7.5 X 11.5.Doubleline.P65

Cambridge University Press 978-0-521-51478-1 - Capnography, Second Edition Edited by J. S. Gravenstein, Michael B. Jaffe, Nikolaus Gravenstein and David A. Paulus Index More information

Index

abbreviated injury score 74 airway–alveolar interface 340 amino acids 240 abdominal aortic cross-clamp 220 alanine 239 anatomic deadspace 83, 196 abdominal aortic surgery 245 alarm systems 378 anesthesia 43 acclimatization 117, 119 alcoholic ketoacidosis 302 airway establishment 48

acetazolamide aliasing 410 and CO2 production 242 high-altitude complications 120 altitude exposure 115 atalectasis 166 respiratory effects 288 alveolar pressure changes 117 breathing circuit 45 acetyl-CoA 239 and pressure 116 capnography 320 acetylene tracer 209 capnometry 124 equipment 44 acid–base balance 250, 295–310 human physiology 116 cardiovascular surgery 50 chemical buffering 295 hypocapnia 256 general 103 normal 295 lung volume 119 intraoperative events acid–base disorders altitude mountain sickness 117 cardiopulmonary bypass 246

approach to 298–99 alveolar CO2 See PaCO 2 laparoscopy 244 compensation equations 299 alveolar deadspace 4, 83, 170, 196, temperature 246 diagnosis 297 200, 226, 315 tourniquet release 245 mixed 300 acute respiratory distress syndrome vascular cross-clamping 245 simple 299 177 laparoscopy 49 acids 295 causes of 177 morbidity 104 acinar airway reduction factor 349 increased 196 neurosurgical 49 acute lung injury 170, 177 gas embolism 205 one-lung ventilation 49 acute mountain sickness 120 pulmonary embolism 201 position-related problems 48 acute respiratory distress syndrome alveolar deadspace fraction 200 ventilation during 43

153, 160, 318 alveolar ejection volume See Va e anion gap See metabolic acidosis alveolar deadspace 177 alveolar gas equation 122, 226 antacids

mechanical ventilation 169 alveolar hyperventilation 117 false-positive CO2 estimates ventilation/perfusion mismatch 322 alveolar hypoventilation 15 39 adults alveolar minute ventilation 150, 152, anthropogenic effect 262 normal respiratory values 5 233 antisialagogues 41

air alveolar O2 See PaO 2 anxiolysis 103, 108 constituents of 116 alveolar plateau 85, 329 anxiolytics 43 air embolism 4, 204, 444 missing 92 aortic body 117, 360 air travel 116 alveolar recruitment 161 aortic pulse pressure 66 airway alveolar ventilation 165 aortic surgery 51 anesthesia 48 monitoring 12 APACHE 63 difficult 34 neonates 83 apnea 16, 26, 34, 58

establishment of 48 relationship to PaCO2 39 central sleep 256 integrity 56 American Heart Association 20, 64, conscious sedation 108–09 neonates 91 192 apnea test for brain death 290 airway devices American Society for Testing and ARDS See acute respiratory distress out-of-hospital setting 20 Materials (ASTM) 373 syndrome airway maintenance 34 American Society of arterial blood gases 297 airway management Anesthesiologists 43, 64 analysis 12 hospital setting 32–35 American Society of Anesthesiology arterial carbon dioxide partial

operating room 37–41 Closed Claims Study 37 pressure See PaCO2 out-of-hospital setting 19–29 American Society of Gastrointestinal arterial CO2 tension See PaCO2 airway obstruction Endoscopy arterial gas embolism 122–23 conscious sedation 108–09 Clinical Outcomes Research arterial–alveolar gradient 56

monitoring 13 Initiative (CORI) 105 arterial-to-alveolar PCO2 gap 235 467

© in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-51478-1 - Capnography, Second Edition Edited by J. S. Gravenstein, Michael B. Jaffe, Nikolaus Gravenstein and David A. Paulus Index More information

Index

asthma 5, 48, 196, 330, 332 Boyle, Robert 415 neonate arterial–alveolar gradient Boyle’s Law of Pressure and Volume devices 80 56 121 emergency medicine and biofeedback 131 brain transport 85

rationale 131 CO2 effects252 intensive care 86 results 131 brain death mainstream and sidestream

CO2 monitoring 58 apnea testing 290 measures 81 hypocapnia 127 brain injury, traumatic 66, 72 operating room 84 waveforms 465 breath detection 392 response time 90 atelectasis 145 breath sounds safety 86 anesthesia-induced 166 auscultation 22 sampling rate 91 atmospheric gases 261 patients in transit 63 small airways 91 atmospheric monitoring 261–69 breathing circuit 45 technical limitations 89 closed ecosystems 265 integrity 56 out-of-hospital setting 24–27 mines 263 during transit 64 patients in transit 63–68 saturation diving 265 breathing, control of 360–68 pulmonary embolism 195–205 SEALAB experiments 265 dynamic end-tidal forcing 363 sleep disorders 96–100 atmospheric pressure 115 frequency response of respiratory time-based See time-based changes in 68 controller 363 capnography ATP 239 hypercapnic ventilatory response 362 veterinary medicine 272–79 Australian Incident Monitoring Study physiology 360 volume-based See volume-based (AIMS) 39 pseudorandom binary forcing 364 capnography

Avogadro’s law 289 response to transient CO2 waveforms inhalation 362 biphasic 40 Badische Anilin und Soda Fabrik British Standards Institute (BSI) 373 use of 76 (BASF) 418 bronchiolitis 58 capnography head-up tilt test bag-valve mask 19 bronchodilators 174 (CHUTT) 16 Bartter syndrome 306 bronchopleural fistula 34 capnometry 27 bases 295 bronchospasm 26, 330 at altitude 124 Beckman metabolic measurement Buteyko breathing technique 128 colorimetric 75 cart 424 conscious sedation Beer–Lambert law See Lambert–Beer calcium metabolism 246 modified nasal cannula 106 law calibration 380 definition23 bicarbonate 240 calorimetry endotracheal tube placement 64 during cardiopulmonary direct 241 quantitative 75 resuscitation 187 indirect 241 semiquantitative 75 regulation 296 capacitance equation 215 sleep disorders 97 bicarbonate buffers295 capnogram capnometry-assisted respiratory bicarbonate infusion 288 analysis of 432 training See biofeedback bicarbonate–carbonic acid equation church-steeple appearance 47 carbohydrate metabolism 239 295 origins of 432 carbon dioxide 239–47, 415 bi-level ventilation 141 capnography 1, 27, 226, 329–37 absorbers 151 biofeedback 127–33 advances in 148 balance 151, 240 asthma 127, 131 alpha angle 13 elimination 151 epilepsy 128 applications 432 embolism 663, 922 hyperventilation syndrome 128 beta angle 13, 319 exhaled 11, 226 panic disorder 127, 129 cardiopulmonary resuscitation increased partial pressures 288 principles and perspectives 132 185–92 apnea testing for brain death Bios-3 265 clinical uses 12 290 Biosphere 2 266 conscious sedation 105 bicarbonate infusion 288 birds, capnography 276 definition23 inhalation test 362 Black, Andrew 459 endotracheal tube placement 64 measurement 381–93, 417 blackdamp 263 history 455 algorithms 392 Bland–Altman plot 212, 215 monitoring chemical 417 blood transfusion air embolism 444 colorimetric detectors 385 decision hemodynamics 219 circulation 437 early clinical applications 420 Bohr equation 59, 65, 83, 198 medical errors 442 infrared absorption 382 Bohr, Christian 417, 421 metabolism 432 mainstream/sidestream Bohr–Enghoff equation 84, 165 technical defects 441 capnography 388 Bouguer, Pierre 416 ventilation 433 mass spectroscopy 386 468

Index

photoacoustic spectroscopy 385 patients in transit 66 closed ecosystems 265 physical 418 thermal dilution 210 Bios-3 265 metabolic changes affecting54 cardiogenic oscillations 3, 7, 437, 465 Biosphere 2 266 cardiovascular function 54 cardiopulmonary bypass 51, 246 International Space Station 267 respiratory function 55 weaning from 146 Space Shuttle 266 monitoring 226 cardiopulmonary resuscitation 33, submarines/submersibles 268 and ambient pressure 124 185–92, 465 Cobra Perilaryngeal Air 19 asthma 58 bicarbonate and epinephrine 187 colorimetric capnometers 11, 32 neonates 58 coronary and cerebral perfusion 187 colorimetric capnometry 75

non-invasive 149 cardiopulmonary system colorimetric CO2 detector 16, 385 spontaneously breathing patients high-altitude changes 119 semi-quantitative 24 58 cardiovascular function Comité Européen pour Normalisation

