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🤓 We inform the publication of the new chapter entitled “Capnography in the Patient Under Invasive Mechanical Ventilation” in our Mechanical Ventilation Manual. This chapter aims to consolidate fundamental concepts, integrated physiology, and the clinical interpretation of capnography in the context of the intubated and mechanically ventilated patient.

The chapter covers:

• Concepts and physical/technological principles, including the differences between capnography and capnometry, as well as the main detection systems (mainstream and sidestream).

• Integration of capnography with CO₂ physiology, explaining the relationship between metabolism, ventilation, and perfusion, and how these interactions are reflected in capnographic waveforms in patients under mechanical ventilation.

• Interpretation of the normal capnogram and its relationship with ventilatory and circulatory determinants when integrated with the mechanical ventilator waveforms.

• Abnormal capnographic patterns and their clinical implications in common scenarios such as alveolar hypoventilation, hemodynamic alterations, flow limitation, and auto-PEEP, as well as critical events such as progression to cardiac arrest.

The figure above presents a summary panel of the main clinical conditions and their respective capnographic findings discussed in this chapter.

The approach is pragmatic and clinically oriented, emphasizing the clinical implications of capnographic monitoring, not only for confirming endotracheal tube placement, but also as a continuous monitor of alveolar ventilation and of pathophysiological changes that may precede traditional clinical signs or alterations in pulse oximetry.

This update represents an important advance for mechanical ventilation practice, reinforcing capnography as a valuable tool in the care of critically ill patients receiving invasive ventilation.

Access the full chapter here

Enjoy the reading!