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|By PR Newswire
Article Rating:
|May 24, 2013 02:34 PM EDT
DEARBORN, Mich., May 24, 2013 /PRNewswire/ --
- Forty-seven of Ford's top-performing suppliers received World Excellence Awards for 2012
- A special honor was given to 35 suppliers who demonstrated the Go Further mindset and continuous pursuit of excellence in the face of unforeseen business challenges
- Ford's supplier partners are recognized for achieving the highest level of excellence in key areas including quality, cost performance and delivery
Ford Motor Company (NYSE: F) hosted its 15th annual World Excellence Awards (WEA) ceremony Thursday evening to celebrate 47 of its top-performing global suppliers in 2012.
Tony Brown, group vice president, global purchasing, thanked the suppliers for their contribution to delivering high-quality products to Ford customers.
"Our partnership with our suppliers played a pivotal role in the progress we made on the One Ford plan in 2012," said Brown. "Our WEA winners have shown a dedication to excellence. Thank you for helping Ford serve customers with the best vehicles in the world."
The WEA honors production and nonproduction suppliers. The award-winning suppliers represent thousands of employees across the globe who bring diverse cultures, values and ideas to Ford Motor Company.
There are three types of awards to recognize these top suppliers:
- Gold is awarded to the top 5 percent of qualifying suppliers who demonstrated superior quality, delivery and cost performance
- Silver recognizes the top 10 percent of qualifying suppliers who excelled in quality, cost and delivery
- Recognition of Achievement is given to suppliers who improve customer satisfaction by providing significant contributions in key areas – New Consumer-Focused Technology, Consumer-Driven 6-Sigma, Durability and Reliability Performance, Corporate Responsibility, Supplier Diversity Development and Community Service
This year Ford recognized 35 additional suppliers with a special Go Further award for their contributions to the Evonik fire recovery, emergency resourcing actions, and extraordinary plant and equipment launch support. The tireless work and assistance of these suppliers helped to minimize production disruptions, and even more importantly, they exhibited courage, strength and leadership during a time of hardship.
Mark Fields, Ford chief operating officer, thanked the supplier partners for continuing to embrace the Go Further mindset in the face of adversity.
"We want to recognize those suppliers who have demonstrated excellence despite the unforeseen challenges that have happened over the past year," said Fields. "Thanks to your unwavering commitment, we are closer than ever to reaching our goal of delivering profitable growth for all."
This year, 14 Gold, 21 Silver and 12 Recognition of Achievement honors were awarded along with the 35 Go Further honors.
The 2012 winners are:
- Acciona Facility Services, Barcelona, Spain; Facility Management
- BASF, Capital Federal, Argentina; Paint
- Devon Industrial Group, Detroit; Demolition and Decommissioning Management
- F. Segura, Burjassot, Valencia, Spain; Stampings
- Flex-N-Gate – Ventra, Grand Rapids, Mich.; Metal Bumpers
- Hulsbeck & Furst – Huf Espana, El Burgo De Osma, Soria, Spain; Door Handles
- Kunshan Macauto Automotive Parts Industry, Kunshan, Jiangsu, China; Luggage Covers
- Mahle Engine Components, Morristown, Tenn.; Pistons
- Minacs Marketing Solutions, Farmington Hills, Mich.; Marketing Programs
- Ogura, Chesterfield Township, Mich.; Differentials
- Summit Plastics, Jiangning, Nanjing, China; IP Finish Panels
- Tenneco Automotive, Gliwice, Poland; Shock Absorbers
- Transportistas Unidos Mexicanos Division Norte, Tlalnepantla, Mexico; Truckload Carriers
- Warn Industries, Milwaukie, Ore.; Axles
- Acumuladores Moura, Belo Jardim, Brazil; Batteries
- Autoneum Poland, Katowice, Poland; NVH Insulation
- Delphi Delco France, Saint Aubain du Cormier, France, Security Systems
- Fanuc Robotics America, Rochester Hills, Mich.; Body Shop and Paint Robots
- Federal-Mogul, South Bend, Ind.; Pistons
- Flextronics – Saturn Electronics and Engineering, Juarez, Mexico; Wiring
- Gil Mar Manufacturing – PGI Far East Precision Products, Shanghai, China; Iron Engine Castings
- Husco Automotive Technologies, Whitewater, Wis.; Variable Valve Timing
- Inalfa SSI Roof Systems, Warren, Mich.; Sliding Roofs
- Inteva Products, Saint Die, France; Door Latches
- Iochpe-Maxion – Hayes Lemmerz, Konigswinter, Germany; Wheels
- Mark IV Industries – Dayco Europe, Chieti Scalo, Italy; Fead Systems
- Morpace, Farmington Hills, Mich.; Market Research
- MRF, Puducherry, India; Tires
- MSX International, Colchester, Essex, U.K.; Agency Labor
- NYK Group, Tokyo, Japan; Transportation
- Pratt Industries, Conyers, Ga.; Corrugated Packaging Material
- Progress-Werk Oberkirch, Oberkirch, Germany; IP Cross Car Beam
- Shanghai GKN Driveshaft, Zhoupu Pudong, Shanghai, China; Driveshafts
- Tower Automotive, Bellevue, Ohio; Frames
- Umicore Brasil, Americana, Sao Paulo, Brazil; Catalytic Converter Internals
Recognition of Achievement
- Dakkota Integrated Systems, Holt, Mich.; Supplier Diversity Development, Diverse Supplier of the Year
- Flex-N-Gate, Urbana, Ill.; ABF Principles
- Flextronics International, San Jose, Calif.; Corporate Responsibility
- Gentex, Zeeland, Mich.; New Consumer-Focused Technology
- GKN Driveline, Newton, N.C.; New Consumer-Focused Technology
- Hewlett-Packard, Palo Alto, Calif.; Corporate Responsibility
- IBM, Armonk, N.Y.; Supplier Diversity Development, Corporation of the Year
- Muhr und Bender, Attendorn, Germany; ABF Principles
- TDK Yurihonjo, Yurihonjo, Akita, Japan; Durability and Reliability
- Tenneco – Walker Manufacturing, Ligonier, Ind.; Warranty Improvement
- The Diez Group – Delaco Steel, Detroit; Community Service
- Tomkins – Gates, Windsor, Ontario, Canada; Consumer-Driven 6-Sigma
Go Further
- Autoliv
- Betz Industries
- Continental
- Cooper Standard
- Delphi
- Denso
- Dytech Automotive
- Easton Fluid Power
- Eberspacher
- Evonik Industries
- Facil
- FTE Automotive
- Inergy Automotive Systems
- Ji Chyuan Enterprise
- Lesco Design and Manufacturing
- LuK-Schaeffler
- Magna-Cosma
- Mahle Metal Leve
- Martinrea International
- MGI Coutier-Avon Automotive
- Nemak Dillingen
- Norma Group Mexico
- Orda Otomotiv-Nobel Plastiques and Nobel Rocket
- Pass
- Robert Bosch
- Spectra Premium Industries
- Taiwan Sanoh Electric
- Textron-Kautex
- TI Automotive
- Troy Design and Manufacturing
- Union Pacific Railroad
- Valeo Lighting
- Voss Automotive
- Yapp Automotive Parts
About Ford Motor Company
Ford Motor Company (NYSE: F), a global automotive industry leader based in Dearborn, Mich., manufactures or distributes automobiles across six continents. With about 175,000 employees and 65 plants worldwide, the company's automotive brands include Ford and Lincoln. The company provides financial services through Ford Motor Credit Company. For more information regarding Ford and its products worldwide, please visit http://corporate.ford.com.