tissue levels 235 and CO2 54 (CEN) 373 pathophysiology 283–86 cardiovascular surgery compensation equations 299–300 physical properties 381 anesthesia 50 complete rebreathing 208 production 60, 239–40 carnitine palmitoyltransferase II compliance, pulmonary 11 anesthesia 242 deficiency 283 computed tomography 162 biochemistry/physiology 239 carotid body 117 congestive heart failure 222 calorimetry 241 carotid pulse 186 conscious sedation 103 intraoperative events 244 cassava, cyanide in 285 airway obstruction 108–09 reduced partial pressures cats, capnography 273 apnea 108–09 carbonic anhydrase disorders 286 cattle, capnography 274 capnography 102–11 mitochondrial disorders 283 Centers for Disease Control (CDC) 262 acceptance by providers 110 regulation 295 central atmosphere monitor 269 acceptance by regulatory agencies respiratory stimulation 118 central nervous system 110

stores 240 CO2 effects252 vs. observation 110 tissue/organ effects250–56 high-altitude changes 120 children 105 central nervous system and brain central sleep apnea 256 definition of103 252 central venous pressure 208 guidelines 102 central sleep apnea 256 cerebral edema history 104 circulatory system and heart 254 high altitude 120 hypercarbia 110 oxygen delivery 252 cerebral perfusion pressure 187 hypoventilation 108 respiratory system 253 Charles, Jacques Alexander César 415 hypoxemia 109 splanchnic perfusion 252 Charles’ Law of Temperature 121 pulse oximetry 107 vascular effects 255 chemical buffering 295 sampling devices 107 transport 162, 225 chemoreceptors 360 ventilatory compromise 108–09 volume 407, 417 chemoresponsiveness ventilatory depression 105 carbon monoxide 263 measurement of 363 constant current anemometer 403 carbonated beverages spontaneous variations in constant temperature anemometer

false-positive CO2 estimates 39, 64 ventilation 366 403 carbonic acid 295, 416 ventilatory stability 366 continuity equations 215 carbonic anhydrase disorders 286 chest wall disorders 99 continuous “waveform” capnography acquired 288 children 25 inherited 287 conscious sedation 105 convection 162, 340 cardiac arrest 54, 438 sedation 15 coronary artery bypass graft 212, out-of-hospital 185, 191 seizures 245 patients in transit 66 respiratory monitoring 16 coronary perfusion pressure 187

PetCO2 185–92 chokedamp 263 Cumming, Gordon 458 and prognosis 188 chokes 123 curare cleft 3, 55, 464 cardiac arrhythmias 119 chronic fatigue syndrome Cushing syndrome 306 cardiac compression 444 occult hyperventilation 15 cyanide 284 cardiac output 65, 208–23, 331 chronic obstructive pulmonary disease biochemistry 284 animal models 347–53 48, 196, 201, 319, 330, 356 poisoning 285 capnodynamic monitoring 215 circulation, monitoring of 437 sources of 285

complete rebreathing CO2 Fick Qc citric acid cycle 240 cytochrome c 285 method 208 Clapeyron, Émile 415 determination of 336 climate Dalton’s Law of Partial Pressure 121

partial rebreathing CO2 Fick Qc extremes of 116 Davenport diagram 299 method 210 clonidine Davy Safety Lamp 264 findings 211 and response to anesthesia 243 D-dimer test 200 469

Index

deadspace 89, 195, 421 enteral feeding tubes clinical issues 397 alveolar See alveolar deadspace placement 16 differential pressure flow sensors anatomic See anatomic deadspace enteric tubes 400 dynamic apparatus 137 avoidance of airway intubation 34 fixed orifice type 402 evaluation of 335 epidural anesthesia 243 Fleisch type 400 Fletcher’s calculation 92 epilepsy 433 hot-wire flow sensors 402 physiological See physiological hypocapnia 128 Silverman and Whittenberg/Lilly deadspace ventilation 6, 56, epinephrine modification 401 314 and cardiopulmonary resuscitation turbulent flowmeters402 decompression sickness 122 187 variable orifice type 401 deep sedation 103 and gas exchange 244 distal dexamethasone equal area method 340 and proximal gas measurement 410 high-altitude complications 120 erythropoietin factors affecting readings398 diabetic ketoacidosis 58, 250, 296 high-altitude changes 119 gas conditions 398

