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K. Smith1, L.K. Murphree2, D. Hubbert1
1Tennessee State University, Physical Therapy, Nashville, United States, 2Middle Tennessee State University, Nursing, Murfreesboro, United States
Background: Capnography is typically used in emergency departments and postoperatively but is not commonly used in physical therapy. Pulse oximetry is typically used to monitor oxygen desaturation and hypoxemia during physical therapy in intensive care. Pulse oximetry does not predict or monitor respiratory depression. Capnography monitoring during exercise and mobility is less common. The potential benefit of monitoring patients during physical therapy and possible insight into how the patient will progress has received little attention. Physical therapists need to be educated on the utility of capnography and determine if it has predictive features in patient care.
Purpose: The purpose of this review is three-fold: first to evaluate the strength and quality of the current research evidence on the use of capnography, second, to determine whether current evidence regarding the use capnography during physical therapy should be considered when making decisions regarding patient’s response to physical therapy; and third, to identify weaknesses in the current evidence and area for continued research.
Methods: A literature search was performed on databases including Science Direct, IOP Science, PLOS one, Google scholar, Wiley, EBSCO Host, CINAHL Complete, Cochrane Library, and PubMed. Keywords: capnometry, capnography accuracy, physical therapy, application of capnography, mobility, monitoring. Articles selected for review were those of original research or systematic review performed since 2009 and evaluated for quality using the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence system.
Results: Twenty-seven articles are included in this study. Six articles were included in the introduction. Seven articles examined the current practices for the use of capnography; six studies looked at the use of capnography in the intensive care unit. Three articles on pulse oximetry and capnography with mobility, two articles on the use of monitoring ventilation and oximetry during exercise, and three studies on biologically-based assessment tools for physical therapy.
Conclusion(s): Evidence suggests that monitoring partial pressure end-tidal carbon dioxide levels in patients during rest and exercise may provide more prognostic value of possible adverse events in patients with conditions such as heart failure. There is a need to monitor ventilatory responses in patients participating in physical therapy to obtain data for patient tolerance to activity. Evidence suggests there is a significant correlation between partial pressure of end-tidal carbon dioxide and cardiac output. Recent research has also suggested regardless of mask or cannula used on patients, the diagnostic accuracy of measuring partial pressure end-tidal carbon dioxide levels is similar during normal and hyper-ventilatory states. With the increasing recognition of the usefulness of capnography in intensive care settings, more studies of the use of capnography during physical therapy are warranted.
Implications: Physical therapists would benefit from the use of capnography during patient care as an additional clinical value in exercise tolerance in critically ill patients. Monitoring the patient's partial pressure end-tidal carbon dioxide levels for safety thresholds could be preventative as measures may be taken accordingly to avoid near future adverse events.
Funding, acknowledgements: No funding sources.
Keywords: capnography, physical therapy, capnometry
Topic: Cardiorespiratory
Did this work require ethics approval? No
Institution: Tennessee State University
Committee: Tennessee State University Research Committee
Reason: systematic review
All authors, affiliations and abstracts have been published as submitted.
