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Airway plans and capnography

Last post 24 Nov 2018, 11:46 PM by James Nielsen. 0 replies.
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  •  24 Nov 2018, 11:46 PM 2694

    Airway plans and capnography

    Chrimes and Marshall's concept of "attempt XYZ" could help anaesthetists retain situational awareness and avoid task fixation when expected and unexpected airway management is difficult [1]. Just as significant is their "million-dollar question" about the next airway intervention. To earn that prize, their sole measure of success is the presence of a capnograph trace. The authors need no references to justify this: its validity is self-evident.  

    We agree.  Whether obtained via face-mask, supraglottic airway, or tracheal tube, the capnograph demonstrates airway patency and alveolar ventilation, which is why anaesthetists use it routinely to confirm the success of intubation. 

    Anaesthetists usually record the operator's comfort ("easy or difficult") rather than the success of bag/mask ventilation. Any further mention often relates only to technique ("Guedel used").

    Since capnography is a valid outcome measure, why not use it before airway crises too? Why not use it every time we mask-ventilate, and record both the technique chosen and its outcome?

    In 2016, we proposed a simple 4-point grading system for mask ventilation to do just that (see figure) [2], with capnography defining immediate and objective success. As with Chrimes and Marshall's "attempt XYZ", failure (our grade D) helps the team identify when mask ventilation is not working and it is time to do something else.

    Chrimes and Marshall are right: the capnograph is what matters. It can help us measure outcome and avoid task fixation both in crises and in routine practice.


    J. R. Nielsen

    K. S. Lim

    Concord Repatriation General Hospital,

    Sydney, Australia.

    Email: jamesrnielsen@gmail.com


    No external funding and no conflicts of interest declared.



    1. Chrimes N, Marshall SD.  Attempt XYZ: airway management at the opposite end of the alphabet. Anaesthesia 2018; 73: 1464-68.
    2. Lim KS, Nielsen JR.  Objective description of mask ventilation. British Journal of Anaesthesia 2016; 117: 828-9. 


    Figure legend

    Figure 1. Proposed capnography grading system for mask ventilation.




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