![]() ![]() ETCO2 and respiratory rates through the duration of care can be archived, which provides documented proof of correct airway placement.ĭifficulty breathing is one of the most common EMS calls for children. Waveform capnography can also be used to monitor placement of pediatric-size supraglottic airway devices. It is a skill that few EMS providers get experience performing and there is a high risk of tube dislodgement during movement and transport.Ī capnography waveform will appear with the first breath if the tube is placed in the trachea and immediately disappear if the tube is displaced. Unacceptably high rates of misplaced endotracheal tubes have been documented in children. In children who require an advanced airway to be placed, waveform capnography is the most reliable method to confirm placement. Waveform capnography can also be used to guide the ventilation rate, which is 12-20 breaths per minute in children. Healthcare providers often ventilate children too fast, which decreases cardiac output and puts children at risk of lung injury. When capnography is utilized with a BVM, a waveform with each ventilation indicates that there is a good mask seal, a patent upper airway and that air is exchanged in the lungs. It is also important to ventilate at the appropriate rate. Just enough air should be delivered to make the chest rise. Capnography can guide when tactile stimulation is effective, and if assisted ventilation is needed.Įffective ventilation with a bag-valve mask requires the upper airway to be in the correct position or alignment and for the mask to be sealed tightly on the face. Occasional tactile stimulation may be all that is necessary to correct some forms of respiratory depression. When hypoventilation is caused by an airway position issue, capnography waveforms will return after repositioning the patient’s head, placing a towel under the shoulders of younger children, or suction. Once hypoventilation is detected, capnography provides continuous feedback on how a patient responds to interventions. Capnography is more reliable than pulse-oximetry to detect hypoventilation, which may take several minutes to change after a patient stops breathing. ![]() A decrease in tidal volume will cause ETCO2 to decrease, as most of the exhaled air captured is from dead space while CO2 continues to accumulate in the lungs. Depending on tidal volume with hypoventilation, ETCO2 may either rise or fall.Ī slow respiratory rate with a normal tidal volume will cause ETCO2 to increase, as CO2 builds in the lungs and gets excreted with each breath. ![]() The capnography waveform and respiratory rate allow for breath-to-breath monitoring, and immediate detection of hypoventilation or apnea. Since it is also common for sick children to fall asleep during the ambulance ride to the hospital and have no respiratory depression waveform capnography can help determine when an airway or ventilation intervention is needed. Seizures, head injuries, and overdoses are common causes of altered mental status in pediatric patients that can cause airway compromise or hypoventilation. Here are five applications for waveform capnography in children: Pediatric and neonatal-sized capnography circuits should be used when indicated to ensure accuracy.Īlterations in ETCO2, the shape of the waveform and respiratory rate are useful to assess and treat a variety of conditions. ETCO2 is measured with either an adaptor connected to a BVM or advanced airway device, or through a nasal cannula with a sampling line. ![]() These values are consistent across all age groups. Normal ETCO2 is 35-45 mm HG, and a normal waveform is rectangular shaped. Capnography measures the amount of CO2 present at the end of exhalation (end-tidal CO2, or ETCO2), displays a waveform that represents air movement through the respiratory cycle, and continuously monitors respiratory rate. Waveform capnography is a noninvasive tool that can be applied to children of all ages to assess ventilation, perfusion and metabolism. ![]()
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