Arterial to end-tidal carbon dioxide gap and its characterization in mechanically ventilated adults in the emergency department
Copyright © 2023 Elsevier Inc. All rights reserved..
PURPOSE: To evaluate early measurement of the arterial to end-tidal carbon dioxide (PaCO2-PetCO2) gap, a surrogate for physiologic dead space, and its association with clinical outcomes in intubated adults in the emergency department (ED).
MATERIALS AND METHODS: Observational cohort study of invasively mechanically ventilated adults in an academic medical center (years 2009 to 2016). The association of the PaCO2-PetCO2 gap was evaluated with respect to clinical outcomes; the primary outcome was in-hospital mortality.
RESULTS: 519 patients were included. 325 (63%) patients had an elevated (>5 mmHg) PaCO2-PetCO2. Patients with an elevated PaCO2-PetCO2 were significantly older, had higher APACHE II scores, more frequently had chronic obstructive pulmonary disease (COPD), had lower arterial oxygen to fraction of inspired oxygen (P:F) ratios, and were more likely to be intubated for exacerbation of COPD or sepsis. There was no difference in mortality for patients with an elevated PaCO2-PetCO2 (25% vs 26%) in unadjusted analysis (p = 0.829) or adjusted analysis (aOR = 0.81 [95% CI: 0.53-1.26]), as compared to a non-elevated PaCO2-PetCO2.
CONCLUSIONS: An elevated PaCO2-PetCO2 gap is common in the post-intubation period in the ED, but not significantly associated with clinical outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:73 |
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| Enthalten in: |
The American journal of emergency medicine - 73(2023) vom: 15. Nov., Seite 154-159 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Upchurch, Cameron P [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory failure |
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| Anmerkungen: |
Date Revised 23.10.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.ajem.2023.08.042 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM361808380 |
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| 100 | 1 | |a Upchurch, Cameron P |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Arterial to end-tidal carbon dioxide gap and its characterization in mechanically ventilated adults in the emergency department |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 23.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: To evaluate early measurement of the arterial to end-tidal carbon dioxide (PaCO2-PetCO2) gap, a surrogate for physiologic dead space, and its association with clinical outcomes in intubated adults in the emergency department (ED) | ||
| 520 | |a MATERIALS AND METHODS: Observational cohort study of invasively mechanically ventilated adults in an academic medical center (years 2009 to 2016). The association of the PaCO2-PetCO2 gap was evaluated with respect to clinical outcomes; the primary outcome was in-hospital mortality | ||
| 520 | |a RESULTS: 519 patients were included. 325 (63%) patients had an elevated (>5 mmHg) PaCO2-PetCO2. Patients with an elevated PaCO2-PetCO2 were significantly older, had higher APACHE II scores, more frequently had chronic obstructive pulmonary disease (COPD), had lower arterial oxygen to fraction of inspired oxygen (P:F) ratios, and were more likely to be intubated for exacerbation of COPD or sepsis. There was no difference in mortality for patients with an elevated PaCO2-PetCO2 (25% vs 26%) in unadjusted analysis (p = 0.829) or adjusted analysis (aOR = 0.81 [95% CI: 0.53-1.26]), as compared to a non-elevated PaCO2-PetCO2 | ||
| 520 | |a CONCLUSIONS: An elevated PaCO2-PetCO2 gap is common in the post-intubation period in the ED, but not significantly associated with clinical outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute respiratory failure | |
| 650 | 4 | |a Dead space | |
| 650 | 4 | |a Emergency department | |
| 650 | 4 | |a End-tidal carbon dioxide | |
| 650 | 4 | |a Mechanical ventilation | |
| 700 | 1 | |a Wessman, Brian T |e verfasserin |4 aut | |
| 700 | 1 | |a Roberts, Brian W |e verfasserin |4 aut | |
| 700 | 1 | |a Fuller, Brian M |e verfasserin |4 aut | |
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