The Use of Capnography in the CCU Setting

Introduction

The process of resuscitation to encourage the return of spontaneous circulation (ROSC) requires constant supervision in the setting of a Coronary Care Unit (CCU). Therefore, it is critical to study the opportunities that capnography provides for detecting the threat of heart failure and facilitating a successful. For this purpose, an overview of the latest studies on this topic is needed. The latest research in this field has shown that the use of capnography offers nurses ample opportunities to address the factors that affect cardiac output rates in patients. Therefore, the incorporation of capnography into the contemporary CCU setting should be deemed essential to increasing positive outcomes. Due to the vastly positive effects that capnography produces when managing the needs of CCU patients and improving ROSC rates, capnography has to be incorporated into the set of nursing techniques. Furthermore, nurses need to be provided with relevant educational opportunities for acquiring capnography-related skills.

Concepts and Themes: Analysis

Concept 1

There are several major themes that the researchers covering the problem of capnography use in the CCU environment address. Most of the studies address the benefits that capnography as the tool for controlling end-tidal CO2 (ETCO2) levels in a patient provides. Therefore, the opportunities for evaluating the ETCO2 value with the help of capnography should be seen as the major theme that a significant portion of the studies in question address. The specified issue incorporates several subthemes, which allow studying the concept of ETCO2 monitoring in-depth and explaining the significance of the specified opportunity, especially for the nurses that operate in the CCU setting and other environments that require immediate responses.

Venkatesh and Keating (2017), in turn, expand the discussion by connecting the use of capnography to the concept of CPR and pointing to the fact that the specified approaches have to be used in tandem. Similarly, Sheak et al. (2015) study the problem of capnography in CPR, introducing the subtheme of the correlation between the specified variables. Particularly, the connection between the use of capnography and the effects of CPR as a tool for ROSC is determined. Finally, the research by Guimarães et al. (2014) brings another subtheme to the discussion, describing the mechanisms responsible for cardiac blockage and, thus allowing us to understand the effects that capnography can have on addressing the blockage process.

Therefore, the research questions that each of the studies mentioned above poses render the same idea of using capnography as the mean of monitoring ETCO2 levels in patients. While each of the researches listed above introduces a specific setting and population, most of them seek to answer the specified question as to their ultimate goal.

Since the articles incorporate the elements of the quantitative design, the ample population is rather big in each case. For instance, Venkatesh and Keating use a total of 232 cases, whereas Sheak et al. (2015) expand their sample size to a total of 583 participants.

The limitations of the specified researches, in turn, are also quite evident. While the sample size is large enough to represent each case respectively, there is a possibility that the selected sampling approaches may have distorted the outcomes. Specifically, the use of the convenience sampling technique may have affected the credibility of the outcomes due to the focus on a specific group of participants. Nonetheless, the outcomes of the analysis can be deemed credible since the study results can be generalized for their further application to other settings.

In regard to the recommendations for further research, one should consider the opportunities for exploring approaches toward using capnography in the CCU setting specifically. Although several articles specify that they are aimed at detailing the specifics of using the proposed approach in the emergency environment during the CPR, these are significantly different from the CCU context. Thus, a profound analysis of the identified subtheme is needed.

Concept 2

When considering the opportunities that capnography provides, one should keep in mind that it also assists in handling several key functions in the CCU setting. Kodali and Uman (2014) detail the essential effects that the use of capnography may have on patient outcomes by stressing that there is a direct correlation between ETCO2 analysis and cardiac output in patients. Therefore, the subtheme allows determining the benefits of capnography as a ROSC tool. Likewise, Hartmann, Farris, Di Gennaro, and Di Roberts (2015) explore the specified correlation, allowing readers to extrapolate the outcomes of the study to manage similar instances in the CCU environment.

Monitoring changes in a patient’s body should be deemed as the essential option that the application of capnography provides, and several studies render the adoption of the proposed method of ETCO2 measurement for different purposes. Specifically, the research by Pantazopoulos et al. (2015) insists that the proposed tool should be utilized for observing the management of the endotracheal tube (ETT). The authors of the analysis pose the following question as to the focus of their investigation: does capnography provide an opportunity to monitor CO2 changes in a patient’s body in different healthcare settings?

Capnography has impressive potential as the tool for assessing the rates of ETCO2 in patients, especially in an environment that requires managing cardiovascular issues, yet the specified measurement tool is also applied to enhancing ROSC rates, as several articles on this list indicate. Therefore, the connection between capnography and ROSC directly is outlined in several studies under analysis. For instance, the specified subtheme is rendered in the study by Bullock, Dodington, Donoghue, and Langhan (2017). In the identified research, the threat of ETT dislodgment and the following failure of ROSC during capnography are studied. The information represented in the identified article adds to the discussion by asking the question of whether capnography is used frequently when addressing critical issues such as ETT dislodgment and the associated problems that may affect the probability of RISC.