SOURCE Ford Motor Company
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hey everyone im traveling to st lucia in dec. i plan on staying at the reef kite and surf for a week. im bringing a 9m and 11m. has anyone ever been there? if so what are some essentials i need to bring with?
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I miss making posters. I used to make posters for bands, but I haven't had the opportunity to do one in awhile. So I'll make one for my favorite geometric meteorological weather pattern. This is a poster for a hurricane on Saturn that is shaped like a hexagon.
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DALLAS, Texas (AP) – Justin Martin is transferring to SMU from Xavier and is expected to be eligible next season.
The 6-foot-6 forward was a starter the last two of his three seasons with the Musketeers. Martin was second on the team in scoring (11.7 points per game) and rebounding (5.2) as a junior.
Martin is eligible because he earned his bachelor's degree at Xavier, which went to the NCAA tournament twice in his three seasons.
Martin will join one of the nation's top recruits in guard Emmanuel Mudiay as SMU tries to build on a 27-10 season that ended with a loss to Minnesota in the NIT championship game.
The Mustangs were left out of the NCAA tournament in their second year under Hall of Fame coach Larry Brown.
(© Copyright 2014 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)
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A nice park which Hubby and I scrolled during noon in early October. Was a nice walk with pretty flowers. Seems like there will be activities occasionally at the exit of Acros... read more
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Dog Days of Summer 7 Days of Deals. Sunday: Take 15% off 1+ Yards of Organic Cotton Sateen Ultra fabric through 11:59 p.m. EDT July 24th.
Preview scale: 8.0 x 8.0 inches

Change DPI Base size is 150
Collection: Colourful Co-ordinates
spirals (720),
miniature (327),
blender print (262),
baby boys (178),
trim (157),
patchwork and quilting (102)
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rhondadesigns says:
I am glad you stopped by to visit and admire my snail designs, Moira! Thank you for the lovely comment!:-) Yes,they are very useful as blender prints in patchwork and quilting projects. I have used them quite a bit lately in making both quilts and bags.:-)
Posted over 2 years ago.
moirarae says:
Love these little snails - can't believe I've only just found them! They'd be terrifically useful for quilting.
rhondadesigns says:
Thank you, Brooke! I appreciate the positive feedback and the excellent suggestion!
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rhondadesigns says:
Thank you, Kathryn! I am glad you like my tiny print, blender design!
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squeakyangel says:
I like these tiny snails especially on the pink & blue :)
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text:
Writer: S Wilton
Date:Saturday November 13 2010
Time: 11:31AM
The DW Stadium
13 November 2010
3.00 pm
After the 2-2 draw at West Ham on Wednesday the Baggies travel to another bottom three side looking to get back to winning ways. It's another difficult game where the opposition will fancy their chances of winning and moving out of the relegation zone. Wigan have been disappointing this season and Roberto Martinez hasn't quite had the same effect on Wigan as Roberto Di Matteo has had at West Brom. Whilst Di Matteo has been getting results at the Emirates and Old Trafford Wigan have been struggling at home against the likes of Blackpool.
The side show here is the return to Wigan of Paul Scharner. The big Austrian is a cult figure for the Latics fans and it will be interesting to see the reaction he gets from them particularly after his revelation this week that he left them so that he could go to a team that can win things.
The game is likely to be an entertaining one with two teams that like to pass the ball around but who have both had trouble keeping clean sheets this season. The last time I said that was before the Blackpool game and the referee stepped in to ruin that game, let's hope it doesn't turn out that way in today's game.
'They are a good side.
I like the way they play.
There are a lot of similarities in what they are trying to do and what we are trying to do.
It's going to be an interesting game because I think we have a similar philosophy in the way we want to play football.'
Steve Gohouri returns for Wigan but Boyce and McCarthy are both out injured.
Wigan from:
Al Habsi, G Caldwell,. Stam, Figueroa, Alcaraz, N'Zogbia, Diame, Cleverley, Gomez, Moses, Thomas, Rodallega, Di Santo, Kirkland, Watson, Boselli, McArthur, S Caldwell, Gohouri.
N'Zogbia has an erratic personality which was shown in his on off transfer to Birmingham City in the Summer but he does have magic in his feet so the Baggies will have to keep a close eye on him.
Good news from the Baggies camp as Mulumbu makes a return from suspension and Shorey is available again after the injury he picked up against Man City. It will be interesting to see if he displaces Cech at left back with Reid keeping the right back position. Dorrans was struggling earlier in the week but he will be fit if selected. Jonas Olsson and Ishmael Miller remain on the injured list.
West Brom from: Carson, Ibanez, Morrison, Barnes, Bednar, Brunt, Reid, Myhill, Fortune, Dorrans, Shorey, Thomas, Mulumbu, Zuiverloon, Meite, Odemwingie, Fortune, Tchoyi, Scharner, Thomas, Tamas, Cox, Downing, Sawyers, Allsopp, Keily.
The speedy Nigerian eased himself back into the team against West Ham with a penalty but he wasn't back to his best and he will be looking to prove that he is back in today's game.
Albion and Wigan have met 13 times in all competitions with the Baggies having won 6 times, Wigan 5 times and 2 draws.
Anthony Taylor from Wythenshawe.
2-1 to the Baggies
Next Saturday sees a Staffordshire derby against Stoke City. It's one that every Albion fan dreads!
Date:Saturday November 13 2010
Time: 11:31AM
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text:
Star Tracks
Hathaway makes a regal showing in New York. Plus: Blake Lively, Britney Spears, Pink & Willow and more
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Updated: Wednesday Nov 02, 2011 | 05:00 PM EDT
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Anyone have any experience w/ walking tours in Singapore? Seeking authentic cultural experiences w/ fluent English speaking guides who are knowledgable ? Have enjoyed this in different countries in Europe !
Recent ActivityView all Asia activity »
- 1 Thoughts on this itinerary
- 2 Bucket List Trip: Bali, Angkor Wat,Japan
- 3 It can be cheap but awesome!
- 4 Totally unprepared
- 5 Yogyakarta - Prambanan and Borobudur Travel Report
- 6 Help plan my 11 days trip to Thailand
- 7 Shanghai Airpor overnight
- 8 Chengdu, China - Giant Panda Research Base Travel Report
- 9 Bhutan with Aman hotels, worth it?
- 10 Rental Car Bali
- 11 1 day in Bangkok Itinerary for Honeymoon
- 12 Kyoto & Tokyo tips
- 13 Good Eats in Chiang Mai / Chiang Rai
- 14 A great trip in India
- 15 Itinerary 3-1/2 week trip to Hong Kong, Vietnam, Cambodia, Thailand
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- 18 A 6-week waking dream in North and South India.
- 19 "China Eastern Airline" is it really bad??
- 20 Beggars in Siem Reap and Angkor
- 21 Some notes about South Korea
- 22 Tokyo Itinerary Help please
- 23 A Memorable Solo Month in Singapore, Java, and Bali
- 24 Burma itinerary critic.
- 25 Fabric shops in India
Walking tours singapore
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Singapore is right on the equator - it will be very hot. Decide what you want to do/dee in Singapore. I love the Botanical Gardens, especially the orchid garden. The verious ethnic enclaves, Chinatown, little India, Arab Street are also interesting. You don't really need a guide. Virtually everyone in Singapore speaks English.
I have to chuckle about "authentic cultural experiences" as the most authentic cultural experience in Singapore is shopping in giant malls.
Singapore is the most modern, cleanest city in the world.
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And shopping of course espIecially in malls is the last thing I would choose to spend vacation time on!
Markets of course are different!
