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Kohlenstoffdioxidmessung in der Notfallmedizin

Measurement of carbon dioxide in emergency medicine

  • Notfallmedizin
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Zusammenfassung

Die Messung des exspiratorischen Kohlenstoffdioxid(CO2)-Gehalts ist ein wertvolles Instrument in der präklinischen Notfallmedizin. Neuere Untersuchungen über unerkannte ösophageale Fehllagen machen es notwendig, dass das notfallmedizinische Personal die Tubuslage sicher mithilfe des CO2-Monitorings verifizieren kann. Mit der Euronorm 1789:2007 ist die Vorhaltung einer Kapnometrie verpflichtend in allen medizinischen Fahrzeugen zu gewährleisten. Allerdings ist die Häufigkeit der Anwendung des CO2-Monitorings nach Atemwegssicherung und bei Patienten mit respiratorischer Insuffizienz niedrig. Dieser Beitrag beschreibt die Terminologie, Physiologie, Technologie und die klinische Anwendung der CO2-Messung. Die Überwachung des Herzzeitvolumens und die Effektivität der Herzdruckmassage mithilfe der Kapnographie werden erläutert. Es wird ferner die Bedeutung des CO2-Monitorings bei Patienten mit schwerem Schädel-Hirn-Trauma und restriktiven sowie obstruktiven Lungenerkrankungen hervorgehoben.

Abstract

Expiratory carbon dioxide (CO2) monitoring is a valuable tool in the prehospital setting. Recent reports of misplaced endotracheal tubes in the prehospital setting make it important to ensure that tube placement is verified by CO2 monitoring. The Euronorm 2007:1789 made provision of capnometry mandatory for all medical vehicles. However, the frequency of utilization of CO2 monitoring after securing the airway and in patients with respiratory insufficiency is low. This article covers the terminology, physiology, technology and clinical applications of CO2 monitoring. Monitoring of cardiac output and the efficiency of cardiopulmonary resuscitation are described and the article also highlights the importance of CO2 monitoring in patients with severe head trauma as well as restrictive and obstructive pulmonary disorders.

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Abbreviations

AMV:

Atemminutenvolumen

CO2 :

Kohlenstoffstoffdioxid

COPD:

„chronic obstructive pulmonary disease“ (chronisch obstruktive Lungenerkrankung)

CPR:

„cardiopulmonary resuscitation“ (kardiopulmonale Reanimation)

HZV:

Herzzeitvolumen

petCO2 :

endtialer Kohlenstoffdioxidpartialdruck

SHT:

Schädel-Hirn-Trauma

SpO2 :

Pulsoxymetrisch gemessene Sauerstoffsättigung

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Authors and Affiliations

  1. Abteilung Anästhesiologie und Schmerztherapie, Helios Klinikum Emil von Behring, 14109, Berlin, Deutschland

    A. Timmermann DEAA, MME & E.A. Nickel

  2. Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland

    A. Timmermann DEAA, MME & E.A. Nickel

  3. Klinik für Anästhesiologie, Universitätsklinikum Aachen, Aachen, Deutschland

    J.C. Brokmann

  4. Ärztlicher Leiter Rettungsdienst Stadt Aachen, Berufsfeuerwehr Aachen, Aachen, Deutschland

    J.C. Brokmann

  5. Abteilung für Anästhesie, Notfall- und Allgemeine Intensivmedizin, Landesklinikum Wiener Neustadt, Wiener Neustadt, Österreich

    R. Fitzka

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  1. A. Timmermann DEAA, MME
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Correspondence to A. Timmermann DEAA, MME.

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Timmermann, A., Brokmann, J., Fitzka, R. et al. Kohlenstoffdioxidmessung in der Notfallmedizin. Anaesthesist 61, 148–155 (2012). https://doi.org/10.1007/s00101-011-1977-x

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