Among the limitations of the described studies, one should mention the fact that some of them pose significant obstacles to generalizing the results of the analysis. For instance, the use of the retrospective chart by Bullock et al. (2017) sets limitations on the analysis of the research outcomes and, thus complicates the task of generalizing the research outcomes, making them too case-specific.

Therefore, it is recommended to conduct a further analysis aimed at designing a more generic approach that could be utilized in a variety of settings. For instance, with Bullock’s study limited to the setting in which the needs of child patients are addressed, one may expand the study by tailoring the proposed tool to the needs of older patients. Furthermore, the study should be conducted with more diverse patients in order to test the efficacy of capnography in improving ROSC rates among other types of patients.

Concept 3

The connection between capnography and the management of cardiovascular issues in association with other concerns such as hemodynamic disturbance should be deemed as an important health management opportunity as well. The specified concept is rendered in several studies, including the paper by Wiryana, Sinardja, GedeBudiarta, Widnyana, and Aryabiantara (2017), whereas Langhan, Shabanova, Li, Bernstein, and Shapiro (2015) address the problem of respiratory depression in young patients. Similarly, Lin et al. (2017) render the idea of using capnography in a pediatric setting as the means of preventing and managing the problem of hypoventilation in the specified demographic.

The key research questions that the authors of the studies pose can be summarized as the circumstances in which capnography should be used as the means of addressing a cardiac issue in patients. The specified way of putting the research question allows detailing the settings in which ROSC is required and what factors may affect the development of a cardiac issue. Therefore, the articles under analysis allow studying the problems associated with comorbid problems as the key indications of the necessity to apply ROSC in the CCU setting and, thus utilize capnography for ETCO2 measurement.

The sample populations that the authors of the studies use can be considered as rather large, typically being represented by at least 100 participants. The specified approach helps maintain the credibility rates high and makes the outcomes of the analysis applicable to other settings due to the high rates of diversity among patients. By studying a

However, there are certain constraints that the described strategy applies. Namely, the number of comorbid issues that typically emerge in the settings that require the use of capnography is quite restricted. As a result, an in-depth study of the cases that require capnography, as well as the identification of all existing links between capnography and positive patient outcomes, particularly, the instances of ROSC, becomes rather complicated. Due to the presence of a vast array of patient-specific factors that may affect the course of the procedure, the research is limited to general statements regarding the use of capnography in the CCU setting.

Given the circumstances in which the described studies were performed, it will be highly recommended to apply the specified themes and concepts to different settings and other types of populations in order to prove that the use of capnography allows managing ETCO 2 levels properly. Specifically, patients of different ages and possibly with comorbid issues will need to be studied in order to identify the opportunities that the application of capnography opens. As a result, an in-depth study of the subject matter will begin, with a profound insight into the challenges associated with the management of comorbid issues during capnography.

Concept 4

Due to the urge to enhance the quality of services in the CCU, a number of authors raise the subthemes associated with a general concept of interdisciplinary cooperation in the CCU environment. For instance, Tobi and Amadasun (2015) render the concept of a cardiac arrest team (CAT) as a framework for managing the problems that may emerge in the process of capnography and improving the general level of care quality.

Kiekkas, Stefanopoulos, Konstantinou, Bakalis, and Aretha (2016) stretch the specified idea even further by introducing the subtheme of nurse education as the method of improving the outcomes of CCU procedures. The research question that the authors ask is what effects a psychometric evaluation of nurses’ ability to perform capnography has on the management of patients’ needs. The research samples a total of 103 data pieces in order to test the hypothesis.

Hamrick et al. (2017) infer the significance of capnography in the CCU setting by studying the mechanics of the process. Specifically, the subtheme of chest compression as the mechanism of ROSC with the help of capnography is added to the overall analysis, helping to detect changes in the attitudes toward capnography in the clinical setting. In an endeavor at expanding the identified subtheme, Gutiérrez et al. (2018) suggest different filtering techniques improve the quality of capnography in the clinical environment and reduce the levels of chest compression in patients.

The research questions that the specified studies ask include whether the introduction of a multidisciplinary team into the CCU context will allow managing patients’ needs more carefully. In addition, the articles tackling the idea of teamwork in the CCU setting posit whether the current guidelines regarding the application of capnography in the CCU context should be revisited and improved to advance the process of care.

The population samples were rather large in the specified studies, with only a few exceptions. For example, Hamrick et al. (2018) preferred to sample 28 participants in order to explore the connection between chest compression and ETCO2 levels in patients. The specified choice was justified by the methods used by the researchers, including the focus on the qualitative aspects of the analysis and the necessity to consider the conversations with patients as the important source of information. Gutiérrez et al. (2018), in turn, includes a total of 202 samples in order to test multiple connections between the use of capnography and patient outcomes.

When considering the limitations of each study mentioned above, one should address the research design first. Because of the quantitative approach that each of the articles mentioned above uses, the sample size is rather low in each case. As a result, certain groups may be underrepresented during the experiments, which, in turn, leads to a drop in credibility rates. Nonetheless, the articles listed above address the specified limitations rather efficiently by introducing high levels of variability into their population and generalizing research outcomes to infer a specific set of principles that allow improving nursing care.

