Advertisement
The American Journal of Surgery
Advanced searchSave search
Original Research Article|Articles in Press

Utility of arterial CO2 - End-tidal CO2 gap as a mortality indicator in the surgical ICU

Published:October 20, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.049
Utility of arterial CO2 - End-tidal CO2 gap as a mortality indicator in the surgical ICU
Previous ArticleExperience of surgical subspecialty residents on general surgery rotations
Next ArticleWhat lies beneath – No need to fear a minimally invasive approach to inguinal hernia repairs after prior low abdominal surgery

      Highlights

      • •
        The PaCO2-ETCO2 gap is defined as the absolute difference between the two values.
      • •
        The PaCO2-ETCO2 gap is a valid predictor of mortality in SICU and is comparable to other biomarkers.
      • •
        Patients withsustained PaCO2-ETCO2 gap above 10 after the first 24 h of SICU admission had a higher mortality rate.

      Abstract

      Background

      End-tidal CO2 (ETCO2) measurements have been an established tool for assessing critically ill patients. We aim to show that PaCO2-ETCO2 gap can be used as a predictor of mortality over a 7-day ICU stay.

      Methods

      A retrospective chart review was performed on intubated surgical/trauma patients with documented ETCO2. We performed a univariate analysis and a receiver operating characteristic (ROC) curve.

      Results

      Thirty-four patients were included. Patients who died were found to have longer days on vasopressors, and higher lactic acid levels on days 2–5, and 7. PaCO2-ETCO2 gap was higher on days 2–4 in those that died. Using ROC, days 2 and 4 PaCO2-ETCO2 gaps had good sensitivities, comparable to lactic acid sensitivity, in predicting mortality.

      Conclusions

      PaCO2-ETCO2 gap was shown to be comparable to lactic acid in predicating mortality. Using this surrogate may aid to predict the clinical course in the ICU.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Nassar B.S.
        • Schmidt G.A.
        Capnography during critical illness.
        Chest. 2016 Feb; 149 (PubMed PMID: 26447854. Epub 20160112): 576-585
        View in Article
        • Donald M.J.
        • Paterson B.
        End tidal carbon dioxide monitoring in prehospital and retrieval medicine: a review.
        Emerg Med J. 2006 Sep; 23 (PubMed PMID: 16921096. Pubmed Central PMCID: PMC2564226): 728-730
        View in Article
        • Askrog V.
        Changes in (a-A)CO2 difference and pulmonary artery pressure in anesthetized man.
        J Appl Physiol. 1966 Jul; 21 (PubMed PMID: 5916666): 1299-1305
        View in Article
        • Campion E.M.
        • Cralley A.
        • Robinson C.
        • et al.
        Prehospital end-tidal carbon dioxide predicts massive transfusion and death following trauma.
        J. Trauma Acute Care Surg. 2020 Oct; 89 (PubMed PMID: 32590557): 703-707
        View in Article
        • Childress K.
        • Arnold K.
        • Hunter C.
        • et al.
        Prehospital end-tidal carbon dioxide predicts mortality in trauma patients.
        Prehosp Emerg Care. 2018 Mar-Apr; 22 (PubMed PMID: 28841360. Epub 20170825): 170-174
        View in Article
        • Tyburski J.G.
        • Carlin A.M.
        • Harvey E.H.
        • et al.
        End-tidal CO2-arterial CO2 differences: a useful intraoperative mortality marker in trauma surgery.
        J Trauma. 2003 Nov; 55 (; discussion 6-7. PubMed PMID: 14608162): 892-896
        View in Article
        • Tyburski J.G.
        • Collinge J.D.
        • Wilson R.F.
        • et al.
        End-tidal CO2-derived values during emergency trauma surgery correlated with outcome: a prospective study.
        J Trauma. 2002 Oct; 53 (PubMed PMID: 12394876): 738-743
        View in Article
        • Shetty A.
        • Sparenberg S.
        • Adams K.
        • et al.
        Arterial to end-tidal carbon dioxide tension difference (CO2 gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis.
        Emerg Med Australasia (EMA). 2018 Dec; 30 (PubMed PMID: 29756414. Epub 20180513): 794-801
        View in Article
        • Safari E.
        • Torabi M.
        Relationship between end-tidal CO2 (ETCO2) and lactate and their role in predicting hospital mortality in critically ill trauma patients; A cohort study.
        Bull Emerg Trauma. 2020 Apr; 8 (PubMed PMID: 32420392. Pubmed Central PMCID: PMC7211390): 83-88
        View in Article
        • Lecompte-Osorio P.
        • Pearson S.D.
        • Pieroni C.H.
        • et al.
        Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS.
        Crit Care. 2021 Sep 15; 25 (PubMed PMID: 34526077. Pubmed Central PMCID: PMC8442447. Epub 20210915): 333
        View in Article
        • Price J.
        • Sandbach D.D.
        • Ercole A.
        • et al.
        End-tidal and arterial carbon dioxide gradient in serious traumatic brain injury after prehospital emergency anaesthesia: a retrospective observational study.
        Emerg Med J. 2020 Nov; 37 (PubMed PMID: 32928874. Pubmed Central PMCID: PMC7588597. Epub 20200914): 674-679
        View in Article
        • Doppmann P.
        • Meuli L.
        • Sollid S.J.M.
        • et al.
        End-tidal to arterial carbon dioxide gradient is associated with increased mortality in patients with traumatic brain injury: a retrospective observational study.
        Sci Rep. 2021 May 17; 11 (PubMed PMID: 34001982. Pubmed Central PMCID: PMC8129079. Epub 20210517)10391
        View in Article

      Article info

      Publication history

      Published online: October 20, 2022
      Accepted: October 18, 2022
      Received in revised form: October 4, 2022
      Received: July 7, 2022

      Publication stage

      In Press Journal Pre-Proof

      Identification

      DOI: https://doi.org/10.1016/j.amjsurg.2022.10.049

      Copyright

      © 2022 Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX