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A practical lecture of
Capnography

Mainstream Sidestream
CO2 sensor is housed external to the breathing circuit CO2 sensor is inserted between the breathing circuit and
endotracheal tube
No gas removed from circuit Gas is constantly aspirated from circuit via a 6 feet
sampling tube into the unit containing CO2 sensor
ncrease in mechanical dead space Minimal dead space
Waveform in real time Waveform is delayed (1–4 seconds) due to transportation
of gases from the patient’s airway to the unit containing
the sensor

 Time capnogram and its components.
 Time capnogram showing segments, phases and angles.
 The inspiratory segment is phase 0
 The expiratory segment is divided into three phases: I, II, and III.
 The maximum value of CO2 at the end of the breath is
designated as end-tidal PCO2 (PetCO2). It is lower than arterial
CO2 by about 5 mm Hg

Prolonged phase II and steeper phase III suggestive of
bronchospasm, or airway obstruction

B. Expiratory valve malfunction resulting in elevation of
the baseline This is due to rebreathing of expiratory
gases from the expiratory limb during inspiration

Inspiratory valve malfunction resulting in
rebreathing of expired gases from inspiratory limb
during inspiration

Capnogram with normal phase II but with an
increased slope of phase III. Observed in pregnant
subjects under general anesthesia.

Patient is attempting to breathe during partial
muscle paralysis. Surgical movements on the chest
and abdomen can also result

The baseline is elevated as a result of CO2
rebreathing

Esophageal intubation resulting in the gastric
washout of residual CO2 and subsequent CO2 will
be zero;

Spontaneously breathing capnograms
where phase III is not well delineated

Dual capnogram in one lung transplantation patient. The first of peak of
phase III is from the transplanted normal lung, whereas the second peak is
from the native disease lung. A leak around the sidestream sensor port at
the monitor can also result in a dual peaked capnogram. This is because of
the dilution of expired PCO2 with atmospheric

Malignant hyperpyrexia where CO2 is raising gradually
with zero baseline suggesting increased CO2
production with CO2 absorption by the soda lime

Sudden raise of baseline and the partial pressure of
end-tidal carbon dioxide (PetCO2) due to
contamination of the sensor with secretions or water
vapor

Intermittent mechanical ventilation (IMV) breaths in
the midst of spontaneously breathing patient

Cardiopulmonary resuscitation: Capnogram showing
positive waveforms during each compression
suggesting effective cardiac compression generating
pulmonary blood

increase in partial pressure of end-tidal carbon
dioxide (PetCO2) values suggest spontaneous
return of circulation during cardiopulmonary
resuscitation

Capnogram showing rebreathing during inspiration.
This is normal in rebreathing circuits such as Mapelson
D or Bain circuit

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