Therefore, regarding the ways in which the studies described above could be expanded and improved, one should view the opportunity of scrutinizing facets of the subthemes mentioned above. The significance of teamwork addressed by Gutiérrez et al. (2018) should be examined closer by determining the ways in which the process of capnography can be improved and used to enhance the ROSC procedure. Specifically, the factors that contribute to faster identification of a problem, the proper application of capnography, and the ability to interpret its results to inform the further actions in regard to maintaining the levels of ETCO2 consistent need to be mentioned. Nurses and other members of an interdisciplinary team in the CCU setting need to develop the identified skills to prevent instances f miscommunication and mismanagement of capnography-related processes.

Concept 5

Finally, the issue of nurse education regarding using capnography needs to be addressed as one of the key problems reemerging in a range of articles focusing on the issue of capnography. Indeed, the specified measurement tool has warranted the title of a very effective device that can save time during a complicated medical procedure and create the setting for ROSC, which means that nurses need to learn to apply it effectively.

Hassankhani, Aghdam, Rahmani, and Mohammadpoorfard (2015) make it evident that there is a need to address the issue of nurse education when it comes to managing capnography in the clinical setting. Specifically, Hassankhani et al. (2015) identify three key subthemes when dealing with the idea of nurse education. The effects of the specified process on the quality of care, the need for teamwork and cooperation, and the improvement of the communication process among nurses are essential components of the identified concept that require further consideration. Thus, the authors of the study seek to answer the question of how nurse education needs to be altered in order to introduce innovative tools into the clinical setting.

The article mentioned above could benefit from exploring the problem of nurse leadership and the focus on interdisciplinary communication as the key concerns. Specifically, nurses’ ability to integrate their communication skills, including decision-making, conflict management, and negotiation techniques into the coordination of the capnography process needs to be researched. Because of the confrontations between nurses and surgeons during cross-disciplinary communication in the operating room setting, in general, and CCU, in particular, patient outcomes may deteriorate, and the quality of care may suffer extensively (Hassankhani et al., 2015). Therefore, locating the tools for improving the dialogue within an interdisciplinary team during capnography is critical.

Moreover, one should seek the tools for encouraging nurse education regarding the use of capnography in the CCU context. There is no need to stress the fact that the specified procedure requires fast and effective decision-making. Thus, nurses must be aware of the key steps of capnography, which calls for the reconsideration and improvement of the existing guidelines. Consequently, further studies should focus on exploring the methods of enhancing capnography instructions for CCU nurses.

Conclusion

Exploring the effects that capnography has on the chances of ROSC in patients in the CCU setting is critical to the overall improvement of outcomes and recovery rates. Therefore, studying the issues associated with managing the target demographic is critical. The themes identified in the course of the analysis will provide a platform for further research. Specifically, the overview of the articles has shown that the type and physiology of capnography, as well as the strategies for increasing ventilation when performing it, need to be explored further. Therefore, it would be beneficial to focus on the introduction of new tools and guidelines for monitoring these issues to prevent any complications that may occur in the process and lead to the development of comorbid and nosocomial problems.

By studying the outcomes of the articles mentioned above, one can determine the methods of improving the existing healthcare services offered to CCU patients. Specifically, the instructions provided to nurses in regard to the application of capnography or maintaining the ETO2 rates at the required level need to be developed. In addition, a strong leadership model for empowering nurses to acquire and improve the skills needed for managing the capnography process will have to be developed. Thus, the opportunities for successful ROSC will be provided, and the survival rates of patients in the CCU setting will rise systematically.

References

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Guimarães, E. F. O., Saldanha, M. M., Fortes, T. C., Grisolia, M., de Miranda, M. L., & Bersot, C. D. A. (2014). Sugammadex in the management of sinus tachycardia after rocuronium administration: A case report. Open Journal of Anesthesiology, 4(09), 203-206. Web.

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Langhan, M. L., Shabanova, V., Li, F. Y., Bernstein, S. L., & Shapiro, E. D. (2015). A randomized controlled trial of capnography during sedation in a pediatric emergency setting. The American Journal of Emergency Medicine, 33(1), 25-30. Web.

Lin, T. Y., Fang, Y. F., Huang, S. H., Wang, T. Y., Kuo, C. H., Wu, H. T.,… Lo, Y. L. (2017). Capnography monitoring the hypoventilation during the induction of bronchoscopic sedation: A randomized controlled trial. Scientific Reports, 7(1), 8685-8687. Web.

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Wiryana, M., Sinardja, I. K., GedeBudiarta, I., Widnyana, I. M. G., & Aryabiantara, W. (2017). Correlation of end tidal CO2 (ETCO2) level with hyperlactatemia in patient with hemodynamic disturbance. Journal of Anesthesia & Clinical Research, 8(741), 2-4. Web.