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GENERAL ARTICLES

Defining Segments and Phases of a Time Capnogram

Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Kodali Bhavani-Shankar, MD, Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115. Address e-mail to Bhavani{at}capnography.com

The division of a time capnogram into inspiratory and expiratory segments is arbitrary and results in the inability of a time capnogram to detect rebreathing instantaneously. Demarcation of a time capnogram into inspiratory and expiratory components using gas flow signals will not only facilitate prompt detection of rebreathing, but will also allow application of standardized and physiologically appropriate nomenclature for better understanding and interpretation of time capnograms. A Novametrix^® CO₂-SMO plus respiratory profile monitor (Novametrix Medical Systems, Wallingford, CT) was used to obtain a simultaneous display of CO₂ and respiratory flow waveforms on a computer screen during spontaneous and controlled ventilation using a circle system with the inspiratory valve competent (no rebreathing) and with the valve displaced (rebreathing). Because the response time of the CO₂ analyzer was similar to the response time of the flow sensor, a comparison was made between the two waveforms to determine the inspiratory segment (Phase 0) and the expiratory segment of the time capnogram and its subdivisions (Phases I, II, and III). The end of expiration almost coincides with the downslope of the CO₂ waveform in the capnograms when there is no rebreathing. However, in the presence of rebreathing, the alveolar plateau is prolonged and includes a part of inspiration (Phase 0), in addition to the expiratory alveolar plateau (Phase III).

Implications: Presently, the division of a time capnogram into inspiratory and expiratory segments is arbitrary. Demarcation of a time capnogram into various components using the gas flow signals facilitates prompt detection of the cause of abnormal capnograms that can widen the scope of future clinical applications of time capnography.

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