I came across a site that advertises colonial history and Chinatown walks.
Thanks for the laughs!
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A walking tour of the historic buildings in the city centre -- what's left of them -- can be pleasant, especially if the Raffles Hotel is on the route and includes a bartender demonstrating the secrets of making a Singapore Sling. A walking-riding visit to Changi Prison will illuminate the horrible suffering during the internments of the Second World War and is a must for Australians interested in their country's role during that war.
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Om Jai Jagdish - Devotional Song - Instrumental [HD]
here's an instrumental of the beautiful devotional song - "Om Jai Jagdish" played entirely by me!! hope you all enjoy!! Raghav Sachar's instrumental is an inspiration to my version; I've ended the song using the same technique as he did in his version {different instruments for each line...} *** watch/listen in 720p HD - this is a High Definition Sound Recording *** *** USE HEADPHONES - makes a BIG difference - trust me :) *** *** please like/comment if you enjoyed my work :D *** GOD BLESS !!
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The Thorn Birds
The Thorn Birds
Avon Books, Paperback, 9780060837556, 673pp.
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Beautiful .Compelling entertainment. New York Times A heart-rending epic truly marvelous. Chicago TribuneOne of the most beloved novels of all time, The Thorn Birds, Colleen McCullough's sweeping family saga of dreams, titanic struggles, dark passions, and forbidden love in the Australian Outback, returns to enthrall a new generation.
About the Author
Colleen McCullough is the author of The Thorn Birds, Tim, An Indecent Obsession, A Creed for the Third Millennium, The Ladies of Missalonghi, The First Man in Rome, The Grass Crown, Fortune's Favorites, Caesar's Women, Caesar, and other novels. She lives with her husband on Norfolk Island in the South Pacific.
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Major Recommendations
The levels of evidence (A-D) and the strength of the recommendations (1-2) are defined at the end of the "Major Recommendations" field. The words "recommended" and "suggested" are used to reflect the strength of the recommendation, as level 1 and level 2, respectively.
Capnography is the continuous analysis and recording of the carbon dioxide (CO2) concentration in respiratory gas. Although the terms capnography and capnometry are sometimes considered synonymous, capnometry means only the measurement of CO2 in respiratory gas (i.e., analysis alone), without a continuous written record or waveform. Capnographic waveforms may be time-based or volume-based (Hess & Branson, 1994).
Capnography can be performed by trained healthcare personnel in any setting in which mechanically ventilated patients are found.
There are 3 broad categories of indications for capnography/capnometry: verification of artificial airway placement; assessment of pulmonary circulation and respiratory status; and optimization of mechanical ventilation.
- Verification of Artificial Airway Placement. Even when the endotracheal tube is seen to pass through the vocal cords and tube position is verified by chest expansion and auscultation during mechanical ventilation, providers should obtain additional confirmation of airway placement with waveform capnography or an exhaled CO2 or esophageal detector device (Neumar et al., 2010).
- Exhaled CO2 detectors, including colorimetric and non-waveform, reliably detect intratracheal placement in patients whose cardiac out-put is not exceedingly low or who have not had prolonged circulatory failure. Their use in prolonged cardiac arrest merits further study (Neumar et al., 2010; Goldberg et al., 1990).
- When waveform capnography is not available, these methods can be used in addition to clinical assessment as the initial method for confirming correct tube placement in a patient in cardiac arrest.
- Capnography may be used as an adjunct to determine that tracheal rather than esophageal intubation has occurred (Hess & Branson, 1994; Wenzel et al., 2001; Rudraraju & Eisen, 2009).
- All intubations must be confirmed by some form of end-tidal CO2 (PETCO2) measurement (Neumar et al., 2010; Field et al., 2010).
- Effective ventilation through a supraglottic airway device such as the laryngeal mask airway (LMA) should result in a capnograph waveform during cardiopulmonary resuscitation (CPR), and after return of spontaneous circulation (Neumar et al., 2010).
- When feasible, monitoring PETCO2 during chest compressions is encouraged (Neumar et al., 2010).
- If the PETCO2 is <10 mm Hg during CPR, the clinician should attempt to improve the quality of compressions.
- An abrupt and sustained increase in PETCO2 is a sensitive indicator of return of spontaneous circulation.
- PETCO2 monitoring is one of the objective standards required for monitoring patients in transport, to ensure integrity of the airway (Goldberg et al., 1990; Braman et al., 1987; Singh et al., 2006).
- Providers should observe a consistent capnographic waveform with ventilation to confirm and monitor endotracheal tube placement in the field, in the transport vehicle, on arrival at the hospital, and after any patient transfer, to reduce the risk of unrecognized tube misplacement or displacement (Neumar et al., 2010; Silvestri et al., 2005).
- Capnography can be used to detect inadvertent airway intubation during gastric tube insertion (Howes, Shelley, & Pickett, 2005).
- Life-threatening airway disasters and ventilator disconnection can be averted with continuous capnography (Poirier et al., 1998; Ahrens & Sona, 2003; Joint Commission, 2002).
- Exhaled CO2 detectors, including colorimetric and non-waveform, reliably detect intratracheal placement in patients whose cardiac out-put is not exceedingly low or who have not had prolonged circulatory failure. Their use in prolonged cardiac arrest merits further study (Neumar et al., 2010; Goldberg et al., 1990).
- Assessment of Pulmonary Circulation and Respiratory Status. Capnography assists in:
- Determining changes in pulmonary circulation and respiratory status sooner than pulse oximetry. In patients without lung disease, substantial hypercarbia may present before pulse oximetry notifies the clinician of a change in ventilation (Poirier et al., 1998; Roberts & Maniscalco, 1995; Hall et al., 1993; Roberts et al., 1995; Shibutani et al., 1994).
- Monitoring the adequacy of pulmonary, systemic, and coronary blood flow (Shibutani et al., 1994; Levine, Wayne, & Miller, 1997), as well as estimation of the effective (non-shunted) pulmonary capillary blood flow by a partial rebreathing method (de Abreu et al., 2002; de Abreu et al., 1997; vanHeerden et al., 2000).
- Evaluating the partial pressure of exhaled CO2, especially PETCO2.
- Screening for pulmonary embolism (Rodger & Wells 2001; Rodger et al., 2001; Bolyard et al., 1998; Rumpf, Krizmaric, & Grmec, 2009).
- Optimization of Mechanical Ventilation. Capnography during mechanical ventilation allows:
- Continuous monitoring of the integrity of the ventilator circuit, including the artificial airway (Spahr-Schopfer, Bissonnette, & Hartley, 1993) or bag mask ventilation, in addition to potentially detecting mechanical ventilation malfunctions (Muniz, 2008; Hardman, Mahajan, & Curran, 1999; Kumar et al., 1992)
- Decreasing the duration of ventilatory support (Cheifetz & Myers, 2007)
- Adjustment of the trigger sensitivity (Thompson & Jaffe, 2005)
- Evaluation of the efficiency of mechanical ventilation, by the difference between PaCO2 and the PETCO2 (Kerr et al., 1996)
- Monitoring of the severity of pulmonary disease (Bedforth & Hardman, 1999; Ghamra & Arroliga, 2005) and evaluating the response to therapy, especially therapies intended to improve the ratio of dead space to tidal volume (VD/VT) and ventilation-perfusion matching (V/Q) (de Abreu et al., 1997; Bolyard et al., 1998; Engoren, 1993; Hardman & Aitkenhead, 1999; Hubble et al., 2000; Jellinek et al., 1993; Kallet et al., 2005; Russell & Graybeal, 1994; Szaflarski & Cohen, 1991; Taskar et al., 1995; McSwain et al., 2010).
