Mean End-tidal Carbon Dioxide Research Articles

Comparison of End-Tidal and Arterial Carbon Dioxide in Infants Using Laryngeal Mask Airway and Endotracheal Tube

The laryngeal mask airway (LMA) has become a popular tool for airway management in selected adult and pediatric patients undergoing routine surgical procedures.The relationship between end-tidal and arterial carbon dioxide during controlled ventilation via the LMA in infants under 10 kg has not been reported. After induction of general anesthesia, the LMA was placed in 12 healthy infants and mechanical ventilation initiated. After maintaining steady-state level of end-tidal carbon dioxide (minimum 5 min), an arterial blood sample was obtained and end-tidal carbon dioxide level noted. The laryngeal mask was then removed, the trachea intubated, and mechanical ventilation resumed with initial ventilatory variables. After reaching a steady-state level of end-tidal carbon dioxide, a second arterial sample was obtained and end-tidal carbon dioxide level noted. The mean end-tidal carbon dioxide and arterial partial pressure of carbon dioxide obtained during ventilation were 42.2 +/- 7.9 and 47.1 +/- 11.0 (LMA) and 37.4 +/- 4.6 and 42.6 +/- 6.7 (endotracheal tube), respectively. Analysis of differences between partial pressure of carbon dioxide and end-tidal carbon dioxide using the Bland and Altman method revealed bias +/- precision of 4.9 +/- 3.9 and 5.3 +/- 3.2 with ventilation via the laryngeal mask and endotracheal tube. Our data indicate that, while ventilating infants under 10 kg with LMA, end-tidal carbon dioxide is an accurate indicator of arterial partial pressure of carbon dioxide. (Anesth Analg 1997;84:51-3)

Changes in intra–ocular pressure during general anaesthesia

Changes in-intra-ocular pressure during spontaneous ventilation with a laryngeal mask were compared with controlled ventilation using a tracheal tube in 40 patients undergoing intra-ocular surgery under general anaesthesia. Intra-ocular pressure was measured before induction, after establishing the airway, at the end of the operation and after removal of the airway device. Anaesthesia was induced with propofol and maintained with enflurane and nitrous oxide in oxygen. Mean end-tidal carbon dioxide tension was significantly higher during spontaneous ventilation than during controlled ventilation 5 min after establishing the airway (5.7 versus 4.5) and at the end of surgery (6.1 versus 4.2) (p < 0.001). Despite this, intra-ocular pressures were lower than baseline and similar in the two groups throughout anaesthesia. At the end of surgery, intra-ocular pressure (mmHg) was 11.2 and 8.6 during spontaneous or controlled ventilation respectively. One min after removal of the device, mean intra-ocular pressure (mmHg) in the tracheal tube group (16.0) was slightly higher than baseline (15.3) and was significantly higher than the laryngeal mask group (10.9) (p < 0.01). Spontaneous ventilation with a laryngeal mask is an acceptable alternative to controlled ventilation with tracheal intubation in elective intra-ocular surgery.

Efficiency of the Carden “Ventmasta” in A and D modes during controlled ventilation in children

We have determined the efficiencies of the enclosed Mapleson A and Mapleson D modes of the Carden "Ventmasta" ventilator during controlled ventilation in 19 anaesthetized children. In addition, we determined the suitability for the A mode of the fresh gas formula, VF = 0.6 x weight0.5. Efficiency was assessed in terms of the fraction of fresh gas delivered to the alveoli. When the minute volume to fresh gas flow ratio exceeded 1.5, fractional delivery of fresh gas was 23% greater in the A mode than in the D mode (0.74 vs 0.60) (P < 0.0001). Under the same conditions, mean end-tidal carbon dioxide concentration in 27 children undergoing ventilation in the A mode with VF = 0.6 x weight0.5 was 4.6% (range 3.5-5.4%). We conclude that the Carden system is up to 23% more efficient in the A mode than in the D mode, and that under the conditions of this study, normocapnia or mild hypocapnia was produced accurately using the formula VF = 0.6 x weight0.5.

