Volume Capnography in the Intensive Care Unit: Potential Clinical Applications.

Volume capnography provides a noninvasive, continuous display of the fractional concentration or partial pressure of carbon dioxide (Pco2) versus exhaled volume. Derived measurements and calculations are influenced by changes in both ventilation and perfusion and are therefore useful for assessing both respiratory and cardiovascular function. This article provides an evidence-based review of several potential uses of volume capnography in the intensive care unit: 1) monitoring the effectiveness of ventilation by using end-tidal Pco2 as a surrogate for arterial Pco2, 2) assessing volume responsiveness, 3) measuring cardiac output, 4) determining prognosis in patients with the acute respiratory distress syndrome, 5) optimizing alveolar recruitment, and 6) excluding pulmonary embolism. Studies performed during the past few decades have clearly shown that volume capnography can provide important prognostic information in patients with acute respiratory distress syndrome and that end-tidal Pco2 should not be used to estimate or even to monitor the direction of change in the arterial Pco2 in mechanically ventilated intensive care unit patients. Unfortunately, few conclusions can be made from studies evaluating other potential applications. Of these, the most promising are the noninvasive measurement of cardiac output and optimization of alveolar recruitment in patients with acute respiratory distress syndrome and in mechanically ventilated, morbidly obese patients.