Intensive Care Medicine
228
Re-audit on "Capnography in the Intensive Care
Units BHR Hospitals NHS Trust"
Carbon dioxide,partial pressure, Intensive care,audit
M. Ganesh Ritesh1, H. Petkova1, A. Bellini1
1BHR HOSPITALS NHS TRUST - ROMFORD (United Kingdom)

Background: The use of capnography is a standard for anaesthesia for patients undergoing endotracheal intubation or placement of a laryngeal mask and subsequently while airway devices remain in place. The fourth National Audit Project ‚Major complications of airway management’ (NAP4) was published in March 2011 and raised particular concerns about complications of airway management in the ICU and the emergency department. At least one in four major airway complications reported to NAP4 was from the ICU or the emergency department .Common factors in both the ICU and emergency department included unrecognised oesophageal intubation or unrecognised displacement of tracheal tubes or tracheostomy tubes after patient movement, intervention, or during transport. Following NAP4 report ,AAGBI has recommended that capnography should be used during critical care during intubation and mechanical ventilation.The Standards, Safety and Quality Committee of the Intensive Care Society (UK) developed guidelines for use of capnograph monitoring in intensive care units.
Audit on the use of capnography in the intensive care unit in our trust was completed and presented in 2013, showed only 20% had continuous monitoring with either oral endotracheal intubation or tracheostomy.

Method: A prospective re-audit was undertaken over 5 days period from 24th March -29th March 2017. We recorded whether patient was intubated or had a tracheostomy and if continuous capnography monitoring was present.

Results: 24 patients were ventilated (14 ETT & 10 Tracheotomy tubes) in the intensive care unit. All the 24 ventilated patients with oral endotracheal intubation or tracheostomy tubes had continuous capnography monitoring present.

Conclusion: We fully comply with the Intensive Care Society (UK) / AAGBI recommendations.

References:
a) http://www.aagbi.org/publications/guidelines/docs/ standardsofmonitoring07.pdf Recommendations for standards of monitoring during anaesthesia and recovery 4th edition. AAGBI 2007 b) NAP 4- chapter 9- Capnography monitoring in ICU
c) Intensive Care Society Guidelines- Capnography
d) AAGBI recommendations- Capnography
Cook TM, Woodall N, Harper J, Benger J.Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society .
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01 / Re-audit on Capnography in the Intensive Care Units BHR Hospitals NHS Trust