Use of ETCO2 Monitors

[itku2er]

Not if you follow the GOLD STANDARD OF ETI CONFIRMATION and thats TO WATCH IT PASS THROUGH THE CORDS UNDER DIRECT VISUALIZATION!!! Everything else is 2nd best :wink:

I do ACE ..........but some out there are lazy ........but after inital placement and movement of the patient i have seen some use the CO2 dector as the placement recheck instead of listening with the stethoscope........and checking tube markings...

8) 8)

[Ace844]

I do ACE ..........but some out there are lazy ........but after inital placement and movement of the patient i have seen some use the CO2 dector as the placement recheck instead of listening with the stethoscope........and checking tube markings...

8) 8)

Stuff like that makes me crazy....How do these people get liscenced, and certified?!?!?!

[itku2er]

I do ACE ..........but some out there are lazy ........but after inital placement and movement of the patient i have seen some use the CO2 dector as the placement recheck instead of listening with the stethoscope........and checking tube markings...

8) 8)

They get a liscense then they GET LAZY..........

[Ace844]

(Prehospital Emergency Care

Publisher: Taylor & Francis Health Sciences @ part of the Taylor & Francis Group

Issue: Volume 10, Number 3 / July-September 2006

Pages: 356 - 362

URL: Linking Options

DOI: 10.1080/10903120600725751

Predictors of Intubation Success and Therapeutic Value of Paramedic Airway Management in a Large, Urban EMS System

Daniel P. Davis A1, Roger Fisher A2, Colleen Buono A1, A2, Criss Brainard A1, A2, Susan Smith A2, Ginger Ochs A2, Jennifer C. Poste A1, James V. Dunford A1

A1 Department of Emergency Medicine, UC San Diego, San Diego, CA

A2 Department of Emergency Medicine, San Diego Medical Services Enterprise, San Diego, CA)

Abstract:

Background. Endotracheal intubation (ETI) is commonly used by paramedics for definitive airway management. The predictors of success and therapeutic value with regard to oxygenation are not well studied. Objectives. 1) To explore the relationship between intubation success and perfusion status, Glasgow Coma Scale (GCS) score, and end-tidal carbon dioxide (EtCO2); 2) to describe the incidence of unrecognized esophageal intubations with use of continuous capnometry; and 3) to document the incremental benefit of invasive versus noninvasive airway management techniques in correcting hypoxemia. Methods. This was a prospective, observational study conducted in a large urban emergency medical services system. Paramedics completed a telephone debriefing interview with quality assurance personnel following delivery of all patients in whom invasive airway management had been attempted. Continuous capnometry was used for confirmation of tube position in all patients. Descriptive statistics were used to document airway management performance, including first-attempt ETI success, overall ETI success, and Combitube insertion (CTI) success. In addition, the incidence of unrecognized esophageal intubation was recorded. The relationship between intubation success and perfusion status, GCS score, and initial EtCO2 value was explored using logistic regression. Finally, recorded SpO2 values and the incidence of hypoxemia (SpO2 < 90%) at baseline, following noninvasive airway maneuvers, and after invasive airway management were compared for perfusing patients.

Results. A total of 703 patients were enrolled over 12 months. First-attempt ETI success was 61%, and overall ETI success was 81%; invasive airway management (ETI or CTI) was unsuccessful in 11% of patients. A single unrecognized esophageal intubation was observed (0.1%). A clear relationship between airway management success and perfusion status, GCS score, and initial EtCO2 value was observed. Only EtCO2 demonstrated an independent association with ETI success after adjusting for the other variables. Significant improvements in mean SpO2 and the incidence of hypoxemia over baseline were observed with both noninvasive and invasive airway management techniques in 168 perfusing patients.

Conclusions. A relationship between intubation success and perfusion status, GCS score, and initial EtCO2 value was observed. Capnometry was effective in eliminating unrecognized esophageal intubations. Both noninvasive and invasive airway management strategies were effective in increasing SpO2 values and decreasing the incidence of hypoxemia, with additional benefit observed with invasive airway maneuvers in some patients.

[AZCEP]

So the use of ventilatory management was able to reduce hypoxemia, and increase pulse oximetry, but no direct mention of ventilation. Pulse oximeters are notoriously garbage when it comes to useful clinical information, and have been well documented as such. Capnography gives real-time information about ventilatory status, and gets no specific mention of it's utility in this article.

[Ace844]

So the use of ventilatory management was able to reduce hypoxemia, and increase pulse oximetry, but no direct mention of ventilation. Pulse oximeters are notoriously garbage when it comes to useful clinical information, and have been well documented as such. Capnography gives real-time information about ventilatory status, and gets no specific mention of it's utility in this article.

I will point you to the 'results section where it says

Only EtCO2 demonstrated an independent association with ETI success after adjusting for the other variables

Hope This Helps,

ACE844

[AZCEP]

My point was more directed toward the lack of using ventilation as an end point, not the sucess of ETI. Where it says the invasive airway is effective in reducing hyoxemia and increasing SpO2. It almost sounds like they see EtCO2 as an ETI assessment, instead of a ventilation assessment tool, but I could be misreading the data.

[Ace844]

My point was more directed toward the lack of using ventilation as an end point, not the sucess of ETI. Where it says the invasive airway is effective in reducing hyoxemia and increasing SpO2. It almost sounds like they see EtCO2 as an ETI assessment, instead of a ventilation assessment tool, but I could be misreading the data.

ahhh...I got ya now. Umm, like you mentioned, it isn't clear in the abstract so I will look for the full text and if I can get it post that here. My apologies for misunderstanding your 'intent' in your post.