Now the kapnografiya is one of the most widespread and important types of monitoring. In anesthesiology practice this method is the standard for a long time. At the same time, use of monitoring of concentration of carbon dioxide on an exhalation did not gain due distribution in chambers of an intensive care and resuscitation in medical institutions in the former Soviet Union yet.
In aspect of a pandemic of a koronavirusny infection importance of high-quality monitoring at the patients who are especially with given pathologies on artificial ventilation of the lungs, it is difficult to overestimate. In this article we will consider the main advantages of use of a kapnografiya at such patients of intensive care units and resuscitation.
Kapnometriya represents measurement of concentration of carbon dioxide in gas mix (the inhaled or exhaled gas, atmospheric air). Kapnometr is a device for measurement of concentration of carbon dioxide in gas mix. Kapnograf — the device displaying on the screen in the form of the schedule results of measurement of concentration of carbon dioxide.
Concentration of carbon dioxide can be measured in test of gas mix in various ways. Now the medical industry releases kapnograf which work is based on use of one of four ways of definition of CO2: mass spectrometry, Raman spectrometry, infrared optical analysis or infrared optico-acoustic analysis. But most in the world infrared kapnograf were widely adopted. The infrared analysis is based on ability of molecules of gas to absorb the infrared radiation of a certain wavelength. The own absorption spectrum is inherent in each gas owing to what, applying radiations of different lengths of waves of infrared range, it is possible to define the maintenance of various components in one test of gas.
On a way of gas offtake distinguish a kapnometriya in a direct stream when the sensor is directly on the ways of gas mix to the patient and a kapnometriya in a side stream when from a rebreathing system there is a constant sampling of gas mix for the analysis in a special system to the sensor. The last way is considered the most widespread now. The Kapnograf working by this principle have the system of dehydration of gas mix, the built-in gas pomp and are supplied with highways for connection to a rebreathing system. Kapnografiya can be carried out as at the patient who is on spontaneous breath and at the patient who is on artificial ventilation of the lungs.
It was originally supposed that the kapnografiya will be used for control of ventilation of patients. However after the beginning of use of a method in daily clinical practice it became clear that the kapnografiya has much ampler diagnostic opportunities, in addition to ventilation control.
But even in aspect of control of ventilation the kapnografiya is important very much as allows to diagnose hypoventilation and an apnoea in due time. At disappearance of respiratory activity of the patient the monitor gives sound and light signals. Inclusion of an alarm-system happens through a certain interval of time after the last exhalation. Usually this interval makes 15–20 seconds, in some models it can be regulated. Thus, for a kapnografiya the clinical states connected with real risk of oppression and an apnoea and in their number, undoubtedly are among indications, severe forms of a koronavirusny infection belong. Also the kapnografiya allows to diagnose quickly a hyperventilation owing to the expressed asthma for such patients.
When carrying out an intubation of patients with a koronavirusny infection the account in certain cases can go for seconds. In such situation it is very important to confirm the correct provision of an endotracheal tube quickly. It is expedient to begin to see Kapnografiya to a trachea intubation as already at this stage it is possible to obtain valuable information. If the intubation of a trachea is executed correctly and the endotracheal tube is located correctly, on the kapnograf display right after the beginning of IVL there is a normal kapnogramma that is considered the most reliable control sign of the correct provision of an endotracheal tube.
Use of a kapnografiya when performing cardiopulmonary resuscitation is very important. It provides the doctor with information on a condition of the patient and on efficiency of resuscitation. Kapnografiya in these cases allows to find in due time a blood circulation stop, to control efficiency of resuscitation actions and to approximately estimate quality of blood circulation after restoration of spontaneous circulation.