- Monitoring of V/Q during independent lung ventilation (Cinnella et al., 2001; Colman & Krauss, 1999).
- Monitoring of inspired CO2 when it is being therapeutically administered (Fatigante et al., 1994).
- Graphic evaluation of the ventilator-patient interface. Evaluation of the capnogram may be useful in detecting rebreathing of CO2, obstructive pulmonary disease, the presence of inspiratory effort during neuromuscular blockade (curare cleft), cardiogenic oscillations, esophageal intubation, and cardiac arrest (Bhavani-Shankar et al., 1992).
- Measurement of the volume of CO2 elimination to assess metabolic rate and/or alveolar ventilation (Russell & Graybeal, 1994; Brandi et al., "Effects of ventilator resetting," 1999; Brandi et al., "Energy expenditure," 1999; Sullivan, Kissoon, & Goodwin, 2005)
- Monitoring of VD/VT to determine eligibility for extubation in children (Hubble et al., 2000; Wratney & Cheifetz, 2006)
- There is a relationship between VD/VT and survival in patients with the acute respiratory distress syndrome (Nuckton et al., 2002; Lucangelo et al., 2008; Raurich et al., 2010).
There are no absolute contraindications to capnography in mechanically ventilated patients, provided that the data obtained are evaluated with consideration given to the patient's clinical condition.
Capnography with a clinically approved device is a safe, noninvasive test, associated with few hazards in most populations. Hazards/complications are different for the 2 types of capnographic device.
- Mainstream
- Dead Space. Adapters inserted into the airway between the airway and the ventilator circuit should have a minimal amount of dead space. This effect is inversely proportional to the size of the patient being monitored (Szaflarski & Cohen, 1991; Jacobus, 2009).
- The addition of the weight of a mainstream adapter can increase the risk of accidental extubation in neonates and small children (Jacobus, 2009).
- Sidestream
- The gas sampling rate from some sidestream analyzers may be high enough to cause autotriggering when flow-triggering of mechanical breath is used. This effect is also inversely proportional to the size of the patient (Jacobus, 2009).
- The gas sampling rate can diminish delivered tidal volume (VT) in neonates and small patients while using volume targeted or volume controlled ventilation modes (Jacobus, 2009).
Limitations of Procedure or Device
Capnography, when performed using a device calibrated and operated as recommended by the manufacturer, has few limitations. It is important to note that although the capnograph provides valuable information about the efficiency of ventilation (as well as perfusion), it is not a replacement or substitute for assessing the PaCO2 (Hess & Branson, 1994; Jellinek et al., 1993; Hess, 1998; Isert, 1994; Laffon et al., 1998). The difference between PETCO2 and PaCO2 increases as dead-space volume increases. (Russell & Graybeal, 1992). In fact, the difference between the PaCO2 and PETCO2varies in the same patient over time (Russell & Graybeal, 1994, 1995; Seguin et al., 2001; Grenier et al., 1999). Alterations in breathing pattern and VT may introduce error into measurements designed to be made during stable, steady-state conditions. (Brandi et al., "Effects of ventilator resetting," 1999; Brandi et al., "Energy expenditure," 1999; Gamma de Abreu, Melo, & Giannella-Neto, 2000). Interpretation of results must take into account the stability of physiologic variables such as minute ventilation, VT, cardiac output, V/Q, and CO2 body stores. Certain situations may affect the reliability of the capnogram. The extent to which the reliability is affected varies somewhat among types of devices. Limitations include:
- The composition of the respiratory gas may affect the capnogram (depending on the measurement technology incorporated).
- The infrared spectrum of CO2 has some similarities to the spectra of both oxygen and nitrous oxide (Bhavani-Shankar et al., 1992). A high concentration of either oxygen or nitrous oxide, or both, may affect the capnogram, so a correction factor should be incorporated into the calibration of any capnograph used in such a setting (Hess, 1998).
- The reporting algorithm of some devices (primarily mass spectrometers) assumes that the only gases present in the sample are those that the device is capable of measuring. When a gas that cannot be detected by the mass spectrometer (such as helium) is present, the reported CO2 values are incorrectly elevated in proportion to the concentration of the gas present (Hess & Branson, 1994; Graybeal, 1994).
- The breathing frequency may affect the capnograph. A high breathing frequency may exceed the capnograph's response capabilities. The presence of high airway resistance, respiratory rate, or inspiratory-to-expiratory ratio may decrease the accuracy of the measurement obtained from a sidestream capnograph, compared to a mainstream capnograph (McEvedy et al., 1990; Tingay, Stewart, & Morley, 2005). In addition, a breathing frequency >10 breaths/min affects different capnographs differently (Graybeal, 1994).
- Contamination of the monitor or sampling system by secretions or condensate, a sample tube of excessive length, too high a sampling rate, or obstruction of the sampling chamber can lead to unreliable results.
- Use of filters between the patient airway and the capnograph's sampling line may lead to artificially low PETCO2 readings (Hardman, Mahajan, & Curran, 1999; Hardman, Curran, & Mahajan, 1997).
- The sensitivity for confirmation of endotracheal intubation by color change could range from 67% to 72% (Keller et al., 2009).
- Clinical conditions associated with false negative readings include:
- Low cardiac output may cause a false negative result when attempting to verify endotracheal tube (ETT) position in the trachea (Li, 2001).
- During CPR a positive test confirms placement of the ETT within the airway, whereas a negative test indicates either esophageal intubation or airway intubation with poor or absent pulmonary blood flow and requires an alternate means of confirmation of tube position (American Heart Association [AHA], 2005; "The International Liaison Committee on Resuscitation [ILCOR]," 2006; American College of Emergency Physicians [ACEP], 2002).
- When the endotracheal tube is in the pharynx and when antacids and/or carbonated liquids are present in the stomach, a false negative reading may be present. However, the waveform does not continue during subsequent breaths (Sum Ping, Mehta, & Symreng, 1992).
- Elimination and detection of CO2 can be dramatically reduced in patients with severe airway obstruction and pulmonary edema (Ward & Yealy, 1998).
- Clinical conditions associated with false positive readings include:
- Colorimetric CO2 detectors may give a false positive if contaminated with acidic or CO2-filled gastric content, intratracheal medications such as epinephrine, extreme humidity, or the presence of trichloroethylene or chloroform anesthetics. Most require at least 6 breaths before a decision can be made (Goldberg et al., 1990; Kamlin et al., 2005).
- Detection of CO2 in expired gas after esophageal intubation as a result of prior bystander mouth-to-mouth ventilation may result in a false positive reading (Kramer-Johansen, Dorph, & Steen, 2008).
- A transient rise in PETCO2 after sodium bi-carbonate administration is expected, but should not be misinterpreted as an improvement in quality of CPR or a sign of return of spontaneous circulation (Neumar et al., 2010).
- Inaccurate measurement of expired CO2 may be caused by leaks or other clinical circumstances preventing collection of expired gases (Kallet, 2008), including:
- Leaks in the ventilator circuit
- Leaks around the tracheal tube cuff, an uncuffed tube, or the mask, including LMA
- Bronchopleural fistula
- Dialysis or extracorporeal life support
Assessment of Need
Capnography is considered a standard of care during general anesthesia. The American Society of Anesthesiologists has suggested that capnography be available for patients with acute ventilatory failure on mechanical ventilatory support (American Society of Anesthesiologists [ASA], 2011). The American College of Emergency Physicians recommends capnography as an adjunctive method to ensure proper endotracheal tube position (ACEP, 2002). The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend capnography to verify endotracheal tube placement in all age groups (Goldberg et al., 1990). Assessment of the need to use capnography with a specific patient should be guided by the clinical situation. The patient's primary cause of respiratory failure and the severity of his or her condition should be considered.
