Medical Training
- Monitoring For internal use only
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Objective of Presentation
• This presentation on Monitoring gives the reader an overview of
current systems which can be used to monitor mechanical
ventilation. It covers medical fundamentals and recognition of lifethreatening situations.
• The reader will also become acquainted with the different priorities
of alarms on MEDUMAT Transport.
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Contents
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Ventilation Monitoring
Pressure/Volume Curve
Capnometry /Capnography
MEDUMAT Transport Alarms
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Ventilation Monitoring
Every use of mechanical ventilation has to be monitored
continuously as a check of its effectiveness and success.
In addition to oxygen saturation -- the ‘sign of success’ –
other measures are required for the assessment and
management of the ventilation process.
The following parameters can be used in an evaluation:
–Clinic
–Capnometry
–Expiration volumetry
–Ventilation pressures
–(Blood Gas Analysis)
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Important Parameters For Assessing the
Quality of Ventilation
• Measurements:
– Tidal volume
– Respiratory Minute Volume
– Respiratory rate
– Maximum pressure
– PEEP level
– etCO2
• Curves
– Flow curve
– Pressure curve
– Capnography
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Pressure Curve
• Composition of Pressure/Time Diagram
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Flow Curve
• Composition Flow/Time Diagram
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Capnometry /Capnography
• Non-invasive continuous monitoring of CO2 portion of exhaled air
– Check position of tube
– Check ventilation
– Check circulatory function
• Sensitive monitoring process
• Two different reporting means
– capnometry (numeric value)
– capnography (curve)
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Structure of CO2 Curve in Capnogram
I.
II.
III.
IV.
Inspiration
CO2 of upper airways (dead space)
CO2 of lower airways (alveoli)
Start of next inspiration
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Functional Principle of etCO2 Measurement
• Infrared spectroscopy with wave length of 426 nm
• Absorption of light proportional to number of available
CO2 gas molecules
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Interpretation of CO2 Curves
• Exponential decrease in PCO2
– Cardiac arrest
– Pulmonary embolism
– Sudden decrease in blood pressure
• Constant low etCO2
– Absolute hyperventilation
– Low body temperature
– Centralization of shock
• Constant high etCO2
– Hypoventilation
• Sudden decrease in etCO2
– Accidental extubation
– Faulty esophageal intubation
– Disconnection
• Slant in etCO2 plateau
– Bronchospasms (e.g., asthma)
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Influences on etCO2 Level
In patients depending on:
– Circulatory function and CO2 transport to lungs
– Metabolism at cellular level
– Ventilation for respiratory elimination of CO2
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Normal Capnometry /Capnography
– etCO2 in patient with normoventilation
• 4-5 Vol% = 30-35 mm Hg
– Conversion:
• 1 Vol% = 7 mmHg
• 1 mmHg = 0.15 Vol%
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Alarms
• Distinction between physiological and system alarms in MEDUMAT
Transport
• Graduated in three (3) alarm escalation levels
• Requires individual adjustment for each patient
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Alarm – High Priority
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Tidal volume high/low
Respiratory Minute Volume high/low
Apnea
Leak on patient side of device
Expiratory CO2 high/low
Inspiratory CO2 high
Airway pressure high/low
Oxygen supply low
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Alarms – Medium Priority
• Respiratory rate high
• Oxygen concentration high
• CO2 Occlusion
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Alarm – Low Priority
• CO2 module defective
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© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Summary
• Every ventilation of a patient requires that thorough checks be made
of the ventilation settings by measuring physiological parameters.
• Knowing the etCO2 numerical values and curves gives the user a
greater degree of safety and certainty during ventilation of
emergency patients.
• Device-specific alarms in three different priority levels indicate
problems or danger.
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