Can mainstream end-tidal carbon dioxide measurement accurately predict the arterial carbon dioxide level of patients with acute dyspnea in ED

Çınar, Orhan; Acar, Yahya Ayhan; Arziman, Ibrahim; Kilic, Erden; Eyi, Yusuf Emrah; Öcal, Ruhşen

doi:10.1016/j.ajem.2010.12.014

Cited by 31 publications

(22 citation statements)

References 14 publications

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“…The relationship between ETCO2 and partial arterial carbon dioxide (PaCO2) in the setting of dyspnoea has not been completely elucidated. Prior studies have shown that ETCO2 may predict PaCO2 in patients with asthma,14 and ED patients with acute dyspnoea 15. However, the accuracy of ETCO2 to predict PaCO2 in acute dyspnoea has been questioned 16.…”

Section: Discussionmentioning

confidence: 99%

Prehospital end-tidal carbon dioxide differentiates between cardiac and obstructive causes of dyspnoea

et al. 2014

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Background Differentiating between cardiac and obstructive causes for dyspnoea is essential for proper management, but is difficult in the prehospital setting. Objective To assess if prehospital levels of end-tidal carbon dioxide (ETCO2) differed in obstructive compared to cardiac causes of dyspnoea, and could suggest one diagnosis over the other. Methods We conducted a retrospective cohort study among patients transported by emergency medical services during a 29-month period who were diagnosed with either obstructive pulmonary disease or congestive heart failure (CHF) by ICD-9 codes. Initial prehospital vital signs, including ETCO2, were recorded. Records were linked by manual archiving of emergency medical services and hospital data. Results There were 106 patients with a diagnosis of obstructive or cardiac causes of dyspnoea that had prehospital ETCO2 levels measured during the study period. ETCO2 was significantly lower in patients diagnosed with CHF (31 mm Hg 95% CI 27 to 35) versus obstructive pulmonary disease (39 mm Hg 95% CI 35 to 42; p<0.001). Lower ETCO2 levels predicted CHF, with an area under the Receiver Operating Characteristics Curve of 0.70 (95% CI 0.60 to 0.81). Using ETCO2 <40 mm Hg as a cut-off, the sensitivity for predicting heart failure was 93% (95% CI 88% to 98%), the specificity was 43% (95% CI 33% to 52%), the positive predictive value was 38% (95% CI 29% to 48%), and the negative predictive value was 94% (95% CI 89% to 99%). Conclusions Lower levels of ETCO2 were associated with CHF, and may serve as an objective diagnostic adjunct to predict this cause of dyspnoea in the prehospital setting.

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Section: Discussionmentioning

confidence: 99%

Prehospital end-tidal carbon dioxide differentiates between cardiac and obstructive causes of dyspnoea

et al. 2014

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“…In this particular study, a mainstream capnometry device designed for invasive measurement was used noninvasively with an adapter. 10 Although we used the original mainstream sensor by the manufacturer, the bias was 13 mm Hg in the current study. Sidestream measurement, even though conducted similar to other studies in the literature, yielded a bias of 9.7 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

“…The mainstream method has advantages by directly performing the measurement through the air passage, and therefore is reported to yield more accurate results. 10 While the mainstream methods were performed only on intubated patients, due to the size and weight of the sensors in the past, it is now practiced noninvasively on non-intubated patients through reduced size and weight of sensors.…”

Section: Introductionmentioning

confidence: 99%

Disparity Between Mainstream and Sidestream End-Tidal Carbon Dioxide Values and Arterial Carbon Dioxide Levels

et al. 2013

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BACKGROUND: Measuring and monitoring end-tidal carbon dioxide (P ETCO 2 ) is an important aspect of caring for critically ill patients. The 2 methods used for P ETCO 2 measurement are the mainstream and sidestream methods. OBJECTIVE: To assess the agreement between P ETCO 2 measurements performed by mainstream and sidestream methods with the P aCO 2 values. METHODS: This was a prospective observational study. A total of 114 subjects were enrolled in the study. P ETCO 2 measurements using mainstream and sidestream methods were performed simultaneously with the arterial blood sampling in subjects who were observed in the emergency department and required arterial blood gas analysis. Agreement between the P ETCO 2 measurements and the P aCO 2 values obtained from arterial blood gas analysis were evaluated using the Bland-Altman method. RESULTS: Sixty subjects (52.6%) were female, and the mean age was 60.9 years (95% CI 58.3-63.6). The mean P aCO 2 was 35.16 mm Hg (95% CI 33.81-36.51), the mainstream P ETCO 2 was 22.11 (95% CI 21.05-23.18), and the sidestream P ETCO 2 was 25.48 (95% CI 24.22-26.75). Bland-Altman analysis showed an average difference between mainstream P ETCO 2 and P aCO 2 values of 13 mm Hg (95% limits of agreement ؊0.6 to 25.5) and moderate correlation (r ‫؍‬ 0.55, P < .001). The average difference between the sidestream P ETCO 2 and P aCO 2 values was 9.7 mm Hg (95% limits of agreement ؊5.4 to 24.7) and poor correlation (r ‫؍‬ 0.41, P < .001). CONCLUSIONS: P ETCO 2 values obtained by mainstream and sidestream methods were found to be significantly lower than the P aCO 2 values. There was essentially no agreement between the measurements obtained by 2 different methods and the P aCO 2 values.

