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both prehospital and hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition to being considered the most reliable confirmation method of the correct placement of the endotracheal tube&#44; it also helps the physician in life support efforts&#44; such as determining the quality of cardiopulmonary resuscitation and detecting the return of spontaneous circulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Capnography is used in various situations&#44; including procedural sedation and analgesia&#44; patient transfer&#44; pulmonary embolism&#44; and acute follow-up of chronic obstructive pulmonary disease &#40;COPD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">EtCO<span class="elsevierStyleInf">2</span> is the level of carbon dioxide released at the end of expiration&#46; For noninvasive EtCO<span class="elsevierStyleInf">2</span> measurement&#44; capnometry&#44; which provides only numerical values&#44; or capnography&#44; which provides both graphical and numerical results&#44; is used&#46; Measurement is made as a mainstream or a sidestream&#46; In sidestream&#44; the CO<span class="elsevierStyleInf">2</span> sensor is located inside the monitor&#44; and a small portion of the exhaled air reaches the breathing circuit through a cable with a delay&#46; In the mainstream type&#44; the CO<span class="elsevierStyleInf">2</span> sensor is directly connected to the breathing circuit and displays the result without delay&#46; While sidestream can be used in intubated and non-intubated patients&#44; mainstream is primarily used in intubated patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6&#44;12&#44;15</span></a> While increased dead space and clogging with secretions are substantial disadvantages in the sidestream type&#44; these are no longer a problem in the mainstream type&#44; and the results are more reliable&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Partial pressure of arterial carbon dioxide &#40;PaCO<span class="elsevierStyleInf">2</span>&#41; is the gold standard for diagnosing and treating patients presenting to the ED with respiratory distress&#46; However&#44; in busy EDs&#44; there is a need for fast&#44; practical&#44; cost-effective&#44; and noninvasive methods that will help us comprehend the severity of patients while they are still in the triage phase&#46; In many of the studies in the literature on non-intubated patients&#44; correlation studies were conducted between EtCO<span class="elsevierStyleInf">2</span> measurements obtained through sidestream detectors and PaCO<span class="elsevierStyleInf">2</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;16&#8211;18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The main aim of this study is to determine whether the EtCO<span class="elsevierStyleInf">2</span> value obtained using the mainstream detector at the first presentation to the ED in non-intubated patients can be safely used instead of the patient&#39;s PaCO<span class="elsevierStyleInf">2</span> value&#46; The reason for using the mainstream detector&#44; which is used in intubated patients&#44; instead of the sidestream detector in non-intubated patients is that the previously described disadvantages that may alter the measurement results&#44; such as dead space and obstruction by secretions&#44; are less likely to be encountered&#46; The secondary aim of the study was to determine whether partial pressure of venous carbon dioxide &#40;PvCO<span class="elsevierStyleInf">2</span>&#41; measurement would be an alternative to partial pressure of arterial carbon dioxide &#40;PaCO<span class="elsevierStyleInf">2</span>&#41; measurement&#44; especially in patients who are not suitable for EtCO<span class="elsevierStyleInf">2</span> &#40;confused or intubated&#41;&#46; The tertiary aim of the study was to determine whether EtCO<span class="elsevierStyleInf">2</span> measurement was associated with hospitalizations&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study design and setting</span><p id="par0030" class="elsevierStylePara elsevierViewall">It was planned as a prospective cross-sectional study with patients who presented to the ED with respiratory distress between April and May 2023 &#40;61 days&#41;&#46; The study was conducted in the ED of a 317-bed tertiary university hospital with approximately 90&#44;000 patient admissions per year&#46; Local Ethics Committee approval was received for the study &#40;Approval ID&#58; 2023&#47;42&#44; dated March 20&#44; 2023&#41;&#46; Patients were included in the study by obtaining informed consent&#46; Patient data were recorded on the study form simultaneously during the patients&#39; application&#46; Descriptive data were obtained from the hospital&#39;s electronic database and ED records&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Participants and measurements</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with a primary complaint of dyspnea regardless of etiology&#44; older than 18 years of age&#44; able to blow into a capnograph device and followed up in the emergency department for at least 2&#160;h were included in the study&#46; Of the 623 patients admitted to the emergency department with respiratory distress&#46; We excluded 111 patients who refused to participate in the study&#44; 162 patients with confused&#44; uncooperative or ineffective blowing&#44; 87 patients with inconclusive blood gas results due to coagulation&#44; 25 patients undergoing tracheal intubation&#44; 