Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis

McGillicuddy, Daniel C.; Tang, Aimee; Cataldo, Lauren; Gusev, Julia; Shapiro, Nathan I.

doi:10.1007/s11739-008-0153-z

Cited by 33 publications

(28 citation statements)

References 10 publications

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“…On the other hand, in another study 29 that found a moderate correlation between EtCO 2 and HCO 3 (r=0.506), it was obtained values of EtCO 2 ≤ 25, with a specificity of 84% for acidosis in its sample, and EtCO 2 ≥37mmHg, with 100% sensitivity for absence of metabolic acidosis. Still, in another previous study 30 , a weak inverse correlation was obtained between EtCO 2 and SOFA (r= -0.35, p<0.01) and between EtCO 2 and lactate (r= -0.35, p<0.01) in febrile and potentially septic patients. However, in a later study 18 , a moderate inverse correlation was found between EtCO 2 and lactate, according to the septic status: in patients with sepsis (r= -0.421, p<0.001), severe sepsis (r= -0.597, p<0.001), and septic shock (r= -0.482, p<0.011).…”

Section: Resultsmentioning

confidence: 67%

“…Palma de Mallorca, IB, Spain, 2016AuthornCannula usedType of sensor Capnograph usedMeasurement durationPishbin et al ( 1 ) 64Nc*SidestreamCapnocheck (r) Sleep Capnograp/oximeter.NK/NA † Agus et al ( 11 ) 72Nc*MicrostreamMDE Escort Prism (r) monitorNK/NA † Gilhotra & Porter ( 23 ) 58Nc*SidestreamPhilips M3046A.1 minSolana et al ( 12 ) 25Nco ‡ MicrostreamPhilips smarth capnoline O2 pediatrics.30 sec-1minNagler et al ( 24 ) 130Nco ‡ MicrostreamMicrocap; Oridion.1-2 minKartal et al ( 29 ) 240O § SidestreamMedlab Cap 10 sidestream.NK/NA † McGillicuddy et al ( 30 ) 97NK/NA † MicrostreamNelcor NBP-70.NK/NA † Soleimanpour et al ( …”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, in the adult population, no correlation and/or concordance was found between the study variables, discouraging the use of this system to assess the patient's metabolic and/or ventilatory status, according to several studies 20 , 27 - 28 , 30 . The final diagnoses of the patients included in these studies 27 - 28 were associated with chronic respiratory or cardiac diseases, which directly influences the physiology and the EtCO 2 values.…”

Section: Discussionmentioning

confidence: 99%

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Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting

Cereceda-Sánchez

Molina-Mula

2017

Rev. Latino-Am. Enfermagem

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Objective:to evaluate the usefulness of capnography for the detection of metabolic changes in spontaneous breathing patients, in the emergency and intensive care settings. Methods:in-depth and structured bibliographical search in the databases EBSCOhost, Virtual Health Library, PubMed, Cochrane Library, among others, identifying studies that assessed the relationship between capnography values and the variables involved in blood acid-base balance. Results:19 studies were found, two were reviews and 17 were observational studies. In nine studies, capnography values were correlated with carbon dioxide (CO2), eight with bicarbonate (HCO3), three with lactate, and four with blood pH. Conclusions:most studies have found a good correlation between capnography values and blood biomarkers, suggesting the usefulness of this parameter to detect patients at risk of severe metabolic change, in a fast, economical and accurate way.

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Section: Resultsmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting

Cereceda-Sánchez

Molina-Mula

2017

Rev. Latino-Am. Enfermagem

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“…There may be a need for new, simple, reliable and clinically available measurements to contribute to the definition of the sepsis. ETCO 2 levels, a good example of this, have been shown as a reliable measurement to identifying sepsis (38,39) and an accurate predictor of mortality. It was found that an ETCO 2 concentration less than 25 mmHg are strongly associated with serum lactate levels >4 mmol L -1 (38).…”

Section: Roadmap For the Futurementioning

confidence: 99%

Changing Definitions of Sepsis

Gül¹,

Arslantaş²,

Cinel³

et al. 2017

Turk J Anaesth Reanim

145

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“…

McGillicuddy et al [1] should be commended on their attempt to identify a non-invasive method of screening febrile patients for possible sepsis. It is now well accepted that sepsis is a life-threatening disease that needs to be identified as soon as possible; multiple studies have demonstrated that early, aggressive resuscitation leads to better outcomes [2,3].

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confidence: 99%

Not the end of end-tidal CO2

Shah

2008

Intern Emerg Med

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McGillicuddy et al. [1] should be commended on their attempt to identify a non-invasive method of screening febrile patients for possible sepsis. It is now well accepted that sepsis is a life-threatening disease that needs to be identified as soon as possible; multiple studies have demonstrated that early, aggressive resuscitation leads to better outcomes [2,3]. If end-tidal capnography (ETCO2) could identify septic patients among the numerous febrile patients seen in the hospital everyday, a significant advance in medicine would be made.In theory, use of ETCO2 is ideal physiologically and practically. When patients become septic, hypoperfusion at the cellular level leads to a metabolic acidosis that results in a compensatory respiratory alkalosis to maintain homeostasis. ETCO2 should reflect these physiologic changes as it has in identifying hypovolemic shock in trauma patients and respiratory status for procedural sedation. ETCO2 is also non-invasive and simple to use; it can be performed at triage, at the bedside or even en route to the hospital by emergency medicine personnel. In fact, in New York City, ETCO2 will be present on all advanced life support ambulances in 2009. Identification of potential sepsis patients even before hospital arrival would allow maximal time for immediate mobilization of any and all resources necessary for early, goal-directed therapy for sepsis.Unfortunately, the evaluation of ETCO2 in predicting elevated SOFA scores and lactic acidosis by McGillicuddy et al. did not yield a strong enough correlation for reliable clinical decision-making. The sensitivity of ETCO2 was 60 and 73% for predicting lactate C4 and SOFA C2, respectively. The positive and negative likelihood ratios I calculated (1.04 and 0.94 for lactate; 1.49 and 0.52 for SOFA score) were too low for any true impact.I would propose that, given the theoretical value of ETCO2 as described above and the less than ideal study design, the results of this study should not halt further research on ETCO2 as a possible non-invasive marker of sepsis.The first and biggest error in study design was using a surrogate marker (ETCO2) for another surrogate marker (SOFA score or lactate level) of sepsis. Although both SOFA scores and lactate levels are predictive of sepsis, they are not perfect [4,5]. Among the five patients with an elevated lactate and 34 patients with an elevated SOFA, how many of these patients had sepsis? It is not entirely clear in this study. Testing or correlating ETCO2 with ''sepsis'' rather than against surrogate markers would be a much more substantial study.Future studies should also attempt to identify an ideal cutoff or threshold for ETCO2. This study used only ETCO2 less than 35 as abnormal but the sensitivity could be higher with a lower or higher threshold. This has yet to be determined. The study design would be further helped by not only studying the patients with sepsis, but a control group that clearly does not have sepsis if one is to determine what range of the CO2 is going to indicate possible seps...

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Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis

Cited by 33 publications

References 10 publications

Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting

Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting

Changing Definitions of Sepsis

Not the end of end-tidal CO2

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