diaphragmatic hernia 87 esophageal CO2 detection 38 humidity 399 difficult airway 34 esophageal detector device 22, 27 inlet conditions 399 diffusion 162, 340 esophageal gastric airway 19–20 operating range of flow sensor 400 diving 122 esophageal intubation 64 resistance 400 saturation 265 unrecognized 21–22, 37 sensor location 398 dogs, capnography 273 auscultation of breath sounds 22 temperature 399 dolphins, capnography 279 chest rise and fall 22 mainstream 410 double-lumen tube ventilation 40 direct visualization 21 measurement site conditions 408 Douglas bag 80, 421 pulse oximetry 22 measurement technologies 400 Duchenne muscular dystrophy 284 esophageal obturator airway 19 proximal dynamic end-tidal forcing 363 esophageal–tracheal combitube 19 and gas measurement 409–10 dysoxia 231, 235 ethylene glycol poisoning 303 signal processing 410 dyspnea 127 etomidate 49 ultrasonic sensors 404 Euler–Lagrange equation 355 volume 397 echocardiography exercise 241 gas laws 121, 415 transesophageal 186, 205 expiration Boyle’s Law of Pressure and Volume electrical impedance tomography 162 incomplete 93 121 electroencephalography 96 expiratory positive airway pressure Charles’ Law of Temperature 121 electromagnetic interference 379 (EPAP) limit 139 Dalton’s Law of Partial Pressure electromagnetic radiation 379 expiratory time-constant 164 121 electromyography 96 expiratory valve incompetence 46 General Gas Law 121 emphysema 330, 356 extubation 155 Henry’s Law of Solubility 121 endobronchial mainstem intubation unplanned 64 Gay-Lussac, Joseph Louis 415 33 neonates 86 general anesthesia 103 endobronchial tube General Gas Law 121 confirmation of placement39 face masks 137, 139 Gitelman syndrome 306 endoscopy 16 selection of 138 glucose oxidation 239 endotoxin-induced lung injury 253 use of 138 glutamine, catabolism 241 endotracheal intubation 19 fiberoptic bronchoscope34 glycerol 239 blind placement 40 fibrecapnic intubation 41 glycogen 239 confirmation of 32, 37–38 Fick principle 208 greenhouse gases 261 out-of-hospital setting 20–21 Fick’s law of diffusion162 Guericke, Otto von 415 patients in transit 63 firedamp 263 positioning Food and Drug Administration (FDA) Haldane, John Scott 417

false-negative CO2 assessment 33 44, 373 halothane 49 false-positive CO2 assessment 33 functional residual capacity 48, Hamberger effect295 monitoring of 56 330–31 harp seals, capnography 279 endotracheal tube head injury 66 kinking of 56 gas analyzer heart

leaks 65 improper calibration 2 CO2 effects254 occlusion of 56, 65 gas diffusive resistance 353–57 heliox 265 placement 148 gas embolism 204 hemodynamic preconditioning 161 Endotrol® tube 38 gas exchange 11, 163 Henderson–Hasselbalch equation 296,

end-tidal CO2 See PetCO2 anesthesia effects243 385 energy expenditure 242 gas flow397–404 Henry’s Law of Solubility 121, 265 energy production 240 calibration 410 Herschel, William 416 470

