AAAAPSF Standards

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"ANESTHESIA MONITORING - applicable to all anesthesia...Ventilation as noted by:....Monitoring of end tidal expired CO₂ including volume, Capnography/Capnometry or mass spectroscopy"

AARC 2003

American Association for Respiratory Care

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Capnography ?..may be indicated for: Evaluation of the exhaled [CO₂], especially end-tidal CO₂; Monitoring severity of pulmonary disease and evaluating response to therapy; as an adjunct to determine that tracheal rather than esophageal intubation has taken place; continued monitoring of the integrity of the ventilatory circuit; evaluation of the efficiency of mechanical ventilatory support; monitoring adequacy of pulmonary, systemic, and coronary blood flow; monitoring inspired CO₂ when CO₂ is being therapeutically administered; graphic evaluation of the ventilatory-patient interface; measurement of the volume of CO₂ elimination to assess metabolic rate and/or alveolar ventilation.

ASA 2002

American Society of Anesthesiologists

?Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists ?In circumstances where patients are physically separated from the care giver, the Task Force believes that automated apnea monitoring (by detection of exhaled CO₂ or other means) may decrease risks during both moderate and deep sedation?? ?Monitoring of exhaled CO₂ should be considered for all patients receiving deep sedation and for patients whose ventilation cannot be directly observed during moderate sedation.?

ASA 1999

?Every patient receiving general anesthesia shall have the adequacy of ventilation continually evaluated. Qualitative clinical signs such as chest excursion, observation of the reservoir breathing bag and auscultation of breath sounds are useful. Continual monitoring for the presence of expired carbon dioxide shall be performed unless invalidated by the nature of the patient, procedure or equipment. Quantitative monitoring of the volume of expired gas is strongly encouraged.? (The mandatory use of CO₂ monitoring will apply to wherever drugs that are capable of interfering with airway protective reflexes are given. ) (General anesthesia, Procedural Sedation, Analgesia) (Intubated, non- intubated, in and out of the OR)

ASA Standards for Basic Anesthetic Monitoring

Approved by House of Delegates on October 21, 1986 and last amended on October 21, 1998 - implementation July 1, 1999.

When an endotracheal tube or laryngeal mask is inserted, its correct positioning must be verified by clinical assessment and by identification of carbon dioxide in the expired gas. Continual end-tidal carbon dioxide analysis, in use from the time of endotracheal tube/laryngeal mask placement, until extubation/removal or initiating transfer to a postoperative care location, shall be performed using a quantitative method such as capnography, capnometry or mass spectroscopy.

ASA 1991

When an ETT is inserted, its correct position in the trachea must be verified by clinical assessment and the identification of carbon dioxide in the expired gas. During all anesthetics, the patient?s oxygenation, ventilation, circulation and temperature shall be continually evaluated.

JCAHO 2001

Joint Commission on Accrediation of Healthcare Organizations

Respiratory frequency and adequacy of pulmonary ventilation shall be continually monitored during conscious sedation.

JCAHO 1999

The standards for anesthesia care apply when patients, in any setting, receive, for any purpose, by any route: General, spinal, or other major regional anesthesia or Sedation (with or without analgesia) which, in the manner used, may be reasonably expected to result in the loss of protective reflexes as defined at right. TX.2.3 . The levels of care provided to patients who have been administered anesthesia in areas outside the operating room is comparable to that provided in the operating room. LD.1.6

JCAHO 1988

Standard anesthesia monitoring is mandated for patients outside the operating room who receive anesthesia or sedation.

SCCM 1999

Society of Critical Care Medicine

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The Society of Critical Care Medicine recommends that all ICUs be capable of providing capnographic monitoring.

SCCM 1993

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Monitoring during transport shall include capnography on selected patients based on clinical status.

SCCM 1991

An ICU has the capability of providing basic monitoring and patient support. In order to do so, an ICU is prepared to provide capnography.