From the Department of Anaesthesia and Perioperative Medicine, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia.
Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California.
Anesth Analg. 2023 Nov 1;137(5):934-942. doi: 10.1213/ANE.0000000000006689. Epub 2023 Oct 20.
Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests that its use improves outcomes in operating rooms, intensive care units, and emergency departments, as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic derangements. In addition to being useful for diagnosing and managing esophageal intubation, capnography provides crucial information when used for monitoring airway patency and hypoventilation in patients without instrumented airways. Despite its ubiquitous use in high-income-country operating rooms, deaths from esophageal intubations continue to occur in these contexts due to incorrect use or interpretation of capnography. National and international society guidelines on airway management mandate capnography's use during intubations across all hospital areas, and recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless, capnography's use across high-income-country intensive care units, emergency departments, and postanesthesia recovery units remains inconsistent. While capnography is universally used in high-income-country operating rooms, it remains largely unavailable to anesthesia providers in low- and middle-income countries. This lack of access to capnography likely contributes to more frequent and serious airway events and higher rates of perioperative mortality in low- and middle-income countries. New capnography equipment, which overcomes cost and context barriers, has recently been developed. Increasing access to capnography in low- and middle-income countries must occur to improve patient outcomes and expand universal health care. It is time to extend capnography's safety benefits to all patients, everywhere.
二氧化碳监测已被公认为是一项不可或缺的患者安全监测手段。有证据表明，其在手术室、重症监护病房和急诊科、镇静套房、麻醉后恢复室以及普通外科病房中的应用，可改善患者的预后。二氧化碳监测可准确、快速地检测到呼吸、循环和代谢紊乱。除了在诊断和管理食管插管方面有用外，在没有仪器气道的患者中，二氧化碳监测用于监测气道通畅性和通气不足时，也提供了至关重要的信息。尽管在高收入国家的手术室中广泛使用，但由于二氧化碳监测的使用或解读不正确，仍会在这些情况下发生食管插管导致的死亡。有关气道管理的国家和国际社会指南规定，在所有医院区域的插管过程中都应使用二氧化碳监测，并建议在通气可能受损时使用，例如在程序性镇静期间。然而，高收入国家的重症监护病房、急诊科和麻醉后恢复室的二氧化碳监测使用仍不一致。虽然二氧化碳监测在高收入国家的手术室中普遍使用，但在中低收入国家的麻醉提供者中仍然难以获得。这种无法获得二氧化碳监测的情况可能导致中低收入国家更频繁和更严重的气道事件以及更高的围手术期死亡率。最近已经开发出一种新的二氧化碳监测设备，克服了成本和环境障碍。必须增加中低收入国家获得二氧化碳监测的机会，以改善患者预后并扩大全民健康覆盖。现在是将二氧化碳监测的安全效益扩展到所有地方的所有患者的时候了。
