Capnographie volumétrique. Mesure du CO2 avancée

Pour plus d'informations. Monitorage volumétrique du CO2

Les phases d'un capnogramme volumétrique, la forme et la morphologie de la courbe, ainsi que les mesures basées sur les calculs qui en découlent peuvent vous en apprendre beaucoup sur :

L'efficacité de la ventilation-perfusion
La fraction d'espace mort physiologique
L'activité métabolique du patient (Jaffe MB. Using the features of the time and volumetric capnogram for classification and prediction. J Clin Monit Comput. 2017;31(1):19-41. doi:10.1007/s10877-016-9830-z1)

Un outil puissant. Le capteur de CO2

Sur nos ventilateurs, le CO2 est mesuré avec un capteur de CO2 « mainstream » CAPNOSTAT-5 près des voies aériennes du patient.

Le capteur CAPNOSTAT-5 fournit une mesure précise du dioxyde de carbone en fin d'expiration (PetCO2) et un capnogramme précis et clair à toutes les fréquences respiratoires jusqu'à 150 cycles par minute.

Graphique de statistiques : analyse des données d'un capteur de CO2

Un petit capteur pour un maximum de données. Les infos qu'il vous faut

La fenêtre du capnogramme volumétrique apparaissant à l'écran affiche des informations quantitatives exactes sous forme d'une combinaison de données de débit proximal et de CO2 proximal telles que :

Courbe de capnogramme volumétrique réel
Courbe de capnogramme volumétrique de référence
Bouton de courbe de référence avec date et heure de la boucle de référence
Valeurs de CO2 les plus pertinentes, mises à jour à chaque cycle

Pour permettre une analyse plus détaillée de l'état du patient, une tendance sur 72 heures (ou sur 96 heures avec le HAMILTON-G5/S1) est disponible pour les valeurs suivantes :

PetCO2
V‘CO2
FetCO2
VeCO2
ViCO2
Valv
V'alv
Vds
VD/Vt
Vds/VTE
PenteCO2

Pour vous faciliter la vie, les ventilateurs Hamilton Medical affichent une présentation de toutes les valeurs pertinentes associées au CO2 dans la fenêtre de monitorage du CO2.

Concentration fractionnelle de CO2 en fin d'expiration : FetCO2 (%)
Pression de CO2 de fin d'expiration : PetCO2 (mmHg)
Pente du plateau alvéolaire sur la courbe PetCO2, indiquant le statut volume/débit des poumons : penteCO2 (%CO2/l)
Ventilation alvéolaire par volume courant : Valv (ml)
Ventilation alvéolaire minute : V’alv (l/min)
Élimination du CO2 : V’CO2 (ml/min)
Espace mort des voies aériennes : Vds (ml)
Fraction d'espace mort mesurée à l'entrée des voies aériennes : Vds/VTE (%)
Volume de CO2 expiré : VeCO2 (ml)
Volume de CO2 inspiré : ViCO2 (ml)

Graphique de statistiques : www.hamilton-medical.com/capnography

Quels sont les avantages ? Focus sur les preuves de réussite

Le capnogramme volumétrique a été utilisé avec succès pour mesurer l'espace mort anatomique, la perfusion des capillaires pulmonaires et l'efficacité du ventilateur (Romero PV, Lucangelo U, Lopez Aguilar J, Fernandez R, Blanch L. Physiologically based indices of volumetric capnography in patients receiving mechanical ventilation. Eur Respir J. 1997;10(6):1309-1315. doi:10.1183/09031936.97.100613092)
Les calculs obtenus à partir de la capnographie volumétrique sont utiles pour identifier une embolie pulmonaire au chevet du patient (Blanch L, Romero PV, Lucangelo U. Volumetric capnography in the mechanically ventilated patient. Minerva Anestesiol. 2006;72(6):577-585. 3)
Dans une étude portant sur des patients souffrant de SDRA et ventilés mécaniquement, les mesures de capnographie volumétrique du ratio espace mort/volume courant physiologique étaient aussi précises que celles obtenues via la technique du monitorage métabolique (Kallet RH, Daniel BM, Garcia O, Matthay MA. Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care. 2005;50(4):462-467. 4)
Le capnogramme expiratoire est une mesure non invasive, rapide et indépendante des efforts qui permet de détecter des bronchospasmes importants chez des patients adultes souffrant d'asthme (Yaron M, Padyk P, Hutsinpiller M, Cairns CB. Utility of the expiratory capnogram in the assessment of bronchospasm. Ann Emerg Med. 1996;28(4):403-407. doi:10.1016/s0196-0644(96)70005-75)
En fournissant des données précieuses en temps réel sur la physiologie de l'affaissement et du recrutement pulmonaires de manière non invasive, la capnographie volumétrique se prête elle-même au monitorage de manœuvres de recrutement cycliques au chevet du patient (Tusman G, Suarez-Sipmann F, Böhm SH, et al. Monitoring dead space during recruitment and PEEP titration in an experimental model. Intensive Care Med. 2006;32(11):1863-1871. doi:10.1007/s00134-006-0371-76)