Assessment of Outcomes
Results should reflect the patient's condition and should validate the basis for ordering the monitoring. Documentation of results (along with all ventilatory and hemodynamic variables available), therapeutic interventions, and/or clinical decisions made based on the capnogram should be included in the patient's chart.
- Equipment: the capnograph and accessories (e.g., airway adapter, sampling tube, depending on capnograph). The capnograph should be calibrated as recommended by the manufacturer.
- Personnel: licensed or credentialed respiratory therapists or individuals with similar credentials (e.g., medical doctor [MD], registered nurse [RN]) who have the necessary training and demonstrated skills to correctly calibrate and evaluate the capnograph, assess the patient and the patient-ventilator system, and the ability to exercise appropriate clinical judgment.
- During capnography the following should be considered and monitored:
- Ventilatory variables: VT, respiratory rate, positive end expiratory pressure (PEEP), ratio of inspiratory-to-expiratory time, peak airway pressure, and concentrations of respiratory gas mixture (Garey et al., 2008; Engoren, 1993; Szaflarski & Cohen, 1991; Li, 2001; Gentile & Cheifetz, 2004).
- Hemodynamic variables: systemic and pulmonary blood pressure, cardiac output, shunt, and V/Q imbalances (de Abreu et al., 1997; Jellinek et al., 1993; Gamma de Abreu, Melo, & Giannella-Neto, 2000).
Capnography (or, at least, capnometry) should be available during endotracheal intubation (Poirier et al., 1998; Roberts et al., 1995; Sum Ping, Mehta, & Symreng, 1991). Capnography is not indicated for every mechanically ventilated patient; however, when it is used, the measurement period should be long enough to allow determination of the PaCO2-PETCO2 difference, to note changes in the PaCO2-PETCO2 difference as a result of therapy, and to allow interpretation of observed trends.
Infection Control
No specific precautions are necessary, although standard precautions (as described by the Centers for Disease Control and Prevention) (Bolyard et al., 1998) and precautions designed to limit the spread of tuberculosis (Kallet, 2008; Jensen et al., 2005) should always be implemented during patient care.
- Reusable mainstream sensors should be subjected to high-level disinfection between patients, according to the manufacturer's recommendations.
- The external surface of the monitor should be cleaned as needed, according to manufacturer's recommendations.
The following recommendations are given based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system (Guyatt et al., 2008; Jaeschke et al., 2008):
- Continuous waveform capnography is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube (1A).
- If waveform capnography is not available, a non-waveform exhaled CO2 monitor in addition to clinical assessment is suggested as the initial method for confirming correct tube placement in a patient in cardiac arrest (2B).
- PETCO2 is suggested as a method to guide ventilator management (2B).
- Continuous capnometry during transport of a mechanically ventilated patient is suggested (2B).
- Capnography is suggested to identify abnormalities of exhaled air flow (2B).
- Volumetric capnography is suggested to assess CO2 elimination and VD/VT to optimize mechanical ventilation (2B).
- Quantitative waveform capnography is suggested in intubated patients to monitor CPR quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions or when rhythm check reveals an organized rhythm (2C).
Strength of the Recommendations and Grade of Quality of the Evidence
|Strength of the Recommendations
|Benefits clearly outweigh the risks and burdens (or vice versa) for nearly all patients.
|Risks and benefits are more closely balanced or are more uncertain.
|Quality of the Evidence
|Well-performed randomized controlled trials or overwhelming evidence of some other sort. Further research is very unlikely to change confidence in the estimate of the effect.
|Randomized controlled trials that are less consistent, have flaws, or are indirect in some way to the issue being graded, or very strong evidence of some other sort. Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate.
|Observational evidence (from observational studies, case series, or clinical experience), or evidence from controlled trials with serious flaws. Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate.
|Very Low
|Any estimate of effect is very uncertain.
Adapted from: Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-926.
Clinical Algorithm(s)
None provided
Any pulmonary disease or condition requiring mechanical ventilation
Note: Refer to the "Indications" section in the "Major Recommendations" field of this summary for specific conditions.
Guideline Category
Clinical Specialty
Critical Care
Emergency Medicine
Internal Medicine
Pulmonary Medicine
Intended Users
Advanced Practice Nurses
Physician Assistants
Respiratory Care Practitioners
Guideline Objective(s)
To provide clinical practice guidelines on capnography/capnometry during mechanical ventilation
Target Population
Adult and pediatric patients receiving mechanical ventilatory support
Interventions and Practices Considered
- Assessment of need for capnography/capnometry
- Assessment of outcome
- Resources (equipment and personnel) required
- Monitoring of ventilatory and hemodynamic variables
- Frequency of capnography
- Infection control
Major Outcomes Considered
Accuracy, reliability, and utility of capnography/capnometry during mechanical ventilation
Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
The guideline authors searched MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1990 and November 2010.
Number of Source Documents
The update of this clinical practice guideline is based on 234 clinical studies and systematic reviews, 19 review articles that investigated capnography/capnometry during mechanical ventilation, and the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Grade of Quality of the Evidence
|Well-performed randomized controlled trials or overwhelming evidence of some other sort. Further research is very unlikely to change confidence in the estimate of the effect.
|Randomized controlled trials that are less consistent, have flaws, or are indirect in some way to the issue being graded, or very strong evidence of some other sort. Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate.
|Observational evidence (from observational studies, case series, or clinical experience), or evidence from controlled trials with serious flaws. Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate.
|Very Low
|Any estimate of effect is very uncertain.
Adapted from: Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-926.
Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence
The American Association for Respiratory Care (AARC) clinical practice guidelines (CPGs) steering committee has initiated a new process by which the "reference-based" guidelines will be revised and updated by adopting a modification of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scoring system (see the "Availability of Companion Documents" field). This guideline is the product of this process. Although it is clear that most treatments and interventions in respiratory care are rarely graded A, it is our responsibility to make recommendations based on the best evidence available at the time the CPG is updated. The words "recommended" and "suggested" are used to reflect the strength of the recommendation, as level 1 and level 2, respectively (see the "Rating Scheme for the Strength of the Recommendations" field). Although grading evidence is complex, the committee has set the goal of recommending what you, the clinician, should do. While the format for most traditional sections of the CPGs remains unchanged, each newly revised CPG includes recommendations with graded evidence. This is the latest in our efforts to improve the value of the AARC CPGs.
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
The recommendations are made following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scoring system.
Rating Scheme for the Strength of the Recommendations
Strength of the Recommendations
|Benefits clearly outweigh the risks and burdens (or vice versa) for nearly all patients.
|Risks and benefits are more closely balanced or are more uncertain.
Adapted from: Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-926.