141 patients who have not been in the ED for at least 2&#160;h &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Participation in the study was purely voluntary and not reliant on coercion&#46; Demographic information of the patients&#44; EtCO<span class="elsevierStyleInf">2</span> level&#44; PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> levels&#44; pulse oximetry saturation level &#40;SpO<span class="elsevierStyleInf">2</span>&#41;&#44; and treatments given were recorded at the moment of first admission &#40;0th minute&#41;&#44; 60th minute&#44; and 120th minute&#46; The patients&#39; hospitalization-discharge status&#44; vital signs&#44; and initial blood gas pH values were also noted&#46; Arterial blood gas samples were obtained simultaneously from the radial artery&#44; brachial artery&#44; or femoral artery&#44; and venous blood gas samples were obtained from the brachial vein simultaneously with heparinized syringes and quickly delivered to the laboratory&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Measuring EtCO<span class="elsevierStyleInf">2</span></span><p id="par0040" class="elsevierStylePara elsevierViewall">EtCO<span class="elsevierStyleInf">2</span> measurements were performed by attaching a 3D-printed disposable apparatus &#40;colorFabb 1&#46;75&#160;mm filament was used with a Creality Ender 3 Pro 3D printer&#41; to the airway adapter of a mainstream EMMA&#174; Capnograph device &#40;PHASEIN AB Sv&#228;rdv&#228;gen&#44; Danderyd&#44; Sweden&#41;&#46; It is produced for intubated patients&#46; It was obtained with spontaneous single pulses from patients presenting with respiratory distress&#46; Carbon dioxide level was classified as follows&#58; &#60;35&#160;mmHg &#40;hypocarbia&#41;&#44; 35&#8722;45&#160;mmHg &#40;normocarbia&#41;&#44; and &#62;45&#160;mmHg &#40;hypercarbia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> End tidal carbon dioxide measurement takes 3&#160;s and arterial and venous carbon dioxide measurement takes approximately 10&#160;min&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using SPSS software for Windows&#44; version 23 &#40;IBM&#44; Chicago&#44; IL&#44; United States&#41;&#46; Descriptive statistics are presented as numbers and percentages&#46; Demographic data were presented as mean&#160;&#177;&#160;standard deviation &#40;SD&#41;&#44; or median &#40;interquartile range&#41;&#46; Spearman correlation analysis was used for correlation analyses between EtCO<span class="elsevierStyleInf">2</span>&#44; PaCO<span class="elsevierStyleInf">2</span>&#44; PvCO<span class="elsevierStyleInf">2</span>&#44; SpO<span class="elsevierStyleInf">2</span>&#44; and cigarette pack&#47;year&#46; If the Spearman correlation coefficient &#40;r&#41; is below 0&#46;20&#44; it is considered an insignificant correlation&#46; A weak correlation is marked between 0&#46;20&#8722;0&#46;50&#44; a moderate correlation is observed between 0&#46;50&#8722;0&#46;70&#44; and a strong correlation is observed when it is greater than 0&#46;70&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Coefficients &#34;<span class="elsevierStyleItalic">i</span>&#34; were given as significance values &#34;<span class="elsevierStyleItalic">p</span>&#46;&#34; Correlation was considered significant at <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46; The Pearson chi-square test and Fisher&#39;s exact test &#40;when the expected number was less than five&#41; were used for independent categorical variables&#46; Bonferroni correction was made for subgroup analysis&#44; and <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;016 was considered significant&#46; The Mc Nemar test was used for dependent categorical variables&#46; For the relationship between the treatment given with EtCO<span class="elsevierStyleInf">2</span> and hospitalization discharge&#44; the Mann-Whitney <span class="elsevierStyleItalic">U</span> test was used for independent two-group comparisons that did not show normal distribution&#44; and the Kruskal Wallis test was used for multi-group comparisons&#46; Student-t test was used for numerical two-group variables with normal distribution&#46; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05 was considered significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 623 patients admitted to the ED with respiratory distress&#44; 512 agreed to participate in the study &#40;&#37;82&#41;&#46; Of these&#44; 415 were excluded from the study for reasons explained in the method&#46; The study was planned with 97 patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The average age of the patients was 70&#46;9&#160;&#177;&#160;9&#46;6 years&#44; and 60&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;59&#41; were male&#46; 43&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;42&#41; of the patients who admitted were ex-smokers&#46; The most common comorbidities were hypertension &#40;HT&#41; with 76&#37; &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;74&#41; and COPD with 58&#37; &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;57&#41;&#46; 34&#37; of the patients were hypercarbic at first presentation &#40;0th minute&#44; PaCO<span class="elsevierStyleInf">2</span> at admission &#62;45&#160;mmHg&#41;&#46; Descriptive data of the patients are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The results of EtCO<span class="elsevierStyleInf">2</span> values between hospitalized and discharged patients&#44; including measurements at admission&#44; 60th and 120th