Журнал «Медицина неотложных состояний» Том 19, №4, 2023

Капнометрія/капнографія — це метод вимірювання та відображення концентрації вуглекислого газу (CO2) у дихальних газах. Найчастіше цей термін передбачає вимірювання парціального тиску вуглекислого газу (PCO2) наприкінці видиху (End-tidal CO2, ETCO2). Крива, що утворюється при капнографії, називається капнограмою, на якій розрізняють інспіраторний та експіраторний сегменти. Основними детермінантами ETCO2 є продукція CO2, серцевий викид, легенева перфузія та альвеолярна вентиляція. У нормі ETCO2 на 2–5 мм рт.ст. нижчий, ніж PCO2 артеріальної крові. Цей градієнт збільшується при порушенні вентиляційно-перфузійних відношень — наприклад, при тромбоемболії легеневої артерії або гіпоперфузії легень під час зупинки кровообігу. Форма капнограми, у свою чергу, залежить від концентрації CO2 в альвеолах та патерну їх спорожнення, а також від серцевого викиду. Це дозволяє використовувати капнографію для реєстрації бронхоспазму, циркуляції CO2 в контурі, спонтанних дихальних спроб тощо. В Україні капнометрія та капнографія рутинно використовуються при анестезіологічному забезпеченні лапароскопічних операцій, які потребують суворого контролю ETCO2 через інсуфляцію CO2 у черевну порожнину та абсорбцію його очеревиною. Разом з тим спектр застосування капнометрії насправді значно ширший, ніж лише лапароскопічна хірургія. У відділенні інтенсивної терапії він включає наступні показання, але не обмежується ними: підтвердження позиції ендотрахеальної трубки при інтубації трахеї; моніторинг цілісності дихального контура, у тому числі при повороті або транспортуванні пацієнта; оцінка ефективності серцево-легеневої реанімації; оцінка ефективності вентиляції маскою; моніторинг дихання під час процедурної седації; моніторинг під час механічної вентиляції легень; допоміжний моніторинг гемодинаміки. У поданому літературному огляді детально розглядаються переваги, недоліки та методика застосування капнометрії/капнографії при кожному з наведених показань.

Capnometry/capnography is a method of measuring and displaying the concentration of carbon dioxide (CO2) in respiratory gases. Most often, this term involves measuring the partial pressure of carbon dioxide (PCO2) at the end of exhalation (end-tidal CO2, ETCO2). The curve formed during capnography is called a capnogram, where the inspiratory and expiratory segments are distinguished. The main determinants of ETCO2 are CO2 production, cardiac output, pulmonary perfusion, and alveolar ventilation. Normally, ETCO2 is 2–5 mm Hg lower than arterial blood PCO2. This gradient increases when the ventilation-perfusion ratio is impaired, for example, in pulmonary embolism or pulmonary hypoperfusion during cardiac arrest. The shape of the capnogram, in turn, depends on the concentration of CO2 in the alveoli and the pattern of their emptying, as well as on cardiac output. This allows the use of capnography to register bronchospasm, CO2 circulation in the circuit, spontaneous breathing attempts, etc. In Ukraine, capnometry and capnography are routinely used in the anesthesia during laparoscopic surgeries, which require strict control of ETCO2 due to the insufflation of CO2 into the abdominal cavity and its absorption by the peritoneum. However, the spectrum of capnometry application is actually much wider than just laparoscopic surgery. In the intensive care unit, it includes but is not limited to the following indications: confirmation of the endotracheal tube position during tracheal intubation; monitoring the respiratory circuit integrity, including while turning and transporting a patient; evaluation of the cardiopulmonary resuscitation effectiveness; evaluation of the mask ventilation effectiveness; breathing monitoring during procedural sedation; monitoring during mechanical ventilation; auxiliary monitoring of hemodynamics. This literature review discusses the advantages, disadvantages and methods of using capnometry/capnography for each of the listed indications in detail.

капнометрія; капнографія; моніторинг; моніторинг у відділенні інтенсивної терапії; вуглекислий газ; огляд

capnometry; capnography; monitoring; monitoring in the intensive care unit; carbon dioxide; review

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