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Not stated
Description of Method of Guideline Validation
Not applicable
Evidence Supporting the Recommendations
References Supporting the Recommendations
|Ahrens T, Sona C. Capnography application in acute and critical care. AACN Clin Issues. 2003 May;14(2):123-32. [34 references] PubMed
|American College of Emergency Physicians. Clinical Policies Committee. Verification of endotracheal tube placement. Ann Emerg Med. 2002 Nov;40(5):551-2. PubMed
|American Heart Association. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support. Pediatrics. 2006 May;117(5):e1005-28. PubMed
|American Society of Anesthesiologists. Standards for basic anesthetic monitoring. [internet]. Park Ridge (IL): American Society of Anesthesiologists; 2011 [accessed 2011 Feb 08]. [3 p].
|Bedforth NM, Hardman JG. Predicting patients' responses to changes in mechanical ventilation: a comparison between physicians and a physiological simulator. Intensive Care Med. 1999 Aug;25(8):839-42. PubMed
|Bhavani-Shankar K, Moseley H, Kumar AY, Delph Y. Capnometry and anaesthesia. Can J Anaesth. 1992 Jul;39(6):617-32. [81 references] PubMed
|Bolyard EA, Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchmann SD. Guideline for infection control in healthcare personnel, 1998. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1998 Jun;19(6):407-63. PubMed
|Braman SS, Dunn SM, Amico CA, Millman RP. Complications of intrahospital transport in critically ill patients. Ann Intern Med. 1987 Oct;107(4):469-73. PubMed
|Brandi LS, Bertolini R, Santini L, Cavani S. Effects of ventilator resetting on indirect calorimetry measurement in the critically ill surgical patient. Crit Care Med. 1999 Mar;27(3):531-9. PubMed
|Brandi LS, Santini L, Bertolini R, Malacarne P, Casagli S, Baraglia AM. Energy expenditure and severity of injury and illness indices in multiple trauma patients. Crit Care Med. 1999 Dec;27(12):2684-9. PubMed
|Cheifetz IM, Myers TR. Respiratory therapies in the critical care setting. Should every mechanically ventilated patient be monitored with capnography from intubation to extubation. Respir Care. 2007 Apr;52(4):423-38; discussion 438-42. [94 references] PubMed
|Cinnella G, Dambrosio M, Brienza N, Giuliani R, Bruno F, Fiore T, Brienza A. Independent lung ventilation in patients with unilateral pulmonary contusion. Monitoring with compliance and EtCO(2). Intensive Care Med. 2001 Dec;27(12):1860-7. PubMed
|Colman Y, Krauss B. Microstream capnograpy technology: a new approach to an old problem. J Clin Monit Comput. 1999 Aug;15(6):403-9. PubMed
|de Abreu MG, Geiger S, Winkler T, Ragaller M, Pfeiffer T, Leutheuser D, Albrecht DM. Evaluation of a new device for noninvasive measurement of nonshunted pulmonary capillary blood flow in patients with acute lung injury. Intensive Care Med. 2002 Mar;28(3):318-23. PubMed
|de Abreu MG, Quintel M, Ragaller M, Albrecht DM. Partial carbon dioxide rebreathing: a reliable technique for noninvasive measurement of nonshunted pulmonary capillary blood flow. Crit Care Med. 1997 Apr;25(4):675-83. PubMed
|Engoren M. Efficacy of capnometry in ventilatory management of cardiac patients. J Cardiothorac Vasc Anesth. 1993 Oct;7(5):538-40. PubMed
|Fatigante L, Cartei F, Ducci F, Marini C, Prediletto R, Caciagli P, Laddaga M. Carbogen breathing in patients with glioblastoma multiforme submitted to radiotherapy. Assessment of gas exchange parameters. Acta Oncol. 1994;33(7):807-11. PubMed
|Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. Part 1: executive summary: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010 Nov 2;122(18 Suppl 3):S640-56. PubMed
|Gamma de Abreu M, Melo MF, Giannella-Neto A. Pulmonary capillary blood flow by partial CO2 rebreathing: importance of the regularity of the respiratory pattern. Clin Physiol. 2000 Sep;20(5):388-98. PubMed
|Garey DM, Ward R, Rich W, Heldt G, Leone T, Finer NN. Tidal volume threshold for colorimetric carbon dioxide detectors available for use in neonates. Pediatrics. 2008 Jun;121(6):e1524-7. PubMed
|Gentile MA, Cheifetz IM. Optimal positive end-expiratory pressure: The search for the Holy Grail continues. Crit Care Med. 2004 Dec;32(12):2553-4. PubMed
|Ghamra ZW, Arroliga AC. Volumetric capnography in acute respiratory distress syndrome: is the era of day-to-day monitoring finally here. Respir Care. 2005 Apr;50(4):457-8. PubMed
|Goldberg JS, Rawle PR, Zehnder JL, Sladen RN. Colorimetric end-tidal carbon dioxide monitoring for tracheal intubation. Anesth Analg. 1990 Feb;70(2):191-4. PubMed
|Graybeal JM. Relative agreement between Raman and mass spectrometry for measuring end-tidal carbon dioxide. Respir Care. 1994;39(3):190-4.
|Grenier B, Verchere E, Mesli A, Dubreuil M, Siao D, Vandendriessche M, Cales J, Maurette P. Capnography monitoring during neurosurgery: reliability in relation to various intraoperative positions. Anesth Analg. 1999 Jan;88(1):43-8. PubMed
|Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ, GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008 Apr 26;336(7650):924-6. PubMed
|Hall D, Goldstein A, Tynan E, Braunstein L. Profound hypercarbia late in the course of laparoscopic cholecystectomy: detection by continuous capnometry. Anesthesiology. 1993 Jul;79(1):173-4. PubMed
|Hardman JG, Aitkenhead AR. Estimation of alveolar deadspace fraction using arterial and end-tidal CO2: a factor analysis using a physiological simulation. Anaesth Intensive Care. 1999 Oct;27(5):452-8. PubMed
|Hardman JG, Curran J, Mahajan RP. End-tidal carbon dioxide measurement and breathing system filters. Anaesthesia. 1997 Jul;52(7):646-8. PubMed
|Hardman JG, Mahajan RP, Curran J. The influence of breathing system filters on paediatric capnography. Paediatr Anaesth. 1999;9(1):35-8. PubMed
|Hess D, Branson RD. Noninvasive respiratory monitoring equipment. In: Respiratory care equipment. Philadelphia (PA): Lippincott; 1994. p. 184-216.
|Hess D. Capnometry. New York (NY): McGraw-Hill; 1998. 377-400 p.
|Howes DW, Shelley ES, Pickett W. Colorimetric carbon dioxide detector to determine accidental tracheal feeding tube placement. Can J Anaesth. 2005 Apr;52(4):428-32. PubMed
|Hubble CL, Gentile MA, Tripp DS, Craig DM, Meliones JN, Cheifetz IM. Deadspace to tidal volume ratio predicts successful extubation in infants and children. Crit Care Med. 2000 Jun;28(6):2034-40. PubMed
|Isert P. Control of carbon dioxide levels during neuroanaesthesia: current practice and an appraisal of our reliance upon capnography. Anaesth Intensive Care. 1994 Aug;22(4):435-41. [69 references] PubMed
|Jacobus C. Noninvasive monitoring in neonatal and pediatric care. St. Louis (MO): Elsevier; 2009. 137-46 p.
