Applicability of Capnography in the Adult ICU During Physical Therapy: A Systematic Review

Abstract

PurposeThe purpose of this review was three‐fold: first, evaluate the strength and quality of the current research evidence on usage of capnography, second, determine whether current evidence regarding the use capnography during physical therapy should be considered when making decisions regarding patient’s response to physical therapy; and third, identify weaknesses in the current evidence and area for continued research.Background/SignificanceCapnography is typically used in emergency departments and postoperatively but is not commonly used during physical therapy. Pulse oximetry is typically used to monitor oxygen desaturation and hypoxemia during physical therapy but does not predict or monitor respiratory depression. Capnography monitoring during exercise and mobility could have benefits for physical therapists monitoring patients during therapy as well as provide prognostic value of patient progress.Methods and MaterialsA literature search was completed using: Science Direct, IOP Science, PLOS one, Google scholar, Wiley, EBSCO Host, CINAHL Complete, Cochrane Library, and PubMed. Keywords: capnometry, capnography accuracy, physical therapy, application of capnography, mobility, monitoring. Articles selected for review were those of original research or systematic review published since 2009 and evaluated for quality using the Oxford Centre for Evidence‐Based Medicine 2011 levels of evidence system.ResultsTwenty‐seven articles are included for this study. Six articles were included in the introduction. Seven articles examined the current practices for use of capnography; six studies looked at the use of capnography in the intensive care unit. Three articles on pulse oximetry and capnography with mobility, two articles on the use of monitoring ventilation and oximetry during exercise, and three studies on biologically‐based assessment tools for physical therapy.ConclusionsEvidence suggests that monitoring partial pressure end‐tidal carbon dioxide (PETCO2) levels in patients during rest and exercise may provide more prognostic value of possible adverse events in patients with conditions such as heart failure. Monitoring ventilatory responses in patients is valuable in physical therapy as it indicates tolerance to activity. Evidence suggests there is a significant correlation between PETCO2 and cardiac output. Recent research also suggests regardless of mask or cannula used on patients, diagnostic accuracy of measuring PETCO2 is similar during normal and hyper‐ventilatory states. With increasing application of capnography in intensive care settings, studies involving usage in physical therapy are warranted.