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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

      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

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      References

        • Nassar B.S.
        • Schmidt G.A.
        Capnography during critical illness.
        Chest. 2016 Feb; 149 (PubMed PMID: 26447854. Epub 20160112): 576-585
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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