In:
Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 87, No. 5 ( 2019-11), p. 1119-1124
Abstract:
End-tidal carbon dioxide (ETCO 2 ) is routinely used during elective surgery to monitor ventilation. The role of ETCO 2 monitoring in emergent trauma operations is poorly understood. We hypothesized that ETCO 2 values underestimate plasma carbon dioxide (pCO 2 ) values during resuscitation for hemorrhagic shock. METHODS Multicenter trial was performed analyzing the correlation between ETCO 2 and pCO 2 levels. RESULTS Two hundred fifty-six patients resulted in 587 matched pairs of ETCO 2 and pCO 2 . Correlation between these two values was very poor with an R 2 of 0.04. 40.2% of patients presented to the operating room acidotic and hypercarbic with a pH less than 7.30 and a pCO 2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO 2 and pCO 2 . A pH less than 7.30 was predictive of an ETCO 2 to pCO 2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders. CONCLUSION Nearly one half (45%) of patients were found to have an ETCO 2 level greater than 10 mm Hg discordant from their PCO 2 level. Reliance on the discordant values may have contributed to the 40% of patients in the operating room that were both acidotic and hypercarbic. Early blood gas analysis is warranted, and a lower early goal of ETCO 2 should be considered. LEVEL OF EVIDENCE Therapeutic, level IV.
Type of Medium:
Online Resource
ISSN:
2163-0763
,
2163-0755
DOI:
10.1097/TA.0000000000002469
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2651313-4
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