Index

high altitude 116 myocardial effects 254 Kearns–Sayre disease 283 acute mountain sickness 120 panic disorder 127 ketoacidosis 302 cardiopulmonary changes 119 hypocapnic alkalosis 252–53 alcoholic 302 early hypoxia response 117 hypokalemic acidosis 305 diabetic 193 hematologic changes 119 hypoplastic left heart syndrome 58 Konzo 285 hypoxic respiratory stimulation 117 hypotension 54, 437 Krebs cycle 285 lung volume increase 118 dangers of 446 Krogh, August 417 neurologic changes 120 vasodilation-induced 216 Krogh, Marie 417 high-frequency oscillation 173 hypothermia 246 Kussmaul respirations 301 high-frequency ventilation 173 hypoventilation 45, 66, 99, 226, 241, Kyoto Protocol 262 jet 52, 173 296 kyphoscoliosis 40 percussive 174 alveolar 15 positive pressure 173 and sedation 66 lactate 231, 239 high-pressure environments 115–25 conscious sedation 108 lactic acidosis 302 history 424–26 nocturnal 100 lactulose 241 clinical capnography 430–55 waveforms 462 Lambert, Johann Heinrich 416 volume-based capnography 457–60 hypovolemia 54, 65, 217, 251 Lambert–Beer law 384, 416 Hooke, Robert 415 hypoxemia 16, 74 laparoscopy 244 horses, capnography 274 conscious sedation 109 anesthesia 49 hospital setting in children 15 laryngeal mask airway 19 airway management 32–35 hypoxic pulmonary vasoconstriction laryngeal tube airway 19 hot-wire anemometers 400, 403 reflex 162 late deadspace fraction constant current 403 pulmonary embolism 201 constant temperature 403 ice core analysis 262 Lavoisier, Antoine-Laurent de 415 Hutchinson, John 420 inferior vena cava compression leaks hydrogen sulfide 263 445 minimization of 142–43 hyperaldosteronism 306 infrared absorption spectroscopy Leber optic neuropathy 283 hyperbaric chambers 123, 125 See infrared detectors 384 Lesch–Nyhan syndrome 288 hyperbaric exposure 120 double-beam-in-space 384 Levenberg–Marquardt algorithm pulmonary effects122 double-beam-in-time 384 341 hypercapnia 11, 250–51, 296 Luft design384 licorice intake, metabolic alkalosis and brain injury 252 non-dispersive 384 306 and cardiac performance 255 Veingerov design 384 lipogenesis 240 and lung injury 253 infrared radiation 382 lipolysis 243 endotoxin-induced 253 absorption 382 Liston, Max 423 cerebral blood flow 253 chopper 385 Liston-Becker Company 423 ischemia–reperfusion injury 254 pressure broadening 383 loop gain 367 myocardial effects 254 sources 384 low-pressure environments 115–25 nocturnal 58 infrared spectrography 80 lower body negative pressure 235 hypercapnic acidosis 253 inspiration Luer connectors 378

hypercarbia 99 decreased CO2 at start of 85 Luft, Karl Friedrich 418 conscious sedation 110 inspiratory baseline 85 lung hyperkalemia 306 inspiratory valve incompetence 46 gas transport in 166 hyperpyrexia See hyperthermia intensive care lung CO2 capacitance hyperthermia 246 neonates 86 compensation for 216 malignant 8, 246, 459 International Electrotechnical lung collapse 160 hyperventilation 7, 66, 118, 229, 241 Commission (IEC) 373 lung function testing alveolar 117 International Liaison Committee on neonates 87 avoidance of 72 Resuscitation 192 lung growth 92 PetCO2 role in 73 International Organization for lung injury hypercapnic 252 Standardization (ISO) 124, 373 endotoxin-induced 253 occult 15 International Space Station 267 hypercapnia 253 waveforms 463 intracranial pressure, raised 250 hypocapnia 253 hyperventilation syndrome 128, 309 ischemia 231, 235 unilateral 172 hypocapnia 11, 66, 74, 127, 250, 296, 308 ischemia–reperfusion injury 250, Lung Injury Score 171 altitude exposure 256 254 lung perfusion 163 and brain injury 252 isopropanol lung recruitment 340–45 and lung injury 253 as contaminant 377 and CO2 kinetics 162 asthma 127 monitoring of 162 epilepsy 128 Jonson, Björn 457 lung resection 323 471

Index

lung transplantation 323 acid infusion 304 weaning from mechanical lung volumes 12 drug-induced 304 ventilation 87 gastrointestinal 304 neuroleptic malignant syndrome 246 magnesium deficiency 306 renal disease 304 neuromuscular blockade 43, 244 hypokalemic alkalosis 305 signs and symptoms 301 neuromuscular disease 58, 99 mainstream capnography 1, 11, 47, metabolic alkalosis 299, 304 neurosurgical anesthesia 49 388–89 alkali administration 305 NICO monitor 212–13, 216 analyzers 390 causes 303 nifedipine neonates 81, 91 chloride-sensitive 305 high-altitude pulmonary edema non-invasive positive pressure gastrointestinal disorders 305 120 ventilation 138, 463 diagnosis 305 nitric oxide 116, 253 sleep disorders 97 metabolic demand 241 nitrogen dioxide 263 Mainz Emergency Evaluation Scoring metabolism 239 nitrogen narcosis 122 System 192 capnographic monitoring 432 nitrogen washout 12 malignant hyperthermia 8, 52, 246, 459 methane 263–64 nitrous oxide 7 mass balance equation 351 methanol poisoning 303 nitrous oxide tracer 209 mass spectroscopy 386 mice, capnography 275 non-invasive positive pressure magnetic sector-fixed detector microcapnometry 276 ventilation 135–43 387 microstream capnography 15, 81, 106 acute respiratory failure 136 quadrupole mass filter387 midazolam patient interfaces 137 technical challenges 388 premedication 243 patient selection 137

