1. Medical Training - Monitoring -
For internal use only

2. Objective of Presentation
© 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 life-threatening situations.
The reader will also become acquainted with the different priorities of alarms on MEDUMAT Transport.

3. Contents Ventilation Monitoring Pressure/Volume Curve
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Contents
Ventilation Monitoring
Pressure/Volume Curve
Capnometry /Capnography
MEDUMAT Transport Alarms

4. Ventilation Monitoring
© 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)

5. Important Parameters For Assessing the Quality of Ventilation
© 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

6. Pressure Curve Composition of Pressure/Time Diagram
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Pressure Curve
Composition of Pressure/Time Diagram

7. Flow Curve Composition Flow/Time Diagram
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Flow Curve
Composition Flow/Time Diagram

8. Capnometry /Capnography
© 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)

9. Structure of CO2 Curve in Capnogram
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Structure of CO2 Curve in Capnogram
Inspiration
CO2 of upper airways (dead space)
CO2 of lower airways (alveoli)
Start of next inspiration

10. Functional Principle of etCO2 Measurement
© 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

11. Interpretation of CO2 Curves
© 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)

12. Influences on etCO2 Level
© 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

13. Normal Capnometry /Capnography
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Normal Capnometry /Capnography
etCO2 in patient with normoventilation
4-5 Vol% = mm Hg
Conversion:
1 Vol% = 7 mmHg
1 mmHg = 0.15 Vol%

14. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO
© 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

15. Alarm – High Priority Tidal volume high/low
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Alarm – High Priority
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

16. Alarms – Medium Priority
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Alarms – Medium Priority
Respiratory rate high
Oxygen concentration high
CO2 Occlusion

17. Alarm – Low Priority CO2 module defective
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
Alarm – Low Priority
CO2 module defective

18. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO
© 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.