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How to Read and Interpret End-Tidal Capnography Waveforms

Capnography is a great way to confirm airway device placement and monitor ventilation, but it can do so much more. Carbon dioxide (CO2) is a product of metabolism transported via perfusion and expelled through ventilation. End-tidal carbon dioxide (EtCO2) waveform monitoring allows you to measure all three simultaneously, making it the most important vital sign you use.1 To evaluate the metabolism, ventilation and perfusion of a patient through EtCO2 waveform monitoring you need to read the PQRST: proper, quantity, rate, shape and trend. Proper means that you should know the normal readings for quantity, rate, shape and trending of EtCO2. In this case, normal means what we find in a healthy person with no metabolism, ventilation or perfusion problems. One of the great things about EtCO2 is that although ventilation rates vary based on age, normal readings for quantity, shape and trends are the same for men and women of all age groups, making them easy to remember. Quantity; target EtCO2 value should be 35-45 mmHg. Rate of ventilation should be 12-20 breaths per minute (bpm) for adults if the patient is breathing on their own and 10-12 bpm if you're ventilating them. Children should be ventilated at a rate of 15-30 bpm; 25-50 bpm for infants. Ventilating too quickly won't let enough CO2 build up in the alveoli, resulting in lower EtCO2 readings. Ventilating too slowly will allow extra CO2 to build up, resulting in higher readings. Shape of the waveform should normally be a rec...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Patient Care Source Type: news

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CONCLUSION: It can be hypothesized that the wide discrepancy in HDR slope versus heparin sensitivity may be explained by an inaccurate prediction of the plasma heparin level and/or the change in HDR of individual patients, depending on in vivo factors such as extravascular sequestration of heparin, decreased intrinsic antithrombin activity level and platelet count and/or activity. PMID: 28820035 [PubMed - in process]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
CONCLUSIONS: Adding sub-valvular procedures when repairing ischemic chronic mitral valve regurgitation may be associated with better durability, even in the case of the presence of predictors for late failure. PERSPECTIVE: Surgical sub-valvular adjunctive procedures have to be considered in the case of the presence of echocardiographic predictors for late failure. PMID: 28820034 [PubMed - in process]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Abstract OBJECTIVES: Unregulated intraoperative distension of human saphenous vein (SV) graft leads to supraphysiologic luminal pressures and causes acute physiologic and cellular injury to the conduit. The effect of distension on tissue viscoelasticity, a biophysical property critical to a successful graft, is not well described. In this investigation, we quantify the loss of viscoelasticity in SV deformed by distension and compare the results to tissue distended in a pressure-controlled fashion. MATERIALS AND METHODS: Unmanipulated porcine SV was used as a control or distended without regulation and distend...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Science and the "fake news" conundrum. Perfusion. 2017 Sep;32(6):429 Authors: Punjabi PP PMID: 28820032 [PubMed - in process]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Abstract Since 2014, several infections with non-tuberculous mycobacteria (NTM) belonging to the species Mycobacterium ( M.) chimaera have been associated with the use of heater-cooler devices during on-pump cardiothoracic surgery both in European countries and the United States of America. Infections have been detected after surgery, with a delay of a few months and up to five years. Bacterial contamination of heater-cooler devices has also been described without any associated infections. In many centres, it has been a challenging task to eliminate NTM from the heater-cooler devices in order to reduce the risk t...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
CONCLUSIONS: There are many different factors affecting the need for perfusionists in the future. An increasing and aging population with a higher prevalence of CVD, an increased number of hospitals offering cardiovascular services and increased access to care increases the need for perfusion services. It is important for the perfusion profession to follow these changing trends in CVD and treatment in order to plan for the future. PMID: 28820030 [PubMed - in process]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
We report on a case involving a 10-month-old infant who received prolonged ECMO therapy following cardiac surgery for multiple ventricular septal defects (VSD). The patient was successfully weaned from 92 days of ECMO support without any long-term deficits. PMID: 28820029 [PubMed - in process]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Abstract OBJECTIVES: Over the last decade, extracorporeal membrane oxygenation (ECMO) has become a promising option for patients with severe acute respiratory distress syndrome (ARDS). In this single-center observational cohort study, data from a patient group with severe ARDS treated with ECMO was analyzed. METHODS: Data from 46 patients [median age 54 years (18 to 72), male: 65.2%] were evaluated retrospectively between January 2009 and September 2015. RESULTS: Diagnosis leading to ARDS was pneumonia in 63.1% of the patients. The median SOFA Score was 13 (10 to 19) and the median LIS was 3.5 (2.67 to 4...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
We report on two cases of patients who had no pre-existing injuries of the affected lung, underwent VA ECMO support after open-heart surgery and received airway extubation (AE) or awake ECMO with the recovery of left ventricular ejection fraction. Atelectasis happened after AE and non-invasive positive pressure ventilation attenuated the atelectasis of one patient. The atelectasis of the other patient was corrected 10 hours after weaning from ECMO. Both patients were discharged successfully. Awake VA ECMO for post-cardiac surgery patients should be performed with prudence and needs further research. PMID: 28820027 [PubMed - in process]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Abstract INTRODUCTION: This manuscript represents a pilot study assessing the feasibility of a single-compartment, individualised, pharmacokinetic algorithm for protamine dosing after cardiopulmonary bypass. METHODS: A pilot cohort study in a specialist NHS cardiothoracic hospital targeting patients undergoing elective cardiac surgery using cardiopulmonary bypass. Patients received protamine doses according to a pharmacokinetic algorithm (n = 30) or using an empirical, fixed-dose model (n = 30). Categorical differences between the groups were evaluated using the Chi-squared test or Fisher's exact test. Contin...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
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