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CO 2 Physiology

CO 2 Physiology. What is Carbon Dioxide?. Capnos comes from the Greek word for “smoke” smoke from the fire of metabolism a natural waste product of cellular activity CO 2 is a compound molecule 1 element of carbon and 2 elements of oxygen colorless and heavier than air

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CO 2 Physiology

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  1. CO2 Physiology

  2. What is Carbon Dioxide? • Capnos comes from the Greek word for “smoke” • smoke from the fire of metabolism • a natural waste product of cellular activity • CO2 is a compound molecule • 1 element of carbon and 2 elements of oxygen • colorless and heavier than air • green plants clean up after our exhaled CO2

  3. Physiology of CO2 • CO2 produced by cellular metabolism diffuses across the cell membrane into the circulating blood. • The blood transports the CO2 to the lungs. • Then it diffuses from the blood into the lungs. • CO2 is eliminated with alveolar ventilation on exhalation.

  4. Physiology of CO2 • Carbon Dioxide is transported in the blood in three (3) principle forms: • 5 to 10% as gas & reflected by the PCO2 • 20 to 30% is bound to blood proteins, the major one being hemoglobin • 60 to 70% is carried as bicarbonate (HCO3)

  5. Physiology of CO2 • About 5-10% of CO2 is eliminate through exhalation only. • The rest is recycled in the body through the circulatory and renal systems. • The heart and lungs would have to increase their work 10 times if they were required to eliminate all the CO2 the body produces!

  6. Ventilation & EtCO2 Monitoring • Endtidal CO2 (EtCO2) is the CO2 measured at the end of expiration. • EtCO2 concentration provides a clinical estimate of the PaCO2, if ventilation and perfusion are appropriately matched. • EtCO2 monitoring allows for a breath by breath assessment of ventilation.

  7. The continuous measurement and graphic display (waveform) of the CO2 concentration in the patient’s airway during the respiratory cycle. Capnography— Normal waveform:

  8. Respiratory Cycle O2 CO2 CO2 O2

  9. Oxygenation = oxygen → lungs→ alveoli→ blood Monitored by a Pulseoximeter Metabolism = oxygen is converted to energy + CO2 Monitored by a Metabolic Computer Hymodynamic Parameter Monitored by ECG, IPB, NIBP, Temperature Ventilation = CO2→ blood→ lungs→ exhalation Monitored by a Capnograph Respiratory Cycle

  10. Normal conditions: EtCO2 is between 35 – 45 mmHg PaCO2 & EtCO2 will be very close EtCO2 ismost2 - 5mmHg less with normal physiology Widening of this difference can be caused by: Incomplete alveolar emptying Ventilation-perfusion abnormalities Poor sampling Capnography monitoring of Critically ill patient may alert clinicians to underlying conditions The relationship – EtCO2 andPaCO2

  11. PaCO2 – Partial pressure of CO2 present in arteries (similar to concentration) Invasive ABG analysis EtCO2 – concentration of CO2 exhaled in each breath Non-invasive measurement at airway PaCO2 vs.EtCO2

  12. D A-B: Baseline = no CO2 in breath B-C: Rapid rise in CO2 C-D: Alveolar plateau D: End expiration (EtCO2) D-E:Inhalation Normal waveform D

  13. Normal waveform - 35-45 mmHg

  14. Hypoventilation

  15. Hypoventilation with shallow breathing

  16. Breath-to-breath measure of ventilatory status Relationship between EtCO2 and RR

  17. Hyperventilation

  18. Capnometer Capnography Some Definitions

  19. Capnometer A Capnometer provides only a numerical measurement of carbon dioxide in mmHg or kPa or Vol.-%

  20. Capnograpy Capnography provides the CO2 value and the waveform of carbon dioxide over time

  21. Earliest sign that something is going wrong Breath by breath assessment of ventilation Capnography—The Ventilation Vital Sign™

  22. 5 0 4 0 3 0 2 0 1 0 0 T i m e Capnography An EtCO2 value of e.g. 38 mm/Hg without a it´s like a heart rate of e.g. 80 without an

  23. CO2 Measurement Technology • General: • CO2 measurement technology • Infrared absorption • Technique of airway gas sampling • Main stream vs. side stream vs. Microstream

  24. Sampling Technology • Mainstream sampling - CO2 analysis chamber is in-line between the patient airway and the ventilator circuit • Sidestream sampling - CO2 analysis chamber is within the device. The patient’s expired gas is sucked from the airway and drawn to that chamber through a sampling line.