Image : étudiante brandissant un diplôme

Bon à savoir ! Supports de formation sur la capnographie volumétrique

Commencer la formation ici

Accessoires et consommables

Nous proposons des consommables d'origine pour patients adultes, enfants et nouveau-nés. Vous avez le choix entre des produits réutilisables ou à usage unique, en fonction de la politique en vigueur dans votre établissement.

Capteur de CO2 CAPNOSTAT-5

Capteur de CO2 CAPNOSTAT-5 (angle de 90°)

Adaptateur de voies aériennes CO2 « mainstream » Néonatal

Adaptateur de CO2 « mainstream » Néonatal

Adaptateur de voies aériennes CO2 « mainstream » Adulte/Enf.

Adaptateur de CO2 « mainstream » Adulte/Enf.

Catalogue en ligne

Disponibilité

La capnographie volumétrique est disponible en option sur les ventilateurs HAMILTON-C6, HAMILTON-G5, HAMILTON-C3, HAMILTON-C1/T1 et en fonctionnalité standard sur le HAMILTON-S1.

HAMILTON-C6

HAMILTON-C3

HAMILTON-C1

HAMILTON-T1

Pour plus d'informations

Document

Notes en bas de page

Using the features of the time and volumetric capnogram for classification and prediction.

Jaffe MB. Using the features of the time and volumetric capnogram for classification and prediction. J Clin Monit Comput. 2017;31(1):19-41. doi:10.1007/s10877-016-9830-z

Link to article

Quantitative features derived from the time-based and volumetric capnogram such as respiratory rate, end-tidal PCO2, dead space, carbon dioxide production, and qualitative features such as the shape of capnogram are clinical metrics recognized as important for assessing respiratory function. Researchers are increasingly exploring these and other known physiologically relevant quantitative features, as well as new features derived from the time and volumetric capnogram or transformations of these waveforms, for: (a) real-time waveform classification/anomaly detection, (b) classification of a candidate capnogram into one of several disease classes, (c) estimation of the value of an inaccessible or invasively determined physiologic parameter, (d) prediction of the presence or absence of disease condition, (e) guiding the administration of therapy, and (f) prediction of the likely future morbidity or mortality of a patient with a presenting condition. The work to date with respect to these applications will be reviewed, the underlying algorithms and performance highlighted, and opportunities for the future noted.

Physiologically based indices of volumetric capnography in patients receiving mechanical ventilation.

Romero PV, Lucangelo U, Lopez Aguilar J, Fernandez R, Blanch L. Physiologically based indices of volumetric capnography in patients receiving mechanical ventilation. Eur Respir J. 1997;10(6):1309-1315. doi:10.1183/09031936.97.10061309