measurement accuracy 374 mill-wheel murmur 444 PetCO2 monitoring 139 measurement drift 376 mines 263 rebreathing 142 mechanical ventilation 169–78 mining accidents 263 short-term vs. long-term use 142 acute respiratory distress syndrome minute ventilation 4–5, 52, 60 sidestream vs. mainstream sampling 169 alveolar 150, 152 138 capnography in treatment loss of 65 time-based capnography 135 evaluation 174 minute volume volume-based capnography 135 disconnection 45 anesthesia 242 Nordström, Lars 457 extubation 155 mitochondrial disorders 283 NPPV See non-invasive positive high-frequency/percussive 173 acquired 284 pressure ventilation leaks 46 inherited 283 nutrient metabolism 239 lung collapse 160 monoethanolamine scrubbers 269 minimization of 148–56 morbidity obesity hypoventilation syndrome monitoring during 54–61 anesthesia-related 104 99 optimization 148–56 multiple inert gas elimination Observer’s Assessment of Alertness/ patient transport 56 technique 229, 315–16 Sedation scale (OAA/S) 15 phases of 149 muscle relaxants 464 obstructive lung disease 320 tracheal gas insufflation 172 effects of 435 obstructive sleep apnea 58, 98, 135 unilateral lung injury 172 onset time 216 Occupational Safety and Health waveforms 464 Administration (OSHA) 262 weaning from 57, 60, 154 NADH 231 one-lung ventilation 49, 323 failure of 153 narcotics 43 operating room importance of 153 nasal cannula 106 airway management 37–41 neonates 87 nasal pressure monitoring 96 neonatal monitoring 84 medical errors 442 National Association of Emergency osmolar gap 303 cardiac compression 444 Medical Services Physicians 64 out-of-hospital setting nearly fatal pain stimulus 442 National Institute of Occupational airway devices 19–20 metabolic acidosis 299, 301 Safety and Health (NIOSH) 263 airway management 19–29 anion gap 301 neonates endotracheal intubation 20–21 causes 303 alveolar ventilation 83 overventilation 66 chloride-resistant 305 incomplete expiration 93 oxidation 239 chloride-sensitive lung function testing 87 oxidative phosphorylation 239 drug-induced 305 monitoring 80–93 oxygen 239 high anion gap 302 normal respiratory values 5 oxygen consumption 231, 239 decreased renal function 304 PaCO2 83 biochemistry/physiology 239 ketoacidosis 302 PetCO2 83 oxygen delivery 231 lactic acidosis 302 sleep laboratory 88 tissues 252 non-anion gap (hyperchloremic) therapeutic CO2 administration oxygen saturation 14 304 58 oxygen toxicity 122 472

Index

PaCO 2 11, 38, 72, 118, 136, 225–29, changes during transport 65 22 250 Phasitron® 174 pulseless electrical activity 66 at altitude 118 Philips V60 non-invasive ventilator 135 PvCO2 209 changes during transport 65 phosphodiesterase inhibitors Collier equilibrium method 209 measurement challenges 138 high-altitude complications 120 Defares exponential method 209 neonates 83 photoacoustic spectroscopy 385 pyruvate 239 pulmonary embolism 198 physiological deadspace 65, 155, 169 relationship to alveolar ventilation anesthetized patients 170 Qc 208 39 pulmonary embolism 198 calibration equation 215 sleep disorders 96 Pieler lamp 264 complete rebreathing method 208 ventilatory adequacy 145 Planck’s constant 381 partial rebreathing method 210

PaCO2–PetCO2 gradient 318 pneumonia 34 Qt See cardiac output panic disorder 127 pneumoperitoneum 244 biofeedback 129 pneumotachometry 96, 150 radical prostatectomy 217–18 methodology 129 pneumothorax 34 Raman scattering 419, 424 results 130 PO2 RAman SCattering AnaLyzer PaO 2 115 at altitude 118 (RASCAL) monitor 424 Parkinson–Cowan dry gas meter 421 pocket mask 19 rapid respiration partial rebreathing method 210 polycythemia 119 damping 2 findings 211 polysomnography 96, 100 Rayleigh scattering 419

PCO2 positive end-expiratory pressure reactive airway disease 13 mixed venous 347–53 See PEEP rebreathing 142, 393 peak expiratory flow rate 332 positive pressure ventilation 74 waveforms 463

