Capnography/Capnometry during mechanical ventilation: 2011

We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1990 and November 2010. The update of this clinical practice guideline is based on 234 clinical studies and systematic reviews, 19 review articles that investigated capnography/capnometry during mechanical ventilation, and the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system: (1) Continuous-waveform capnography is recommended, in addition to clinical assessment to confirm and monitor correct placement of an endotracheal tube. (2) If waveform capnography is not available, a non-waveform exhaled CO₂ monitor, in addition to clinical assessment, is suggested as the initial method for confirming correct tube placement in a patient in cardiac arrest. (3) End-tidal CO₂ (P_ETCO2) is suggested to guide ventilator management. Continuous capnometry during transport of the mechanically ventilated patients is suggested. Capnography is suggested to identify abnormalities of exhaled air flow. (6) Volumetric capnog-raphy is suggested to assess CO₂ elimination and the ratio of dead-space volume to tidal volume (V_D/V_T) to optimize mechanical ventilation. (7) Quantitative waveform capnography is suggested in intubated patients to monitor cardiopulmonary quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions or when rhythm check reveals an organized rhythm.