Capnography – Detailed
Explanation
Definition
• Capnography is the continuous measurement
and graphical display of the concentration or
partial pressure of carbon dioxide (CO₂) in
respiratory gases during the respiratory cycle.
• The waveform displayed is called a
capnogram.
Principle
• • Based on the infrared absorption principle –
CO₂ absorbs infrared light at a specific
wavelength.
• • The analyzer detects the amount of light
absorbed and calculates the CO₂
concentration.
Parts of Capnograph
• 1. Sampling System
• • Mainstream (sensor placed directly at
airway)
• • Sidestream (gas sample aspirated through
tubing)
• • Microstream (low-flow sidestream, more
accurate)
• 2. Analyzer – Measures CO₂ concentration
using infrared technology.
• 3. Display – Shows the waveform (capnogram)
Types of Capnography
• 1. Qualitative – Colorimetric detector (changes
color with CO₂)
• 2. Quantitative –
• • Mainstream
• • Sidestream
• • Microstream
Uses of Qualitative Capnography
• • Confirms endotracheal tube placement
quickly.
• • Useful in emergency and pre-hospital
settings.
• • No numerical EtCO₂ value; just
presence/absence of CO₂.
• • Pros: Fast, portable, low cost.
• • Cons: No continuous waveform or numeric
data.
Quantitative Capnography
• Measures actual CO₂ concentration and
displays a waveform (capnogram).
Types of Quantitative Capnography
• 1. Mainstream – Continuous, real-time
measurement during anesthesia or
ventilation.
• Pros: Immediate response, accurate.
• Cons: Adds weight and dead space to airway;
expensive.
• 2. Sidestream – Gas sample aspirated through
tubing.
• Pros: Lightweight at airway, versatile.
Capnogram (Waveform Phases)
• Phase I (Inspiratory baseline) – No CO₂.
• Phase II (Expiratory upstroke) – Rapid rise as
alveolar gas mixes with dead space gas.
• Phase III (Alveolar plateau) – Alveolar gas rich
in CO₂ is exhaled; end = EtCO₂.
• Phase 0 (Inspiratory downstroke) – Rapid fall
back to baseline.
Normal Values
• • EtCO₂: 35–45 mmHg
• • Gradient between arterial PaCO₂ and EtCO₂:
~2–5 mmHg
Indications
• • Monitoring during general anesthesia
• • Confirming endotracheal tube placement
• • Monitoring in ICU patients on ventilator
• • During CPR – assess quality of chest
compressions & ROSC
• • Sedation procedures
• • Detection of airway obstruction or
disconnection
Advantages
• • Provides real-time, continuous monitoring
• • Early detection of hypoventilation, apnea,
disconnection
• • Confirms ET tube placement instantly
• • Non-invasive and easy to use
• • Useful in CPR and trauma settings
Disadvantages
• • Equipment cost is high
• • Sampling tube may get blocked with
secretions or moisture
• • Mainstream sensors increase dead space
and weight
• • Sidestream system may have delay in
reading
Abnormal Capnogram Patterns
• 1. Apnea / Disconnection → flat line
• 2. Bronchospasm / COPD → sloping (shark-fin
appearance)
• 3. Rebreathing → baseline not returning to
zero
• 4. Hypoventilation → increased EtCO₂
• 5. Hyperventilation → decreased EtCO₂
• 6. Cardiac arrest → sudden fall of EtCO₂
Clinical Applications Summary
• • Anesthesia: Ventilation monitoring
• • ICU: Detect disconnections, monitor
ventilated patients
• • Emergency: Tube placement, CPR quality
• • Pulmonary: Detect airway obstruction
