Procedures: Fellow Case Report Poster - Procedures |

A Novel Capnography Monitoring Technique During Bronchoscopy FREE TO VIEW

Joseph Thachuthara-George, MBBS; Mohit Chawla, MD; Robert Lee, MD
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Memorial Sloan Kettering Cancer Center, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):982A. doi:10.1016/j.chest.2016.08.1088
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SESSION TITLE: Fellow Case Report Poster - Procedures

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Capnography measures end-tidal CO2 (ETCO2) which provides continuous, dynamic assessment of ventilatory status of patients. In patients receiving moderate sedation, respiratory depression is a potential risk. Capnography has been shown to decrease the incidence of hypoxemic episodes during sedation. We present here a novel method of ETCO2 measurement during bronchoscopy.

CASE PRESENTATION: 68 year-old man with recurrent laryngeal squamous cell carcinoma treated with radiation and chemotherapy was referred to us for EBUS TBNA of FDG avid mediastinal lymph nodes. He had a Shiley #6 cuffless tracheostomy tube in place. Due to his complicated neck anatomy from radiation and progressive cancer, exchanging tracheostomy tube with a cuffed tracheostomy tube was deemed to carry significant risk of bleeding and potential airway loss. We decided to perform the procedure with continuous capnography. The inner cannula of tracheostomy was removed to accommodate the EBUS scope. Once EBUS bronchoscope was introduced, it became apparent that accurate ETCO2 measurement was difficult to obtain due to its size. ETCO2 catheter was then attached to the Olympus EBUS bronchoscope balloon channel with no balloon attached to the EBUS scope. Satisfactory ETCO2 waveform was obtained. Procedure was performed successfully without any complications.

DISCUSSION: Capnography has become an integral component of patient monitoring in clinical medicine especially in the practice of anesthesia and emergency medicine. Procedures under moderate sedation carry a risk of respiratory depression, decreased ventilation, and subsequent hypoxemia. In our patient with head and neck cancer with a small cuffless tracheostomy tube, monitoring ETCO2 was challenging. The novel method that we used where capnography was done via EBUS bronchoscope balloon channel has not been reported to the best of our knowledge.

CONCLUSIONS: Capnography is a simple but effective tool in monitoring ventilation and preventing hypoxemia in patients undergoing moderate sedation. Capnography using EBUS bronchoscope balloon channel opens up a new method for ET CO2 monitoring and this needs to be explored further.

Reference #1: Conway et al. Systematic Reviews (2015) 4:92

Reference #2: American Emergency Medicine, April 2001, Vol 9 Number 4

Reference #3: Elbert TJ et al;J Clin Monit Comput. 2015 Dec 1

DISCLOSURE: The following authors have nothing to disclose: Joseph Thachuthara-George, Mohit Chawla, Robert Lee

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