|Jaeschke R, Guyatt GH, Dellinger P, Schunemann H, Levy MM, Kunz R, Norris S, Bion J, GRADE working group. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 2008;337:a744. PubMed
|Jellinek H, Hiesmayr M, Simon P, Klepetko W, Haider W. Arterial to end-tidal CO2 tension difference after bilateral lung transplantation. Crit Care Med. 1993 Jul;21(7):1035-40. PubMed
|Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005 Dec 30;54(17):1-141. [487 references] PubMed
|Joint Commission. Preventing ventilator-related deaths and injuries. Sentinel Event Alert. 2002 Feb 26;(25):1-3. PubMed
|Kallet RH, Daniel BM, Garcia O, Matthay MA. Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care. 2005 Apr;50(4):462-7. PubMed
|Kallet RH. Capnography and respiratory care in the 21st century. Respir Care. 2008 Jul;53(7):860-1. PubMed
|Kamlin CO, O'Donnell CP, Davis PG, Morley CJ. Colorimetric end-tidal carbon dioxide detectors in the delivery room: strengths and limitations. A case report. J Pediatr. 2005 Oct;147(4):547-8. PubMed
|Keller WR, Biehler J, Linares MY, Garcia-Pena BM. False-positive colorimetric capnometry after ingestion of carbonated beverages. Pediatr Emerg Care. 2009 Feb;25(2):69-73. PubMed
|Kerr ME, Zempsky J, Sereika S, Orndoff P, Rudy EB. Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma. Crit Care Med. 1996 May;24(5):785-90. PubMed
|Kramer-Johansen J, Dorph E, Steen PA. Detection of carbon dioxide in expired air after oesophageal intubation; the role of bystander mouth-to-mouth ventilation. Acta Anaesthesiol Scand. 2008 Jan;52(1):155-7. PubMed
|Kumar AY, Bhavani-Shankar K, Moseley HS, Delph Y. Inspiratory valve malfunction in a circle system: pitfalls in capnography. Can J Anaesth. 1992 Nov;39(9):997-9. PubMed
|Laffon M, Gouchet A, Sitbon P, Guicheteau V, Biyick E, Duchalais A, Mercier C. Difference between arterial and end-tidal carbon dioxide pressures during laparoscopy in paediatric patients. Can J Anaesth. 1998 Jun;45(6):561-3. PubMed
|Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med. 1997 Jul 31;337(5):301-6. PubMed
|Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med. 2001 Apr;20(3):223-9. PubMed
|Lucangelo U, Bernabe F, Vatua S, Degrassi G, Villagra A, Fernandez R, Romero PV, Saura P, Borelli M, Blanch L. Prognostic value of different dead space indices in mechanically ventilated patients with acute lung injury and ARDS. Chest. 2008 Jan;133(1):62-71. PubMed
|McEvedy BA, McLeod ME, Kirpalani H, Volgyesi GA, Lerman J. End-tidal carbon dioxide measurements in critically ill neonates: a comparison of side-stream and mainstream capnometers. Can J Anaesth. 1990 Apr;37(3):322-6. PubMed
|McSwain SD, Hamel DS, Smith PB, Gentile MA, Srinivasan S, Meliones JN, Cheifetz IM. End-tidal and arterial carbon dioxide measurements correlate across all levels of physiologic dead space. Respir Care. 2010 Mar;55(3):288-93. PubMed
|Muniz AE. False-negative capnographic reading caused by a malfunctioning bag-valve-mask device resulting in a pneumomediastinum. Resuscitation. 2008 Sep;78(3):378-80. PubMed
|Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S729-67. PubMed
|Nuckton TJ, Alonso JA, Kallet RH, Daniel BM, Pittet JF, Eisner MD, Matthay MA. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med. 2002 Apr 25;346(17):1281-6. PubMed
|Poirier MP, Gonzalez Del-Rey JA, McAneney CM, DiGiulio GA. Utility of monitoring capnography, pulse oximetry, and vital signs in the detection of airway mishaps: a hyperoxemic animal model. Am J Emerg Med. 1998 Jul;16(4):350-2. PubMed
|Raurich JM, Vilar M, Colomar A, Ibanez J, Ayestaran I, Perez-Barcena J, Llompart-Pou JA. Prognostic value of the pulmonary dead-space fraction during the early and intermediate phases of acute respiratory distress syndrome. Respir Care. 2010 Mar;55(3):282-7. PubMed
|Roberts WA, Maniscalco WM, Cohen AR, Litman RS, Chhibber A. The use of capnography for recognition of esophageal intubation in the neonatal intensive care unit. Pediatr Pulmonol. 1995 May;19(5):262-8. PubMed
|Roberts WA, Maniscalco WM. A novel cause of error in capnographic confirmation of intubation in the neonatal intensive care unit. Pediatrics. 1995 Jan;95(1):140-2. PubMed
|Rodger M, Wells PS. Diagnosis of pulmonary embolism. Thromb Res. 2001 Sep 15;103(6):V225-38. [72 references] PubMed
|Rodger MA, Jones G, Rasuli P, Raymond F, Djunaedi H, Bredeson CN, Wells PS. Steady-state end-tidal alveolar dead space fraction and D-dimer: bedside tests to exclude pulmonary embolism. Chest. 2001 Jul;120(1):115-9. PubMed
|Rudraraju P, Eisen LA. Confirmation of endotracheal tube position: a narrative review. J Intensive Care Med. 2009 Sep-Oct;24(5):283-92. [91 references] PubMed
|Rumpf TH, Krizmaric M, Grmec S. Capnometry in suspected pulmonary embolism with positive D-dimer in the field. Crit Care. 2009;13(6):R196. PubMed
|Russell GB, Graybeal JM. End-tidal carbon dioxide as an indicator of arterial carbon dioxide in neurointensive care patients. J Neurosurg Anesthesiol. 1992 Oct;4(4):245-9. PubMed
|Russell GB, Graybeal JM. Reliability of the arterial to end-tidal carbon dioxide gradient in mechanically ventilated patients with multisystem trauma. J Trauma. 1994 Mar;36(3):317-22. PubMed
|Russell GB, Graybeal JM. The arterial to end-tidal carbon dioxide difference in neurosurgical patients during craniotomy. Anesth Analg. 1995 Oct;81(4):806-10. PubMed
|Seguin P, Bleichner JP, Branger B, Guillou YM, Feuillu A, Malledant Y. [The measurement of end-tidal carbon dioxide (PETCO2) is not a significant parameter to monitor in patients with severe traumatic brain injury]. Can J Anaesth. 2001 Apr;48(4):396-400. PubMed
|Shibutani K, Muraoka M, Shirasaki S, Kubal K, Sanchala VT, Gupte P. Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output. Anesth Analg. 1994 Nov;79(5):829-33. PubMed
|Silvestri S, Ralls GA, Krauss B, Thundiyil J, Rothrock SG, Senn A, Carter E, Falk J. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005 May;45(5):497-503. PubMed
|Singh S, Allen WD Jr, Venkataraman ST, Bhende MS. Utility of a novel quantitative handheld microstream capnometer during transport of critically ill children. Am J Emerg Med. 2006 May;24(3):302-7. PubMed
|Spahr-Schopfer IA, Bissonnette B, Hartley EJ. Capnometry and the paediatric laryngeal mask airway. Can J Anaesth. 1993 Nov;40(11):1038-43. PubMed
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|Sum Ping ST, Mehta MP, Symreng T. Reliability of capnography in identifying esophageal intubation with carbonated beverage or antacid in the stomach. Anesth Analg. 1991 Sep;73(3):333-7. PubMed
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Type of Evidence Supporting the Recommendations
The type of supporting evidence is identified and graded for selected recommendations (see the "Major Recommendations" field).
Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
Appropriate utilization of capnography during mechanical ventilation
Potential Harms
Certain situations may affect the reliability of the capnogram. The extent to which the reliability is affected varies somewhat among types of devices. Refer to "Limitations of Procedure or Device" in the "Major Recommendations" field.
Capnography with a clinically approved device is a safe, noninvasive test, associated with few hazards in most populations. Hazards/complications are different for the 2 types of capnographic devices.
- Adapters inserted into the airway between the airway and the ventilator circuit should have a minimal amount of dead space. This effect is inversely proportional to the size of the patient being monitored.
- The addition of the weight of a mainstream adapter can increase the risk of accidental extubation in neonates and small children.
- The gas sampling rate from some sidestream analyzers may be high enough to cause autotriggering when flow-triggering of mechanical breath sis used. This effect is also inversely proportional to the size of the patient.
