capnography as mandatory monitoring UK ICS still debating this Most units now have capnography as mandatory for intubation purposes, but only 50% use this! Comparisons of theatre and ICU patients

22. Conclusion Capnography has a wide range of uses For better compliance of UK unit protocols, probably need it as bedside monitoring Lagging behind other world-wide practises Probably needed more by ICU than theatres?

23. Any Questions?