PeCO2 determination 392 prehospital situation 15 receiver operating characteristics PEEP 56, 65, 75, 169, 211 capnography as guide to ventilation (ROC) curve 191 management 153 72–77 red blood cell transfusion titration 340–45 pressure rapid 212 percussive ventilation 173 and altitude 116 repressurization 123 perfluorocarbons, ventilation with and depth 121 reptiles, capnography 277 175 pressure broadening 383 respiration performance measures 374 pulmonary artery wedge pressure 208 central neurologic disturbances 448 PerforMax™ face mask 137 pulmonary blood flow208–23 respiratory acidosis 251, 299, 306, perfusion abdominal aortic cross-clamp 220 309 in relation to ventilation 315 assessment shortcuts 214 causes 306–07 congestive heart failure 222 airway factors 308 PetCO2 5, 11, 23, 27, 32, 136, 169, 225–29, 232, 318, 329 hypotension due to vasodilation 216 central factors 306 and cardiac arrest 185–92 hypovolemia 217 neuromuscular factors 308 muscle relaxant onset time 216 parenchymal factors 308 as predictor of PaCO2 14, 58 avoidance of hyperventilation 73 radical prostatectomy 217–18 diagnosis 306 clinical applications 54 thready pulse 216 respiratory alkalosis 7, 251, 299, critically ill patients 146 pulmonary capillary blood flowSee Qc 308–09 dilution effects 139 pulmonary edema 145 causes 309 field uses high altitude 120 inciting factors 308 guidance of ventilation 76 pulmonary embolism 7, 176, 195–205 CNS stimulation 309 troubleshooting 77 alterations associated with 197 drugs and hormones 309 high 52 detection hyperventilation syndrome 309 low 52 alveolar deadspace 201 hypoxemia/tissue hypoxia 309 monitoring with ventilators 77 late deadspace fraction 201 stimulation of chest receptors 310 neonates 83 limitations of capnography 202 signs and symptoms 308 normal 52 physiological deadspace 198 respiratory assessment NPPV monitoring 139 time-based capnography 198 outside operating room 11–17 optimization of 216 thrombolytic therapy 203 respiratory deadspace See deadspace out-of-hospital monitoring 22, 72 ventilation/perfusion mismatch 324 respiratory gas monitors justification for 72 pulmonary fibrosis323 calibration 380 panic disorder 127 pulmonary hypertension 54 definition of374 pulmonary embolism 198 pulse interfering gas/vapor effects377 ventilatory weaning thready 216 ISO 21647 standard 373 postoperative 145–46 pulse oximetry 14–15, 44 performance measures 374 Pfund, August Herman 418 conscious sedation 107 accuracy 374 pH unrecognized esophageal intubation drift376 473

Index

respiratory gas monitors (cont.) sodium nitroprusside 285 non-invasive positive pressure range 375 Space Shuttle 266 ventilation 135 response time 376 spirometry 11 pathologic 330 types of 374 splanchnic perfusion 252 altered inspiratory phase 332 respiratory quotient 232 spontaneous breathing trial 155 phase I 330 respiratory rate 5, 52 spontaneous circulation, return of phases II and III 330–31 respiratory system resistance 332 186, 188 patterns of 461–65 response time 376 spontaneous ventilation pulmonary embolism 198 resuscitation 438 disconnection 46 uses 12–16 Rhan sampler 80 leaks 46 airway obstruction monitoring 13 Röntgen, Wilhelm 418 standard temperature and pressure dry alveolar ventilation monitoring 12 rotating vane spirometers 400 (STPD) conditions 407 deadspace ventilation monitoring rotational energy transitions 383 standards development organizations 13 373 endoscopy 16 salicylate overdose 303 stinkdamp 263 enteral feeding tube placement 16