  25. Conventional main stream technology Monitor Inspiration Expiration Fresh gas

  26. Conventional side stream technology Sample line (Monitor)

  27. Unique solutions for Capnography = Microstream®

  28. Microstream® CO2 • A combination of a unique CO2 sidestream measurement technology and; • FilterLine (proprietary sampling lines) - for single patient use • Only system providing accurate EtCO2 readings for non-intubated patients that receive supplemental O2 and switch between oral and/or nasal breathing

  29. Microstream® CO2— Major benefits • Ease of Use • Reliable Technology • Flexible for all patient types • Versatile for all environments

  30. Superior moisture handling of liquids, secretions and humidity CO2 specificity – no cross-sensitivity to anesthetic gases Rugged – no moving parts in sensor Long-term monitoring Microstream® advantages • Reliable technology

  31. Microstream® advantages Flexible for all patient populations – solution for monitoring Neonates • 50 ml/min flow rate supports entire patient population – including neonates (Competition at 3 – 5 times the flow rate) • Does not compete for Neonate tidal volume • The lower the flow, the less moisture to be handled

  32. No expensive sensors to replace Yearly calibration – done in 5 minutes Warm up time – 45 seconds from ON until first waveform and number appears One-piece Plug & Playconsumables Microstream® advantages Ease of use

  33. Microstream® advantages Micro sample cell 15 µL 1 Eurocent Light source Light source housing

  34. Microstream® Core Technology Sensor Housing I.R Source Optic Block (Micro Sample Cell) I.R Detectors

  35. Fast response time 1 mm micro bore tubing reduces delay time Crisp waveform – longitudinal filter maintains laminar flow Build-in water trap – don't clean and re-use any FilterLine – it destroys the inline filter Microstream® advantages • Reliable Technology

  36. Flexible Microstream® advantages • Both intubated and nonintubated applications • Alternating mouth and nose breathing • Oxygen delivery (low flow O2 solution; solution for high flow O2 delivery) • Adult, pediatric, and neonates

  37. Microstream® advantages Versatile • All clinical environments: • Critical Care • Sedation Procedures • EMS/ED • Operating Room

  38. Unique solutions for Capnography FilterLine® patient interfaces

  39. Intubated FilterLine® Sets FilterLine® solutions for all applications Non-Intubated Smart Solutions NIV-Line Smart CapnoLine / Smart CapnoLine O2 CapnoLine H

  40. Smart Solutions for nonintubated patients “Microstream® technology allows the accurate measurement of EtCO2 in the absence of an endotracheal tube.”* • Continuous sampling from both mouth and nose • Special oral-piece design optimally samples from mouth -Increased surface area provides greater sampling accuracy in the presence of low tidal volume (adult/intermediate size) *ASA 2001 Jay Brodsky, MD Professor of Anesthesia, Stanford University Medical Center, CA USA

  41. Smart Solutions for nonintubated patients Smart CapnoLine™ Plus /Smart CapnoLine™ Plus O2nasal cannula for CO2 measurement and O2 delivery • Uni-junction sampling method ensures optimal waveform and ultra-fast response time • Unique O2 delivery method reduces CO2 sampling dilution (up to 5l/min) • Solution for high flow O2 delivery (works effectively under oxygen delivery mask)

  42. Solutions for non-intubated patients CapnoLine H*™ / CapnoLine H O2 • Enables continuous EtCO2 monitoring in high humidity environments (i.e. ICU) • Can be used up to 72 hours Piece of Nafion * = Humidity

  43. Microstream®—A Unique Solution For Non-intubated Patients CO2 sampling / O2 delivery for non-intubated patients (up to 5 L/min.) Nasal and Oral Sampling Small pin holes deliver pillow of oxygen around both nose and mouth Increased surface area provides greater sampling accuracy in the presence of low tidal volume Uni-junction™ of sampling ports prevents dilution from non-breathing source

  44. Easily handles moisture and secretions without water traps Able to measure in any position Nafion® tubing allows for long-term monitoring without moisture build up Easily switches to non-intubated monitoring without re-calibration of monitor Low add. dead space (0,4 cc) to use on neonates FilterLine® Sets - Solutions for intubated patients

  45. FilterLine® recommendations: Sedation Areas; GI Lab, Cath Lab, EP Lab

  46. Do not try to dry the FilterLine® - this will damage the filter Ensure there are no kinks in the sampling line Do not cut the oral flange on the Smart CapnoLine Do not cover the Nafion® Do not instill medications through the airway adapter Never pass a suction catheter or stylus through the airway adapter Change the FilterLine® or the Set if a “Blockage” message appears on the monitor screen or if the readings become extremely erratic FilterLine® information to avoid problems

  47. Latex free Single-patient use Not sterile FilterLine® answers for the most FAQ´s:

  48. Sedation Procedures “Monitoring of exhaled carbon dioxide should be considered for all patients receiving deep sedation and for patients whose ventilation cannot be directly observed during moderate sedation.”* *Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists, Developed by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non Anesthesiologists: Anesthesiology 2002; 96:1004

  49. Assesses - patent airway (airway obstruction) protective reflexes response to verbal/physical stimuli Respiratory changes can immediately be assessed Microstream® allows for continuous respiratory monitoring with no nuisance alarms in procedural sedation environments where currently there is minimal usage of monitoring Microstream®solutions during Sedation Procedures Benefits and Uses

  50. Microstream®solutions during Sedation Procedures Applications • Cardiac Cath. Lab • GI lab • Pulmonary lab • Emergency Department • Hyperbaric medicine • Dental Clinics • Radiology

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