I intend to use this heading to list any breaking news about capnography.
February 22, 2007 - JEMS Report Capnography Nationwide
According to the February 2007 JEMS 200 City Survey, capnography use in intubated patients increased from 76% in 2003 to 94.8% of the cities in 2006. The article does not mention whether or not the cities are using continous wave-form capnography or colorimetric.
February 4, 2007- Capnography Grant
I found on the internet an application for a large research grant for EMS Capnography.
EMS Capnography Grant
Here's an excerpt:
PURPOSE OF THE CAPNOGRAPHY CAREER DEVELOPMENT AWARD
Capnography is the non-invasive measurement of the partial pressure of carbon dioxide in exhaled breath expressed as an end-tidal CO2 number and a waveform in adults, children, infants, and neonates. CO2 can be sampled from the patient’s mouth or nostrils. Although standard of care in anesthesia practice, the use of capnography in emergency medicine has primarily been limited to intubated patients for verification of endotracheal tube placement and for cardiac arrest. There has been little emphasis on the use of capnography for assessing ventilatory, perfusion, or metabolic status in spontaneously breathing patients. Carbon dioxide measured at the airway can be displayed as a function of time or exhaled tidal volume. This award is specifically for human clinical research on time-based capnography in spontaneously breathing patients and is especially interested in new clinical applications for use of capnography in non-intubated patients. Specific examples of eligible projects would include but not be limited to:
· Capnography to determine ventilatory status in non-intubated infants and children undergoing lumbar puncture
· Capnography in patients with known lung disease to predict the arterial partial pressure of CO2 using nonlinear computational methods, e.g., genetic algorithms, artificial intelligence
· Capnography in patients receiving procedural sedation as a surrogate measurement of minute ventilation
· Prognostic significance of a single measurement of CO2 as a predictor of in-hospital complications in patients with known heart and lung disease
· Utility of capnography as an effort-independent mechanism to assess severity of obstructive lung disease
· Diagnostic accuracy of exhaled CO2 to detect and risk-stratify acute pulmonary embolism
· Accuracy of capnography as a measurement of respiratory rate in triage
· Capnography as an early indicator of mechanical pacer capture
· Capnography as a measure of the effectiveness of fluid resuscitation in hemorrhagic shock
· Relationship between blood pressure and EtCO2 in early cardiogenic shock
· Accuracy of EtCO2 as a measure of cardiac output in patients with tachyarrhymias
· Relationship between EtCO2 and carboxyhemoglobin in carbon monoxide poisoning
· Utility of EtCO2 to distinguish methanol or propylene glycol from isopropyl poisoning
These scenarios are offered only to provide a conceptual basis as to the scope of the award and include ventilation, perfusion, and metabolism applications of capnography. Projects that would be considered nonresponsive would include use of vertebrate animals, post-operative patients, or intubated patients in the emergency department.
May 29, 2006 -- The Use of Capnography as a Guide for Oral Intubation
I just read about a study, which may have just concluded in New Jersey. No results have been published yet to my knowledge. Here's the purpose:
"The purpose of this study is to assess if capnography can be utilized to assist in the process of endotracheal intubation. Specifically, in locating the glottic opening. Ultimately this would result in a new use of capnography to aid in securing normal and difficult airways. Currently capnography is only utilized for the confirmation of endotracheal tube placement.
If successful, this study will provide information, and allow for the development of instrumentation, that will assist in difficult airway management. Specifically in locating the glottic opening when visualization may be impaired. Ultimately, this technique will be useful for routine and emergency airway management."
The Use of Capnography as a Guide for Oral Intubation
I also came across this new study using a technique called fibrecapnic intubation. It sounds like they use the device to capture capnography wave forms (perhaps much like we listen for breathing when nasally intubating)to gain proper positioning. They also visualize the tracheal rings. For more click:
Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway.
Capnography and Terrorism
Capnography as a rapid assessment and triage tool for chemical terrorism.
In an article the August 2005 Emergency Pediatric Care, Baruch Krauss proposes the use of capnography as "a prehospital assessment and triage tool for monitoring victims of chemical terrorism and for critically ill patients" because "Capnography provides the ABGs in less than 15 seconds and identifies the common complications of chemical terrorism."
Here's an easy to read article from the June JEMS on the same topic:
15 Second Triage Tool: The use of capnography for the rapid assessment & triage of critically injured patients & victims of chemical terrorism