Arterial and end‐tidal carbon dioxide partial pressure difference during prehospital anaesthesia in critically ill patients

Harve‐Rytsälä, Heini; Ångerman, Susanne; Kirves, Hetti; Nurmi, Jouni

doi:10.1111/aas.13751

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…Two recent publications investigated the CO 2 gap in critically ill patients after prehospital emergency anesthesia [25,26]. Their ndings are in line with our results and showed only moderate correlation between EtCO 2 and PaCO 2 , con rming that EtCO 2 alone should be used with caution to guide ventilation in the critically ill.…”

Section: The Co 2 Gapsupporting

confidence: 90%

End-tidal to arterial carbon dioxide gradient in traumatic brain injury after prehospital emergency anesthesia is associated with in-hospital mortality: a retrospective observational study

Doppmann

Meuli

Sollid

et al. 2021

Preprint

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Background Early definitive airway protection and normoventilation are key principles in the treatment of severe traumatic brain injury. These are currently guided by end tidal CO2 as a proxy for PaCO2. We assessed whether the difference between end tidal CO2 and PaCO2 at hospital admission is associated with in-hospital mortality.Method We conducted a retrospective observational cohort study of consecutive patients with traumatic brain injury who were intubated and transported by Helicopter Emergency Medical Services to a Level 1 trauma center between January 2014 and December 2019. We assessed the association between the CO2 gap—defined as the difference between end tidal CO2 and PaCO2—and in-hospital mortality using multivariate logistic regression models.Results 105 patients were included in this study. The mean ±SD CO2 gap at admission was 1.64 (± 1.09) kPa and significantly greater in non-survivors than survivors (2.26 ±1.30 kPa vs. 1.42 ±0.92 kPa, p<.001). The correlation between EtCO2 and PaCO2 at admission was low (Pearson's r=.287). The mean CO2 gap after 24 hours was only 0.64 ±0.82 kPa, and no longer significantly different between non-survivors and survivors. The multivariate logistic regression model showed that the CO2 gap was independently associated with increased mortality in this cohort and associated with a 2.7-fold increased mortality for every 1 kPa increase in the CO2 gap (OR 2.692, 95% CI 1.293 to 5.646, p=.009).Conclusions This study demonstrates that the difference between EtCO2 and PaCO2 is significantly associated with in-hospital mortality in patients with traumatic brain injury. EtCO2 was significantly lower than PaCO2, making it an unreliable proxy for PaCO2 when aiming for normocapnic ventilation. The higher-than-expected CO2 gap will lead to iatrogenic hypoventilation when normocapnic ventilation is aimed at, and might thereby increase in-hospital mortality.

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Section: The Co 2 Gapsupporting

confidence: 90%

End-tidal to arterial carbon dioxide gradient in traumatic brain injury after prehospital emergency anesthesia is associated with in-hospital mortality: a retrospective observational study

Doppmann

Meuli

Sollid

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Two recent publications investigated the CO 2 gap in critically ill patients after prehospital emergency anesthesia 25 , 26 . Their findings are in line with our results and showed only moderate correlation between EtCO 2 and PaCO 2 , confirming that EtCO 2 alone should be used with caution to guide ventilation in the critically ill.…”

Section: Discussionmentioning

confidence: 99%

End-tidal to arterial carbon dioxide gradient is associated with increased mortality in patients with traumatic brain injury: a retrospective observational study

Doppmann

Meuli

Sollid

et al. 2021

Sci Rep

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Early definitive airway protection and normoventilation are key principles in the treatment of severe traumatic brain injury. These are currently guided by end tidal CO2 as a proxy for PaCO2. We assessed whether the difference between end tidal CO2 and PaCO2 at hospital admission is associated with in-hospital mortality. We conducted a retrospective observational cohort study of consecutive patients with traumatic brain injury who were intubated and transported by Helicopter Emergency Medical Services to a Level 1 trauma center between January 2014 and December 2019. We assessed the association between the CO2 gap—defined as the difference between end tidal CO2 and PaCO2—and in-hospital mortality using multivariate logistic regression models. 105 patients were included in this study. The mean ± SD CO2 gap at admission was 1.64 ± 1.09 kPa and significantly greater in non-survivors than survivors (2.26 ± 1.30 kPa vs. 1.42 ± 0.92 kPa, p < .001). The correlation between EtCO2 and PaCO2 at admission was low (Pearson's r = .287). The mean CO2 gap after 24 h was only 0.64 ± 0.82 kPa, and no longer significantly different between non-survivors and survivors. The multivariate logistic regression model showed that the CO2 gap was independently associated with increased mortality in this cohort and associated with a 2.7-fold increased mortality for every 1 kPa increase in the CO2 gap (OR 2.692, 95% CI 1.293 to 5.646, p = .009). This study demonstrates that the difference between EtCO2 and PaCO2 is significantly associated with in-hospital mortality in patients with traumatic brain injury. EtCO2 was significantly lower than PaCO2, making it an unreliable proxy for PaCO2 when aiming for normocapnic ventilation. The CO2 gap can lead to iatrogenic hypoventilation when normocapnic ventilation is aimed and might thereby increase in-hospital mortality.

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“…Previous studies were mainly conducted in the ICU; researchers studied participants exposure to hyperoxaemia for several hours or even days. Henry et al 29 found that early hyperoxaemia (>40 kPa) happening less than two hours from hospital admission was not associated with increased hospital mortality. However, hyperoxaemia occurring later was associated with poor outcomes.…”

Section: Discussionmentioning

confidence: 98%

Association among blood pressure, end-tidal carbon dioxide, peripheral oxygen saturation and mortality in prehospital post-resuscitation care

Heikkilä,

Setälä,

Jousi

et al. 2024

Resuscitation Plus

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Arterial and end‐tidal carbon dioxide partial pressure difference during prehospital anaesthesia in critically ill patients

Cited by 9 publications

References 17 publications

End-tidal to arterial carbon dioxide gradient in traumatic brain injury after prehospital emergency anesthesia is associated with in-hospital mortality: a retrospective observational study

End-tidal to arterial carbon dioxide gradient in traumatic brain injury after prehospital emergency anesthesia is associated with in-hospital mortality: a retrospective observational study

End-tidal to arterial carbon dioxide gradient is associated with increased mortality in patients with traumatic brain injury: a retrospective observational study

Association among blood pressure, end-tidal carbon dioxide, peripheral oxygen saturation and mortality in prehospital post-resuscitation care

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