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Table 3.4

Abnormal EtCO2 Waveforms

Waveform CharacteristicPossible Causes
Rapidly diminishing or absent EtCO2 levelsExcess of sedatives, opioids, or other respiratory suppressing medications; displaced or kinked sampling line; dislodged, displaced or kinked ETT; disconnection from the ventilator; complete airway obstruction, esophageal intubation
Rising EtCO2 levelsInadequate respiratory rate/volume (hypoventilation); may be Secondary to sedatives, opioids or other respiratory suppressing medications, inadequate weaning from ventilator
Falling EtCO2 levelsIncreased respiratory rate/volume (hyperventilation); may be secondary to pain or anxiety, excessive tidal volume
Elevated baseline CO2Typical of rebreathing, inadequate oxygen flow, shallow breathing, unable to clear dead space, ventilator malfunction
EtCO2 waveform does not reach plateauSmall airway obstruction, bronchospasm, COPD/emphysema, airway secretions, dislodged, misplaced or partially kinked ETT; uncuffed ETT air leak
Cleft present in EtCO2 plateauIndicates spontaneous respiratory effort in mechanically ventilated patient