- The gas sampling rate can diminish delivered tidal volume (VT) in neonates and small patients while using volume targeted or volume controlled ventilation modes.
Implementation of the Guideline
Description of Implementation Strategy
An implementation strategy was not provided.
Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Getting Better
Living with Illness
Staying Healthy
IOM Domain
Identifying Information and Availability
Bibliographic Source(s)
|Walsh BK, Crotwell DN, Restrepo RD. Capnography/capnometry during mechanical ventilation: 2011. Respir Care. 2011 Apr;56(4):503-9. PubMed
Not applicable: The guideline was not adapted from another source.
Date Released
1995 Dec (revised 2011 Apr)
Guideline Developer(s)
American Association for Respiratory Care - Professional Association
Source(s) of Funding
American Association for Respiratory Care (AARC)
Guideline Committee
American Association for Respiratory Care Clinical Practice Guidelines Steering Committee
Composition of Group That Authored the Guideline
Committee Members: Ruben D Restrepo MD RRT FAARC (Chair), Department of Respiratory Care, The University of Texas Health Sciences Center at San Antonio, San Antonio, Texas; Brian K Walsh RRT-NPS FAARC, Children's Medical Center, Dallas, Texas; David N Crotwell RRT-NPS, Seattle Children's Hospital, Seattle, Washington
Financial Disclosures/Conflicts of Interest
Dr Restrepo is a consultant and researcher for Oridion, which manufactures capnographs. Mr Walsh and Mr Crotwell have disclosed no conflicts of interest.
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: McArthur CD. AARC clinical practice guideline. Capnography/capnometry during mechanical ventilation--2003 revision & update. Respir Care 2003 May;48(5):534-9.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the American Association for Respiratory Care (AARC) Web site .
Print copies: Available from AARC, 9425 N. MacArthur Blvd., Ste. 100, Irving, TX 75063.
Availability of Companion Documents
The following is available:
- Restrepo RD. American Association for Respiratory Care (AARC) clinical practice guidelines: from "reference-based" to "evidence-based." Respir Care. 2010 Jun;55(6):787-9. Available in Portable Document Format (PDF) from the American Association for Respiratory Care (AARC) Web site .
Print copies: Available from AARC, 9425 N. MacArthur Blvd., Ste. 100, Irving, TX 75063.
Patient Resources
None available
NGC Status
This summary was completed by ECRI on November 30, 1998. The information was verified by the guideline developer on December 15, 1998. This summary was updated by ECRI on August 20, 2003. This NGC summary was updated by ECRI Institute on February 1, 2012.
Copyright Statement
This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.
NGC Disclaimer
The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.
All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.
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NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.


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It's tough being Gomez. Last year the British press labelled the band the saviors of British rock, then turned around and called Beta Band the same thing. One could almost forgive Gomez for getting overwhelmed by the hype and the award wins and nominations and stinking it up on its sophomore effort. But they don't. Sure, the boys picked up a few new studio tricks or two and rounded out their sound with fuller textures and better-produced mixes, but the back-to-the-country-sounding songs with a trippy vibe, flying in the face of Britpop's slickness, are just as good as ever.
Heavily indebted to The Band and Creedence Clearwater Revival and even The Verve, the vocals on Liquid Skin betrays the obvious imprint of many repeated listenings of John Fogerty singing "Suzy Q." Meanwhile, the band broadens their instrumentation, while managing to pull British rock back to a rusticism it hasn't heard since the days of Ronnie Lane.
Sarah Sharpe's #1 pick
This album hooked me from the first listen, and I still smile with uncontrollable delight every time I push play and the sounds of "Hangover" begin. Guitar lines mingling muddy blankets of sound with quiet acoustic melodies are backed by percussive rhythms that drive the tunes. Ben Ottewell's deep and gravelly voice carries the weighty stoicism of blues' best yowlers, but it's the harmonies that wind their way into my unconscious. From the restrained and bitter "Rosalita" to the raucous fun of "Bring It On," Gomez's craggy rock is under my skin.
Steve Lichtenstein's #4 pick
If ever a modern band sounded like it was playing a tribute album of original songs, it's Gomez. Drawing from unspecific American rock and blues influences, these Brits have banged out a stellar album for the second year in a row. Liquid Skin is full of illusions to music you like, and creates its own of some you will. You'll swear you've heard "Devil Will Ride" before, but nothing is quite as solid. The real prize here is "Revolutionary Kind," with its contagious riff and electronica skewing lyrics. Gomez are here to stay, in or out of the face of other worthy U.K. competition, and they're gonna do it their way, with supremely constructed everyman rock sensibility. Thank God.
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text:
Aliso Viejo
Nick Prud'homme, Aliso Viejo, on 141-yard No. 12 (blue tees), using a 54-degree wedge (Note: Made shot during an Aliso Niguel High tryout)
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Ed Van Horn, San Clemente, on 155-yard No. 9, using a 4-hybrid
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text:
June 13 and 14, 2001
Published: Friday, June 15, 2001 at 6:01 a.m.
Last Modified: Thursday, June 14, 2001 at 11:00 p.m.
Terrebonne Parish Sheriff's Office
June 13, 2001
Claude H. Galmore, 41, 711 Linda Ann St., Gray, distribution of a schedule II controlled dangerous substance, distribution of a controlled dangerous substance in a drug free zone.
Kimberly S. Rochel, 36, 713 Roussell St., Houma, failure to pay fine and cost.
Ericka M. Trosclair, 24, 517-A Palmisano St., Houma, failure to appear in court, simple assault.
Clarence R. Simon Jr., 34, 1300 Bolo Court, Apartment 202, Bridge City, theft of goods less than $100.
Lorenza C. Jackson Jr., 21, 1288 St. Charles St., Thibodaux, simple battery (domestic violence).
Bradley M. Steele, 22, 477 Highridge Drive, Houma, littering a public place, contempt of court.
Roy G. Jerasi, 47, 3909 Bellview St., Metairie, holding.
June 14, 2001
William H. Minnix, 46, 180 Short Road, Santa Rosa, Calif., fugitive from justice.
Ken A. Leger, 30, Route One Box 284, Roxis, Miss., contempt on non-support.
Mark A. Pellegrin, 37, 202-G Southland Circle, Houma, contributing to the delinquency of a juvenile.
Dinah P. Briggs, 45, 5660 North Bayou Black Drive, Gibson, violation of the open container law, contempt of court.
Roger J. Coleman, 18, 226 Levron St., Houma, possession of a schedule II controlled dangerous substance.
Charles K. Carter, 35, 219 St. Paul St., Houma, probation violation.
Houma Police Department
June 13, 2001
Steven A. Theriot, 26, 1525 Dr. Beatrous Road, Theriot, contempt on non-support.
Tyeast L. Verdin, 26, 235-B Senator Circle, Houma, contempt on non-support, simple obstruction of a highway.
Jason P. Marie, 33, 112 Jadon Drive, Houma, possession of a schedule II controlled dangerous substance, violation of a support order, contempt of court.
June 14, 2001
Danielle Nixon, 23, 178-B Senator Circle, Houma, illegal possession of stolen things, driving under suspension, misuse of a temporary license plate, improper headlight equipment, possession of marijuana.
Louisiana State Police
June 13, 2001
Tyson L. Maddox, 25, 906 Sunset Ave., Houma, seat belt violation, driving under suspension, speeding in a reduced zone, driving under suspension.
Henry C. Gann, 55, 192 Oak Manor Court, Houma, first offense DWI, running a red light, driving under suspension.
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