minutes&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; EtCO<span class="elsevierStyleInf">2</span> value was statistically significantly higher in all measurements in hospitalized patients than in discharged patients&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the results of the correlations between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements at the time of admission&#44; the sixtieth and the 120th minute&#44; in detail&#46; When the EtCO<span class="elsevierStyleInf">2</span> value was above 45 mmHg&#44; a strong positive &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;844 and <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;803&#41; and significant relationship was found between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001 for both&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">When the EtCO<span class="elsevierStyleInf">2</span> value was above 45 mmHg&#44; a strong positive and significant relationship was found between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;730 and <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;702&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001 for both&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A strong positive and significant correlation was found between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurement when the EtCO<span class="elsevierStyleInf">2</span> value was below 35 mmHg &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;858&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; A strong positive and significant relationship was seen when PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> EtCO<span class="elsevierStyleInf">2</span> values were between 35&#8722;45 mmHg &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;883&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; There was a strong positive and significant relationship between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurement when the EtCO<span class="elsevierStyleInf">2</span> value was above 45 &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;891&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the last measurements at the 120th minute&#44; a moderately positive and significant relationship was found between EtCO<span class="elsevierStyleInf">2</span>&#44; PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> values &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;677 and <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;609&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001 for both&#41;&#46; When the EtCO<span class="elsevierStyleInf">2</span> value was above 45 mmHg&#44; a moderate positive and significant relationship was observed between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;667 and <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;563&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001 for both&#41;&#46; When the EtCO<span class="elsevierStyleInf">2</span> value was below 35 mmHg&#44; a moderately positive and significant correlation was observed between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurement &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;697&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; A strong positive and significant &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;791&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; relationship was detected between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements when the EtCO<span class="elsevierStyleInf">2</span> value was between 35&#8722;45 mmHg&#46; There was a strong positive and significant relationship between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurement when the EtCO<span class="elsevierStyleInf">2</span> value was above 45 mmHg &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;870&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">We found a strong positive and significant relationship between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> measurements at admission &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;820&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; The variance explained by the variables on each other is 67&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; We found a strong positive and significant relationship between 60th-minute EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> measurement &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;729&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; The variance explained by the variables on each other is 53&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; A strong positive and significant relationship existed between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurement at the 60th minute &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;937&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; The variance explained by the variables on each other is 87&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; A moderately negative and significant relationship existed between EtCO<span class="elsevierStyleInf">2</span> and SpO2measurement at admission &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;&#8722;0&#46;516&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; There was no significant relationship between EtCO<span class="elsevierStyleInf">2</span> and SpO<span class="elsevierStyleInf">2</span> measurement at the 60th minute and 120th minute &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;402 