Link to article

Several indices of ventilatory heterogeneity can be identified from the expiratory CO2 partial pressure or CO2 elimination versus volume curves. The aims of this study were: 1) to analyse several computerizable indices of volumetric capnography in order to detect ventilatory disturbances; and 2) to establish the relationship between those indices and respiratory system mechanics in subjects with normal lungs and in patients with acute respiratory distress syndrome (ARDS), both receiving mechanical ventilation. We studied six normal subjects and five patients with early ARDS mechanically ventilated at three levels of tidal volume (VT). Respiratory system mechanics were assessed by end-expiratory and end-inspiratory occlusion methods, respectively. We determined Phase III slopes, Fletcher's efficiency index, Bohr's dead space (VD,Bohr/VT), and the ratio of alveolar ejection volume to tidal volume (VAE/VT) from expiratory capnograms, as a function of expired volume. Differences between normal subjects and ARDS patients were significant both for capnographic and mechanical parameters. Changes in VT significantly altered capnographic indices in normal subjects, but failed to change ventilatory mechanics and VAE/VT in ARDS patients. After adjusting for breathing pattern, VAE/VT exhibited the best correlation with the mechanical parameters. In conclusion, volumetric capnography, and, specifically, the ratio of alveolar ejection volume to tidal volume allows evaluation and monitoring of ventilatory disturbances in patients with adult respiratory distress syndrome.

Volumetric capnography in the mechanically ventilated patient.

Blanch L, Romero PV, Lucangelo U. Volumetric capnography in the mechanically ventilated patient. Minerva Anestesiol. 2006;72(6):577-585.

Link to article

Expiratory capnogram provides qualitative information on the waveform patterns associated with mechanical ventilation and quantitative estimation of expired CO2. Volumetric capnography simultaneously measures expired CO2 and tidal volume and allows identification of CO2 from 3 sequential lung compartments: apparatus and anatomic dead space, from progressive emptying of alveoli and alveolar gas. Lung heterogeneity creates regional differences in CO2 concentration and sequential emptying contributes to the rise of the alveolar plateau and to the steeper the expired CO2 slope. The concept of dead space accounts for those lung areas that are ventilated but not perfused. In patients with sudden pulmonary vascular occlusion due to pulmonary embolism, the resultant high V/Q mismatch produces an increase in alveolar dead space. Calculations derived from volumetric capnography are useful to suspect pulmonary embolism at the bedside. Alveolar dead space is large in acute lung injury and when the effect of positive end-expiratory pressure (PEEP) is to recruit collapsed lung units resulting in an improvement of oxygenation, alveolar dead space may decrease, whereas PEEP-induced overdistension tends to increase alveolar dead space. Finally, measurement of physiologic dead space and alveolar ejection volume at admission or the trend during the first 48 hours of mechanical ventilation might provide useful information on outcome of critically ill patients with acute lung injury or acute respiratory distress syndrome.

Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method.

Kallet RH, Daniel BM, Garcia O, Matthay MA. Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care. 2005;50(4):462-467.

Link to article

BACKGROUND

Volumetric capnography is an alternative method of measuring expired carbon dioxide partial pressure (P(eCO2)) and physiologic dead-space-to-tidal-volume ratio (V(D)/V(T)) during mechanical ventilation. In this method, P(eCO2) is measured at the Y-adapter of the ventilator circuit, thus eliminating the effects of compression volume contamination and the need to apply a correction factor. We investigated the accuracy of volumetric capnography in measuring V(D)/V(T), compared to both uncorrected and corrected measurements, using a metabolic monitor in patients with acute respiratory distress syndrome (ARDS).

METHODS

There were 90 measurements of V(D)/V(T) made in 23 patients with ARDS. The P(eCO2) was measured during a 5-min expired-gas collection period with a Delta-trac metabolic monitor, and was corrected for compression volume contamination using a standard formula. Simultaneous measurements of P(eCO2) and V(D)/V(T) were obtained using volumetric capnography.

RESULTS

V(D)/V(T) measured by volumetric capnography was strongly correlated with both the uncorrected (r2 = 0.93, p < 0.0001) and corrected (r2 = 0.89, p < 0.0001) measurements of V(D)/V(T) made using the metabolic monitor technique. Measurements of V(D)/V(T) made with volumetric capnography had a bias of 0.02 and a precision of 0.05 when compared to the V(D)/V(T) corrected for estimated compression volume contamination.

CONCLUSION

Volumetric capnography measurements of V(D)/V(T) in mechanically-ventilated patients with ARDS are as accurate as those obtained by metabolic monitor technique. .

Utility of the expiratory capnogram in the assessment of bronchospasm.

