EBQ:End-Tidal CO2 PaCO2 correlation: Difference between revisions
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'''Can end tidal CO2 be used as a surrogate for PaCO2 in critically Ill Patients?''' | '''Can end tidal CO2 be used as a surrogate for PaCO2 in critically Ill Patients?''' | ||
==Pro Argument== | ==Pro Argument== | ||
'''The greatest correlation of etCO2 to PaCO2 is in hemodynamically stable patients and isolated TBI''' | |||
===Lee 2009 Journal of Trauma<ref>Lee S-W, Hong Y-S, Han C, et al. Concordance of End-Tidal Carbon Dioxide and Arterial Carbon Dioxide in Severe Traumatic Brain injury. J Trauma. 2009;67(3):526–530. doi:10.1097/TA.0b013e3181866432.</ref>=== | ===Lee 2009 Journal of Trauma<ref>Lee S-W, Hong Y-S, Han C, et al. Concordance of End-Tidal Carbon Dioxide and Arterial Carbon Dioxide in Severe Traumatic Brain injury. J Trauma. 2009;67(3):526–530. doi:10.1097/TA.0b013e3181866432.</ref>=== | ||
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[[Category:EBQ]] | [[Category:EBQ]][[Category:Critical Care]][[Category:Pulm]][[Category:Trauma]][[Category:Neuro]] | ||
Revision as of 18:02, 21 May 2014
Clinical Question
Can end tidal CO2 be used as a surrogate for PaCO2 in critically Ill Patients?
Pro Argument
The greatest correlation of etCO2 to PaCO2 is in hemodynamically stable patients and isolated TBI
Lee 2009 Journal of Trauma[1]
- Prospective observational study
- Included 66 adults at single center with GCS <9 after any traumatic injury in the Emergency Dept
- Patients were mechanically ventilated with PetCO2 and PaCO2 obtained simultaneously
- Median difference of PaCO2 etCO2 was 3.6 mm Hg with 77.3% concordance
- Differences of greater than 5mm occurred in patents with hypotension, acidosis and lactate > 7 mm/L
- Conclusion
- An acceptable correlation except in severely ill
Warner 2009 Journal of Trauma[2]
- Prospective observational study
- Included adult patients with TBI regardless of other injuries, however, critical patients were excluded if they required immediate OR intervention
- Concurrent PaCO2 measurement with etCO2 of patients who remained in the ED.
- Not all had repeat PaCO2 measurements to correlated trends of convergence or divergence
- Correlation of R=.27 between PaCO2
- Only 53% of TBI patients had a difference of < 5mm Hg between PaCO2 and etCO2
- Only 36% in severe abdominal trauma and 29% in severe chest trauma had an acceptable difference of <5 mm Hg.
- Conclusion
- An unnacceptable correlation especially in abdominal and chest trauma
Yosefy 2004 Emerg Med Journal[3]
- Prospective semi-blind ED study of 73 adultpatients with respiratory distress
- Non trauma patients
- Correlation coefficient of 0.792 with etCO2 and PaCO2 with young patients having less correlation
Con Argument
- etCO2 will differ the most from PaCO2 in patients with multi system trauma especially those with chest wall and abdominal trauma
- EtCO2 may be a reflection of perfusion rather than ventilation status. [2]
Sources
- ↑ Lee S-W, Hong Y-S, Han C, et al. Concordance of End-Tidal Carbon Dioxide and Arterial Carbon Dioxide in Severe Traumatic Brain injury. J Trauma. 2009;67(3):526–530. doi:10.1097/TA.0b013e3181866432.
- ↑ 2.0 2.1 Warner KJ, Cuschieri J, Garland B, et al. The Utility of Early End-Tidal Capnography in Monitoring Ventilation Status After Severe Injury. J Trauma. 2009;66(1):26–31. doi:10.1097/TA.0b013e3181957a25.
- ↑ Yosefy C. End tidal carbon dioxide as a predictor of the arterial PCO2 in the emergency department setting. Emerg Med J. 2004;21(5):557–559. doi:10.1136/emj.2003.005819.