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;771&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Our study found a high correlation between EtCO<span class="elsevierStyleInf">2</span> at admission &#40;zero minutes&#41; and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;820 and <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;772&#44; respectively&#41;&#46; We also found a high correlation between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;891&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; We found a moderately positive and significant relationship between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements when the EtCO<span class="elsevierStyleInf">2</span> value was between 35&#8722;45 mmHg &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;621 and <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;657&#44; respectively&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001 for both&#41;&#46; When the EtCO<span class="elsevierStyleInf">2</span> value was above 45 mmHg&#44; a strong positive and significant relationship was found between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;844 and <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;803&#44; respectively&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001 for both&#41;&#46; Apart from this&#44; a strong correlation was observed between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> for all measurements&#46; These results showed that in triage patients presenting to the emergency department with respiratory distress&#44; if the EtCO<span class="elsevierStyleInf">2</span> value measured with a single blow is above 45 mmHg&#44; the patient is considered hypercapnic&#44; and treatment can be started early&#46; Another important conclusion is that venous blood gas measurement is a strong alternative to arterial blood gas measurement&#44; which is an excruciating procedure&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Arterial blood gas sampling in a patient presenting with respiratory distress is often challenging for both the patient and the physician&#46; It may need to be repeated from time to time&#46; Many clinical studies have been designed to increase patient comfort and identify new reliable methods&#46; One of the alternative methods is EtCO<span class="elsevierStyleInf">2</span> measurement&#46; Healey et al&#46; demonstrated a high correlation between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> measured before and after withdrawal of assisted-controlled mechanical ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Plewa et al&#46; found that the patients&#39; EtCO<span class="elsevierStyleInf">2</span> value obtained by the forced expiration model showed a high correlation with the PaCO<span class="elsevierStyleInf">2</span> value&#46; They also reported the negative predictive value of capnographic hypercapnia &#40;EtCO<span class="elsevierStyleInf">2</span> &#62; 45&#160;mmHg&#41; in detecting arterial hypercapnia &#40;PaCO<span class="elsevierStyleInf">2</span> &#62; 45&#160;mmHg&#41; as 95&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Other studies conducted with non-intubated patients have also reported a high correlation&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;18</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Measuring EtCO<span class="elsevierStyleInf">2</span> in non-intubated patients has difficulties&#46; Patient cooperation comes first among these difficulties&#46; Although the initial panic of outpatients with respiratory distress is another difficulty for measuring EtCO<span class="elsevierStyleInf">2</span> in the ED&#44; it is easier than arterial blood gas sampling&#46; Suzuki et al&#46; their study of non-intubated patients followed up due to respiratory diseases found a high positive correlation between EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;88&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;0001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Joe et al&#46; in their study&#44; it was stated that there was a significant correlation between EtCO<span class="elsevierStyleInf">2</span> measurement and PvCO<span class="elsevierStyleInf">2</span> in patients with chronic pulmonary disease and using oxygen &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;63&#41; and that the PvCO<span class="elsevierStyleInf">2</span> level of the patients could be predicted with capnography&#44; which is a noninvasive method&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> These studies support our results&#46; EtCO<span class="elsevierStyleInf">2</span> is a more comfortable&#44; faster&#44; and easily reproducible alternative to arterial blood gas sampling when starting the initial treatment of patients presenting to the ED with respiratory distress&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Venous blood gas sampling is easy&#46; Although it is an invasive procedure&#44; it is not as difficult for the patient and physician to repeat as arterial blood gas sampling&#46; Therefore&#44; understanding the relationship between PaCO<span class="elsevierStyleInf">2</span>&#44; EtCO<span class="elsevierStyleInf">2</span> and PvCO2 was investigated&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> However&#44; studies in the literature contain a partial consensus&#46; In a systematic review&#44; only 22&#46;5&#37; of included studies identified a strong correlation between arterial and venous parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Predictably&#44; different results may occur depending on patient characteristics&#46; In their methodological study with 20 patients with various diagnoses and complaints&#44; Lumholdt et al&#46; investigated the mathematical adaptability of peripheral venous blood gas values to arterial blood gas values&#46; They stated that there was a mathematically predictable relationship between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> A study in non-intubated patients followed up for respiratory diseases indicated a positive correlation between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;81&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Our study showed a high correlation between venous and arterial blood gas in terms of partial carbon dioxide pressure &#40;pCO<span class="elsevierStyleInf">2</span>&#41; in patients with respiratory distress from admission until the second hour of treatment&#46; In light of all these findings&#44; end-tidal carbon dioxide measurement seems to be an excellent alternative to arterial carbon dioxide measurement&#46; In addition&#44; venous carbon dioxide measurement is a good alternative in non-cooperative patients unsuitable for non-invasive end-tidal carbon dioxide measurement&#46; The fact that it is less painful and can be taken from the vein simultaneously with many other blood tests makes venous carbon dioxide measurement more important&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Conflicting results have been revealed in the literature regarding whether capnography can replace PaCO<span class="elsevierStyleInf">2</span> as a reliable tool in patients with acute respiratory distress&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;28&#44;29</span></a> In our study&#44; EtCO<span class="elsevierStyleInf">2</span> values of patients admitted with acute respiratory distress at admission and in the 1st and 2nd hours after treatment were associated with hospitalization&#46; EtCO<span class="elsevierStyleInf">2</span> measurements were higher in hospitalized patients compared to discharged patients&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The main limitation of this study is that it was conducted in a single center with a study group consisting of patients who presented to the ED of a tertiary university hospital&#46; The low number of cases in the city where the study was conducted caused the number of patients included in this study to be limited&#46; Second&#44; we did not correct pCO<span class="elsevierStyleInf">2</span> based on body temperature in any patient&#46; Phan et al&#46; noted that EtCO<span class="elsevierStyleInf">2</span> correlated better with pCO<span class="elsevierStyleInf">2</span> after temperature correction&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Third&#44; the patient&#39;s respiratory rate was not recorded&#46; When the respiratory rate increases&#44; the dead space ratio increases&#44; and the EtCO<span class="elsevierStyleInf">2</span> level may decrease&#46; Additionally&#44; the capnometer may not detect EtCO<span class="elsevierStyleInf">2</span> changes in case of a high respiratory rate&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The fourth limitation is that end tidal carbon dioxide measurement can only be performed in cooperative patients&#46; Finally&#44; conditions such as age&#44; existing lung disease&#44; and smoking may cause EtCO<span class="elsevierStyleInf">2</span> values to change&#46; Prediction ability decreases in the elderly and those with lung disease&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> We did not perform subgroup analysis on the patients&#46; Large-scale and multi-center studies in which subgroups are studied separately and necessary corrections are made according to the patient&#39;s vital values&#44; such as respiratory rate and temperature&#44; are needed to confirm this alternative diagnostic method&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">The EtCO<span class="elsevierStyleInf">2</span> value obtained from adding an insufflation device we produced to the capnograph and spontaneously inhaling patients with respiratory distress is a powerful alternative to arterial blood gas in the ED triage of patients and the first two hours of acute treatment&#46; It has also been shown that venous blood gas may be a good alternative&#46; In patients with acute respiratory distress &#40;patients who can cooperate and whose hemodynamics have not yet deteriorated&#41;&#44; this simple&#44; noninvasive EtCO<span class="elsevierStyleInf">2</span> measurement is also helpful in the early prediction of hospitalization decisions&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Author&#39;s contribution</span><p id="par0120" class="elsevierStylePara elsevierViewall">KS&#44; MCD&#44; MB contributed to conception&#59; KS&#44; MCD&#44; MB contributed to design&#59; MCD&#44; E&#350;&#44; MB contributed to supervision&#59; KS&#44; HG&#44; AKFK&#44; MT&#44; EE contributed to data collection and processing&#59; KS&#44; MCD contributed to analysis and interpretation&#59; KS&#44; MCD&#44; E&#350;&#44; MB contributed to literature review&#59; KS&#44; MCD&#44; E&#350;&#44; MB contributed to writing&#59; MCD&#44; MB contributed to critical review&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">The author&#40;s&#41; received no financial support for the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Declaration of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The