Yaron M, Padyk P, Hutsinpiller M, Cairns CB. Utility of the expiratory capnogram in the assessment of bronchospasm. Ann Emerg Med. 1996;28(4):403-407. doi:10.1016/s0196-0644(96)70005-7

Link to article

STUDY OBJECTIVE

To determine whether the plateau phase of the expiratory capnogram (dco2/dt) can detect bronchospasm in adult asthma patients in the emergency department and to assess the correlation between dco2/dt and the peak expiratory flow rate (PEFR) in spontaneously breathing patients with asthma and in normal, healthy volunteers.

METHODS

We carried out a prospective, blinded study in a university hospital ED. Twenty adults (12 women) with acute asthma and 28 normal adult volunteers (15 women) breathed through the sampling probe of an end-tidal CO2 monitor, and the expired CO2 waveform was recorded. The dco2/dt of the plateau (alveolar) phase for five consecutive regular expirations was measured and a mean value calculated for each patient. The best of three PEFRs was determined. The PEFR and dco2/dt were also recorded after treatment of the asthmatic patients with inhaled beta-agonists.

RESULTS

The mean +/- SD PEFR of the asthmatic subjects was 274 +/- 96 L/minute (57% of the predicted value), whereas that of the normal volunteers was 527 +/- 96 L/minute (103% of the predicted value) (P < .001). The mean dco2/dt of the asthmatic subjects (.26 +/- .06) was significantly steeper than that of the normal volunteers (.13 +/- .06) (P < .001). The dco2/dt was correlated with PEFR (r = .84, P < .001). In 18 asthmatic subjects the pretreatment and posttreatment percent predicted PEFRS were 58% +/- 17% and 74% +/- 17%, respectively (P < .001), whereas the dco2/dt values were .27 +/- .05 and .19 +/- .07, respectively (P < .005).

CONCLUSION

The dco2/dt is an effort-independent, rapid noninvasive measure that indicates significant bronchospasm in ED adult patients with asthma. The dco2/dt value is correlated with PEFR, an effort-dependent measure of airway obstruction. The change in dco2/dt with inhaled beta-agonists may be useful in monitoring the therapy of acute asthma.

Monitoring dead space during recruitment and PEEP titration in an experimental model.

Tusman G, Suarez-Sipmann F, Böhm SH, et al. Monitoring dead space during recruitment and PEEP titration in an experimental model. Intensive Care Med. 2006;32(11):1863-1871. doi:10.1007/s00134-006-0371-7

Link to article

OBJECTIVE

To test the usefulness of dead space for determining open-lung PEEP, the lowest PEEP that prevents lung collapse after a lung recruitment maneuver.

DESIGN

Prospective animal study.

SETTING

Department of Clinical Physiology, University of Uppsala, Sweden.

SUBJECTS

Eight lung-lavaged pigs.

INTERVENTIONS

Animals were ventilated using constant flow mode with VT of 6ml/kg, respiratory rate of 30bpm, inspiratory-to-expiratory ratio of 1:2, and FiO(2) of 1. Baseline measurements were performed at 6cmH(2)O of PEEP. PEEP was increased in steps of 6cmH(2)O from 6 to 24cmH(2)O. Recruitment maneuver was achieved within 2min at pressure levels of 60/30cmH(2)O for Peak/PEEP. PEEP was decreased from 24 to 6cmH(2)O in steps of 2cmH(2)O and then to 0cmH(2)O. Each PEEP step was maintained for 10min.

MEASUREMENTS AND RESULTS

Alveolar dead space (VD(alv)), the ratio of alveolar dead space to alveolar tidal volume (VD(alv)/VT(alv)), and the arterial to end-tidal PCO(2) difference (Pa-ET: CO(2)) showed a good correlation with PaO(2), normally aerated areas, and non-aerated CT areas in all animals (minimum-maximum r(2)=0.83-0.99; p<0.01). Lung collapse (non-aerated tissue>5%) started at 12[Symbol: see text]cmH(2)O PEEP; hence, open-lung PEEP was established at 14cmH(2)O. The receiver operating characteristics curve demonstrated a high specificity and sensitivity of VD(alv) (0.89 and 0.90), VD(alv)/VT(alv) (0.82 and 1.00), and Pa-ET: CO(2) (0.93 and 0.95) for detecting lung collapse.

CONCLUSIONS

Monitoring of dead space was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.

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Capnographie volumétrique. Mesure du CO2 avancée