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“…Hasil penelitian ini sejalan dengan hasil penelitian Cinar et al (2010) Mode ventilasi mekanik yang digunakan pasien dalam penelitian adalah CPAP, SIMV, dan IPPV/ CMV. Mode CPAP sebanyak 55 data (69,62%) memiliki selisih nilai PETCO2 dan PaCO2 ≤5 mmHg, dan 24 data (30,38%) memiliki selisih nilai >5 mmHg.…”

Section: Pembahasanunclassified

Perbandingan Nilai PETCO2 dan PACO2 pada Pasien dengan Pemasangan Ventilasi Mekanik

Soetioputro¹,

Susilaningsih²,

Mulyati³

2016

JKP

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AbstrakPasien dengan ventilasi mekanik perlu dilakukan pemantauan CO 2 karena berperan penting pada regulasi pernapasan dan keseimbangan asam-basa tubuh. Pemantauan CO 2 dapat dilakukan dengan mengukur PaCO 2 melalui analisis gas darah arteri. Pengukuran PaCO 2 tidak dapat dilakukan secara kontinu sehingga perlu sering dilakukan pengambilan darah arteri yang dapat menimbulkan komplikasi. Pengukuran PETCO 2 dapat memantau CO 2 secara kontinu dan non invasif. PETCO 2 adalah tekanan parsial CO 2 ekspirasi yang diukur pada saat akhir volume tidal pernapasan. Penelitian ini bertujuan membandingkan nilai PETCO 2 dan PaCO 2 pada pasien dengan ventilasi mekanik di ruang GICU RSUP Dr. Hasan Sadikin Bandung. Rancangan penelitian yang digunakan adalah prospective cross sectional. Pemilihan sampel dilakukan secara consecutive sampling. Penelitian dilakukan terhadap 21 pasien yang menggunakan ventilasi mekanik di ruang GICU RSUP Dr. Hasan Sadikin Bandung. Data PETCO 2 dicatat pada saat perawat mengambil sampel darah arteri untuk pemeriksaan analisis gas darah. Didapatkan 122 pasang data nilai PETCO 2 dan PaCO 2 . Data yang diperoleh dianalisis dengan Bland-Altman plot. Hasil penelitian nilai PETCO 2 berada pada rentang 14-67 mmHg dan nilai PaCO 2 berada pada rentang 17-77 mmHg. Bias nilai PETCO 2 dan PaCO 2 adalah -4,6475 mmHg lebih rendah daripada estimasi nilai bias ±5 mmHg sehingga bisa diterima secara klinik. Presisi nilai PETCO 2 adalah 12,7969 mmHg (limit of agreement= 1,7509; -11,0460) lebih tinggi daripada estimasi nilai presisi ±5 mmHg sehingga tidak bisa diterima secara klinik. Kesimpulan dari penelitian ini adalah pengukuran PETCO 2 tidak dapat menggantikan pengukuran PaCO 2 , tetapi pengukuran PETCO 2 dapat digunakan untuk memperkirakan nilai PaCO 2 pasien dengan ventilasi mekanik.Kata kunci: PETCO 2 , PaCO 2 , ventilasi mekanik. Comparison of PETCO 2 and PACO 2 Values in Patients with Mechanical Ventilation AbstractPatients with mechanical ventilation need to be monitored for the CO 2 value because it has an important role in regulation of respiration and body acid-base equilibrium. Monitoring of CO 2 can be done by measuring PaCO 2 through arterial blood gas analysis. Measurement of PaCO 2 could not be done continuously so that the arterial blood are needed to be taken quite often which could cause complication. The measurement of PETCO 2 can monitor the CO 2 continuously and non-invasively. PETCO 2 is partial pressure of CO 2 expiration that is measured at the end of respiration tidal volume. This study aimed to compare the PETCO2 value and PaCO 2 in patients with mechanical ventilation in GICU Dr. Hasan Sadikin Hospital. The research design was prospective crosssectional using consecutive sampling method. The total sample was 21 patients who used mechanical ventilator in GICU Dr. Hasan Sadikin Hospital Bandung. The PETCO 2 data were recorded when the patients' arterial blood sample were taken for blood gas analysis test. The total of 122 pair date of PETCO 2 and PaCO 2 values were recorded. The data were anal...

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Can mainstream end-tidal carbon dioxide measurement accurately predict the arterial carbon dioxide level of patients with acute dyspnea in ED

Cited by 31 publications

References 14 publications

Prehospital end-tidal carbon dioxide differentiates between cardiac and obstructive causes of dyspnoea

Prehospital end-tidal carbon dioxide differentiates between cardiac and obstructive causes of dyspnoea

Disparity Between Mainstream and Sidestream End-Tidal Carbon Dioxide Values and Arterial Carbon Dioxide Levels

Perbandingan Nilai PETCO2 dan PACO2 pada Pasien dengan Pemasangan Ventilasi Mekanik

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