author&#40;s&#41; declared no potential conflicts of interest with respect to the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Availability of data and materials</span><p id="par0135" class="elsevierStylePara elsevierViewall">Submitted work is original and has not been published elsewhere in any language&#46; Raw data are available for the editor on request&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Ethical statement</span><p id="par0140" class="elsevierStylePara elsevierViewall">Ethics Committee approval was obtained from the local ethics committee &#40;Date&#58; March 20&#44; 2023&#44; Decision No&#58; 2023&#47;42&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">Written consent was obtained from all patients&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Human rights</span><p id="par0150" class="elsevierStylePara elsevierViewall">Authors declare that human rights were respected according to the Declaration of Helsinki&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">The address of the institution where the study was performed</span><p id="par0155" class="elsevierStylePara elsevierViewall">D&#252;zce University&#44; School of Medicine&#44; D&#252;zce&#44; T&#252;rkiye&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">To assess the feasibility of using end-tidal carbon dioxide &#40;EtCO<span class="elsevierStyleInf">2</span>&#41; as a non-invasive substitute for partial pressure of arterial carbon dioxide &#40;PaCO<span class="elsevierStyleInf">2</span>&#41; in emergency department &#40;ED&#41; triage and follow-up&#44; and to explore the potential of partial pressure of venous carbon dioxide &#40;PvCO<span class="elsevierStyleInf">2</span>&#41; as an alternative to PaCO<span class="elsevierStyleInf">2</span>&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Prospective cross-sectional study&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Tertiary university hospital&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients or participants</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">97 patients presenting with acute respiratory distress to the ED&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">EtCO<span class="elsevierStyleInf">2</span>&#44; arterial blood gases&#44; and venous blood gases measured at admission &#40;0&#160;min&#41;&#44; 60&#160;min&#44; and 120&#160;min&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables of interest</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> levels&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Among 97 patients &#40;mean age&#58; 70&#46;93&#160;&#177;&#160;9&#46;6 years&#59; 60&#46;8&#37; male&#41;&#44; EtCO<span class="elsevierStyleInf">2</span>&#160;&#62;&#160;45 mmHg at admission showed strong positive correlations with PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;844&#44; <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;803&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#44; respectively&#41;&#46; Significant positive correlation was observed between 60-min EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;729&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; Strong correlation between PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> at 120&#160;min when EtCO<span class="elsevierStyleInf">2</span>&#160;&#62;&#160;45 mmHg &#40;<span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;870&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; EtCO<span class="elsevierStyleInf">2</span> was higher in hospitalized patients compared to discharged ones&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">EtCO<span class="elsevierStyleInf">2</span> appears promising as a substitute for PaCO<span class="elsevierStyleInf">2</span> in ED patients with acute respiratory distress within the initial two hours of treatment&#46; Venous blood gas sampling offers a less invasive alternative to arterial sampling&#44; facilitating simultaneous blood tests&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Evaluar la viabilidad de utilizar el di&#243;xido de carbono al final de la espiraci&#243;n &#40;EtCO<span class="elsevierStyleInf">2</span>&#41; como un sustituto no invasivo de la presi&#243;n parcial de di&#243;xido de carbono arterial &#40;PaCO<span class="elsevierStyleInf">2</span>&#41; en el triaje y seguimiento en el departamento de emergencias &#40;ED&#41;&#44; y explorar el potencial de la presi&#243;n parcial de di&#243;xido de carbono venoso &#40;PvCO<span class="elsevierStyleInf">2</span>&#41; como alternativa a PaCO<span class="elsevierStyleInf">2</span>&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo transversal&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Hospital universitario terciario&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes o participantes</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">97 pacientes que se presentaron con dificultad respiratoria en el ED&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Se midieron EtCO<span class="elsevierStyleInf">2</span>&#44; gases en sangre arterial y gases en sangre venosa al ingreso &#40;0&#160;min&#41;&#44; 60&#160;min y 120&#160;min&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Principales variables de inter&#233;s</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Niveles de CO<span class="elsevierStyleInf">2</span>&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Entre 97 pacientes &#40;edad media&#58; 70&#44;93&#160;&#177;&#160;9&#44;6 a&#241;os&#59; 