ICU Vivas · Airway management
Data viva: capnography through the peri-intubation period
A CICM cross-table data viva on waveform capnography — the single most important monitor in airway management. The candidate reads the trace to confirm tracheal placement, to detect oesophageal intubation, to spot obstruction and circuit leaks, and to pair the capnography with the peri-intubation vital signs that flag cardiovascular collapse — the monitoring skill that NAP4 made non-negotiable.
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Target exams
Stimulus
A 68-year-old man was intubated three minutes ago for pneumonia. You are shown the capnography trace and the observation panel from the moment of induction. The trace falls flat over the next two breaths. The observation panel reads:
| Variable | Pre-induction | At intubation | Three minutes later |
|---|---|---|---|
| SpO2 | 92% on 15 L/min mask | 95% | 84% |
| Heart rate | 112/min | 118/min | 58/min |
| Blood pressure | 104/62 mmHg | 96/58 mmHg | 62/38 mmHg |
| End-tidal CO2 (trace) | — | 38 mmHg (sustained waveform) | flat, 0 mmHg |
Interpret the capnography trace, confirm or refute the airway, and judge whether the patient is safe.[1]
[1]References4ShowHide
- [1]Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-Intubation Events in Critically Ill Patients From 29 Countries. JAMA, 2021.PMID 33755076
- [2]Cook TM, Woodall N, Frerk C (eds) Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth, 2011.PMID 21447489
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.