San Diego Paramedic Rapid Sequence Stow–Severinghaus PaCO2 electrode evaluation of non-intubated Intubation (RSI) Trial 72 386 patients 14 saturation diving 265 strong ion theory 297 occult hyperventilation 15 SEALAB 265 subarachnoid block 43 pediatric sedation 15 sedation submarines/submersibles 268 pediatric seizure monitoring 16 conscious 102–11 succinylcholine 244 prehospital 15 definitions of103 sudden cardiac death 185 sleep disorders 13 patients in transit 66 sulfur dioxide 263 ventilated patients 149 procedural 102 sulfuric acid 295 Tissot spirometer 421 sedatives 43 syncope tissue buffering250 seizures occult hyperventilation 15 tissue hypoxia 309 respiratory monitoring 16 systemic vascular resistance 208 tissue oxygen delivery 252 shivering 246 tissue oxygenation/perfusion 251 shock 231–36 Tobin index 146 Tau-CO2 164 capnometric monitoring 231 technical defects 441 tourniquet release 51, 245 tissue CO2 monitoring and technical specifications 373–80 tracheal gas insufflation 172 perfusion 235 alarm systems 378 transesophageal echocardiography tissue-specific monitoring 234 calibration 380 186, 205 shunt perfusion 56 Luer connectors 378 transport of patients sidebands 383 performance measures 374 capnography during 63–68 sidestream capnography 1–2, 47, units 378 complications 67 388–89 technical standards 373, 379 mechanical ventilation 56 analyzers 390 temporal mismatching 331 monitoring of respiration neonates 81, 89 tension pneumothorax 76 circuit integrity 64 non-invasive positive pressure thermistors 96 neonates 85 ventilation 138 thermogenesis, diet-induced 242 procedural sedation 66 sleep disorders 97 thermoneutrality 241 sources of measurement error 67 sidestream gas sampling 410 thiopental 49 transpulmonary pressure 160 SIII 166 Thomson, William 416 trauma single-breath capnography 12 thrombolytic therapy 203 ventilation/perfusion mismatch 324 single-path model 353 Thumper® device 186 triglycerides 239 sleep tidal volume 5, 52 Tyndall effect419 non-rapid eye movement (NREM) at endotracheal tube 150 Tyndall, John 416, 418 98 delivery 150 rapid eye movement (REM) 98 size of 141 units 378 ventilation during 97 small 139 unrecognized misplaced intubation sleep disorders 13 time-based capnography 1–4, 11, 148, See esphageal intubation, capnography 96–100 329 unrecognized obesity hypoventilation syndrome 99 artifacts 2 upper airways resistance syndrome 98 obstructive sleep apnea 58, 98, 135 cardiovascular status 149 uric acid 295 snoring 98 history 423 sleep laboratory 98 interpretation 4–6 Va e /Vt336 neonates 88 cardiovascular issues 4 van der Waals, Johannes 416 snoring 98 pulmonary issues 4 Van Helmont, Jan Baptista 415 sodium bicarbonate 241 neonates 82 Van Slyke apparatus 418 474

Index

vascular cross-clamping 245 regional increase 227 neonates 82

VCO2 decreased pulmonary blood flow non-invasive positive pressure age variation 243 228 ventilation 135 anesthesia effects242 ventilator-associated lung injury 253 PEEP titration 340–45 VD shunt 165 ventilator disconnection 64 phase II deformation 334 ventilation 165 ventilator-induced lung injury 154 phase III deformation 334 adequacy of 145 ventilatory failure 123 variables 342–43 consistency of 65 ventilatory maldistribution 166 SIII 344 deadspace 314 ventilatory requirements, prediction veterinary medicine 272 in relation to perfusion 313 of 60 volutrauma 150

PetCO2-guided 72, 76 veterinary capnography 272–79 prehospital acid–base values 275 wasted ventilation 195 capnography as guide to 72–77 birds 276 water trap 89 step changes 227 blood gases 275 artifacts 2–3 weaning from dogs and cats 273 waveforms postoperative 145–46 dolphins 279 normal 462 ventilation/perfusion matching 136 harp seals 279 real time and trend 462 ventilation/perfusion mismatch 11, 55, horses and cattle 274 asthma 465 232, 313–25 limitations of 272 cardiogenic oscillations 465 acute respiratory distress syndrome lung volumes 276 cardiopulmonary resuscitation 322 reptiles 277 465 capnography 317 respiratory parameters 274 faulty ventilatory circuit valve clinical correlation 319 small laboratory animals 275 464 low cardiac output state 324 species differences 273 hyperventilation 463 obstructive lung disease 320 volume-based capnography 6–7, 11, hypoventilation 462 one-lung ventilation, lung resection 38, 148, 151, 333 mechanical ventilation 464 and lung transplantation 323 analysis 340–45 muscle relaxants 464 pulmonary embolism 324 clinical implications 344 non-diagnostic 463 pulmonary fibrosis323 Fowler’s method 340 rebreathing 463 trauma 324 cardiac output estimation 336, 347 sudden loss of expiratory CO2 ventilation/perfusion ratio 11, 40, 160, clinical uses 59 464 169, 226, 330 deadspace evaluation 335 Wheatstone bridge 403 acute increase 227 history of 423, 457–60 global increase. See hyperventilation lung recruitment 340–45 Zuntz, Nathan 420

475