Bedside End‐tidal Carbon Dioxide in Evaluation for Pulmonary Embolism

Wallis, Marianne; Wilson, Matthew D.; Koroshetz, Lydia; Soares, Rui; Goyal, Munish

doi:10.1111/acem.13546

Cited by 4 publications

(3 citation statements)

References 8 publications

(8 reference statements)

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“…Moreover, these data raise the question of whether additional preimaging PE diagnostic strategies should be added to the BPA guideline—especially for the hospitalized patient population with multiple comorbid conditions. For example, alveolar dead space assessment with Et co 2 monitoring is one emerging diagnostic tool that may be a useful adjunct to help exclude additional PE-negative patients and minimize costs and health risks associated with unnecessary radiological imaging 29,50–55 …”

Section: Discussionmentioning

confidence: 99%

“…For example, alveolar dead space assessment with EtCO 2 monitoring is one emerging diagnostic tool that may be a useful adjunct to help exclude additional PEnegative patients and minimize costs and health risks associated with unnecessary radiological imaging. 29,[50][51][52][53][54][55] Implications for Clinical Nurse Specialists One of the competencies of the CNS is to evaluate clinical guidelines and then translate safe and effective guidelines into their specific practice setting. In addition, the CNS is often in a position to evaluate guideline adherence and, when necessary, impact change to improve adherence.…”

Section: Implications For Researchmentioning

confidence: 99%

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Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism

Prentice

Wipke‐Tevis²

2022

Clin Nurse Spec

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This study evaluated clinician adherence to the American College of Physicians Best Practice Advice for diagnosis of pulmonary embolism. Design:A prospective, single-center, descriptive design was utilized. Methods:A heterogeneous sample of 111 hemodynamically stable adult inpatients with a computed tomography pulmonary angiogram ordered was consented. Electronic medical records were reviewed for demographic and clinical variables to determine adherence. The 6 individual best practice statements and the overall adherence were evaluated by taking the sum of "yes" answers divided by the sample size. Results:Overall adherence was 0%. Partial adherence was observed with clinician-recorded clinical decisions rules and obtaining D-dimer (3.6% [4/111] and 10.2% [9/88], respectively) of low/ intermediate probability scorers. Age adjustment of D-dimer was not recorded. Computed tomography pulmonary angiogram was the first diagnostic test in 89.7% (79/88) in low/intermediate probability patients. Conclusion: In hemodynamically stable, hospitalized adults, adherence to best practice guidelines for diagnosis of pulmonary embolism was minimal. Clinical utility of the guidelines in hospitalized adults needs further evaluation. Systems problems (eg, lack of standardized orders, age-adjusted D-dimer values, information technology support) likely contributed to poor guideline adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Implications For Researchmentioning

confidence: 99%

Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism

Prentice

Wipke‐Tevis²

2022

Clin Nurse Spec

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“…To date, only five studies have purposely evaluated the usefulness of an absolute EtCO 2 assessment, the simplest and only noninvasive method, for PE exclusion. All five studies, with samples (range 69–298 participants) of prehospital, emergency department, and/or hospitalized adults, found patients without PE had a significantly higher EtCO 2 than patients with PE (Hemnes et al, 2010; Ramme et al, 2016; Riaz & Jacob, 2014; Rumpf et al, 2009; Wallis et al, 2019). Moreover, four of these studies found promising diagnostic accuracy of absolute EtCO 2 for PE exclusion; specifically, sensitivity (range 87.2–100%), specificity (range 7–83%), and negative predictive value (range 94.2–100%; Hemnes et al, 2010; Ramme et al, 2016; Riaz & Jacob, 2014; Rumpf et al, 2009).…”

Section: Use Of Capnography (Etco2) In Pe Diagnostic Processmentioning

confidence: 99%

Excluding Pulmonary Embolism with End-tidal Carbon Dioxide: Accuracy, Cost, and Harm Avoidance

2020

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A non-randomized single center prospective, descriptive, correlational design was used to determine what end-tidal carbon dioxide (EtCO2) level provided the best sensitivity, specificity, and negative predictive value to exclude pulmonary embolism (PE) diagnosis in hemodynamically stable hospitalized adults ( n = 111). The financial impact and harm avoidance of adding EtCO2 to the PE diagnostic process also were examined. PE diagnosis was determined by computed tomography pulmonary angiography (CTPA). PE prevalence was 18.9%. Mean±SD EtCO2 was lower for PE positive than negative participants (28 ± 7.8 to 33 ± 8.1 mmHg respectively 95% CI: 1.22–8.96; P = .01). For PE exclusion, an EtCO2 cutoff ≥42 mmHg yielded 100% sensitivity, 12.2% specificity, and 100% negative predictive value. For every six inpatients assessed with EtCO2, one could be saved from unnecessary CTPA. Eliminating unnecessary CTPA removes the potential harm associated with radiation and intravenous contrast exposure. Additionally, an EtCO2 cutoff ≥42 mmHg could eliminate ~$88,000/year in healthcare waste at this institution.

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Capnography

Gravenstein¹,

Jaffe²

2021

Anesthesia Equipment

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Bedside End‐tidal Carbon Dioxide in Evaluation for Pulmonary Embolism

Cited by 4 publications

References 8 publications

Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism

Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism

Excluding Pulmonary Embolism with End-tidal Carbon Dioxide: Accuracy, Cost, and Harm Avoidance

Capnography

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