A Study of Chest Compression Rates During Cardiopulmonary Resuscitation in Humans

. A prospective, cross-over trial was performed comparing two different rates of precordial compression using endtidal carbon dioxide as an indicator of the efficacy of cardiopulmonary resuscitation in 23 adult patients. A second purpose of this study was to determine the effect of audioprompted, rate-directed chest compressions on the endtidal carbon dioxide concentrations during cardiopulmonary resuscitation. Patients with cardiac arrest received external chest compressions, initially in the usual fashion without rate direction and then with rhythmic audiotones for rate direction at either 80 compressions per minute or 120 compressions per minute. Nineteen of 23 patients had higher end-tidal carbon dioxide levels at the compression rate of 120 per minute. The mean end-tidal carbon dioxide level during compressions of 120 per minute was 15.0±1.8 mm Hg, slightly but significantly higher than the mean level of 13.0±1.8 mm Hg at a compression rate of 80 per minute. However, end-tidal carbon dioxide levels increased rather dramatically when audiotones were used to guide the rate of chest compressions. Mean end-tidal carbon dioxide concentration was 8.7±1.2 mm Hg during standard cardiopulmonary resuscitation immediately before audio-prompted, rate-directed chest compression and increased to 14.0±1.3 mm Hg after the first 60 seconds of audible tones directing compressions. Using end-tidal carbon dioxide as an indicator of cardiopulmonary resuscitation efficacy, we conclude that audible rate guidance during chest compressions may improve cardiopulmonary resuscitation performance. (Arch Intern Med. 1992;152:145-149)

A Study of Chest Compression Rates During Cardiopulmonary Resuscitation in Humans

A prospective, cross-over trial was performed comparing two different rates of precordial compression using end-tidal carbon dioxide as an indicator of the efficacy of cardiopulmonary resuscitation in 23 adult patients. A second purpose of this study was to determine the effect of audio-prompted, rate-directed chest compressions on the end-tidal carbon dioxide concentrations during cardiopulmonary resuscitation. Patients with cardiac arrest received external chest compressions, initially in the usual fashion without rate direction and then with rhythmic audiotones for rate direction at either 80 compressions per minute or 120 compressions per minute. Nineteen of 23 patients had higher end-tidal carbon dioxide levels at the compression rate of 120 per minute. The mean end-tidal carbon dioxide level during compressions of 120 per minute was 15.0 +/- 1.8 mm Hg, slightly but significantly higher than the mean level of 13.0 +/- 1.8 mm Hg at a compression rate of 80 per minute. However, end-tidal carbon dioxide levels increased rather dramatically when audiotones were used to guide the rate of chest compressions. Mean end-tidal carbon dioxide concentration was 8.7 +/- 1.2 mm Hg during standard cardiopulmonary resuscitation immediately before audio-prompted, rate-directed chest compression and increased to 14.0 +/- 1.3 mm Hg after the first 60 seconds of audible tones directing compressions. Using end-tidal carbon dioxide as an indicator of cardiopulmonary resuscitation efficacy, we conclude that audible rate guidance during chest compressions may improve cardiopulmonary resuscitation performance.

A microcomputer-based system for the accurate continuous measurement of ventilation and blood pressure parameters under anaesthesia.

A microcomputer system for the measurement of parameters of ventilation and blood pressure in the spontaneously breathing anaesthetized patient is described. The system continuously calculates minute volume, respiratory frequency, and mean end tidal carbon dioxide concentration. Additionally four cardiovascular parameters are measured. The inputs are obtained from a wet-wedge spirometer, a capnograph and a blood pressure monitor. The methods of computer calculation are described in detail. The computer-generated results are compared with those obtained by manual calculation. The system described has the capacity to record and display a wide variety of further measurements made during anaesthesia. This system provides invaluable information for research and teaching, but may also be useful during routine anaesthesia.

CO2 and exercise tidal volume

In progressive exercise increased tidal volume (VT) accompanies increased ventilation (VE) until a VT plateau is reached. We observed in 13 subjects a correspondence between the arrival of the VT plateau and the anaerobic threshold (AT). To examine this association between a mechanical event (the VT plateau) and a metabolic event (the AT), we changed those variables that change at the AT and looked for changes in VT. We found in 13 subjects that CO2 addition to prevent alveolar hypocapnia during cycle ergometer exercise progressing to exhaustion in 12-15 min significantly elevated the VT plateau (mean increase 4.4%; P less than 0.01) as compared with a spontaneous test that induced a mean end-tidal carbon dioxide tension fall of 5.5 Torr. This VT increase was mediated by a significant increase in inspiratory time (TI; P less than 0.02); both the ratio of TI to the total breath duration (TI/Ttot) and the mean rate of inspired airflow (VT/TI) were unchanged at matched VE. Changing other variables known to change at the AT--blood lactate ion concentration and alveolar oxygen tension--left ventilatory pattern unchanged. These results suggest that hypocapnia in severe exercise measurably lowers the VT plateau in normal man.