60&#44;8&#37; hombres&#41;&#44; EtCO<span class="elsevierStyleInf">2</span>&#160;&#62;&#160;45&#160;al ingreso mostr&#243; correlaciones positivas fuertes con PaCO<span class="elsevierStyleInf">2</span> y PvCO<span class="elsevierStyleInf">2</span> &#40;r&#160;&#61;&#160;0&#44;844&#44; r&#160;&#61;&#160;0&#44;803&#59; p&#160;&#60;&#160;0&#44;001&#44; respectivamente&#41;&#46; Se observ&#243; una correlaci&#243;n positiva significativa entre EtCO<span class="elsevierStyleInf">2</span> a los 60&#160;min y PaCO<span class="elsevierStyleInf">2</span> &#40;r&#160;&#61;&#160;0&#44;729&#59; p&#160;&#60;&#160;0&#44;001&#41;&#46; Fuerte correlaci&#243;n entre PaCO<span class="elsevierStyleInf">2</span> y PvCO<span class="elsevierStyleInf">2</span> a los 120&#160;min cuando EtCO<span class="elsevierStyleInf">2</span>&#160;&#62;&#160;45 &#40;r&#160;&#61;&#160;0&#44;870&#59; p&#160;&#60;&#160;0&#44;001&#41;&#46; EtCO<span class="elsevierStyleInf">2</span> fue mayor en los pacientes hospitalizados en comparaci&#243;n con los dados de alta&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">EtCO<span class="elsevierStyleInf">2</span> parece prometedor como sustituto de PaCO<span class="elsevierStyleInf">2</span> en pacientes del ED con dificultad respiratoria dentro de las dos primeras horas de tratamiento&#46; La toma de muestras de gases en sangre venosa ofrece una alternativa menos invasiva a la toma de muestras arterial&#44; facilitando pruebas de sangre simult&#225;neas&#46;</p></span>"
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      ]
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      ]
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Gender&#44;</span> Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;60&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Age&#44; years &#40;mean&#160;&#43;&#160;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;9&#160;&#177;&#160;9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Initial arterial blood gas pH value &#91;mean&#160;&#43;&#160;SD &#40;min&#8211;max&#41;&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;37&#160;&#177;&#160;0&#46;08 &#40;7&#46;081&#8722;7&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Treatment at admission</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhaler bronchodilatorDiureticNoninvasive mechanical ventilation &#40;NIMV&#41;Oxygen support onlyInhaler&#160;&#43;&#160;diureticDiuretic&#160;&#43;&#160;NIMVInvasive mechanic ventilation &#40;IMV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;46&#46;4&#37;&#41;12 &#40;12&#46;4&#37;&#41;12 &#40;12&#46;4&#37;&#41;11 &#40;11&#46;3&#37;&#41;12 &#40;12&#46;4&#37;&#41;5 &#40;5&#46;2&#37;&#41;0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Treatment at the first hour</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhaler bronchodilatorDiuretic NIMVOxygen support only Inhaler&#160;&#43;&#160;diureticDiuretic&#160;&#43;&#160;NIMVIMV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;41&#46;2&#37;&#41;15 &#40;15&#46;5&#37;&#41;15 &#40;15&#46;5&#37;&#41;10 &#40;10&#46;3&#37;&#41;12 &#40;12&#46;4&#37;&#41;5 &#40;5&#46;2&#37;&#41;0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Treatment at the second hour</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhaler bronchodilatorDiuretic NIMVOxygen support only Inhaler&#160;&#43;&#160;diureticDiuretic&#160;&#43;&#160;NIMVIMV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;36&#46;1&#37;&#41;17 &#40;17&#46;5&#37;&#41;18 &#40;18&#46;5&#37;&#41;12 &#40;12&#46;4&#37;&#41;11 &#40;11&#46;3&#37;&#41;4 &#40;4&#46;1&#37;&#41;0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbidities</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart failureHypertensionChronic obstructive pulmonary diseaseDiabetesCoronary artery diseaseChronic renal failureLung malignancyTuberculosisOther malignanciesInterstitial lung disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;38&#37;&#41;74 &#40;76&#37;&#41;57 &#40;58&#37;&#41;36 &#40;37&#37;&#41;13 &#40;13&#37;&#41;11 &#40;11&#37;&#41;7 &#40;7&#37;&#41;9 &#40;9&#37;&#41;4 &#40;4&#37;&#41;1 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Smoking</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Active drinkerEx-smokerNever drank&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;16&#46;5&#37;&#41;42 &#40;43&#46;3&#37;&#41;39 &#40;40&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Diagnosis of chronic hypercarbia &#40;PaCO<span class="elsevierStyleInf">2</span> at admission &#62; 45&#160;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COPD exacerbationHeart failurePneumoniaAcute renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;34&#46;0&#37;&#41;18 &#40;18&#46;6&#37;&#41;11 &#40;11&#46;3&#37;&#41;2 &#40;2&#46;1&#37;&#41;2 &#40;2&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Outcome</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DischargedChest disease ward admissionCardiology ward admissionIntensive care unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;63&#46;9&#37;&#41;23 &#40;23&#46;7&#37;&#41;5 &#40;5&#46;2&#37;&#41;7 &#40;7&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All patients&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Discharged&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EtCO<span class="elsevierStyleInf">2</span> at admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;30&#8722;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;17&#160;&#177;&#160;15&#46;235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;95&#160;&#177;&#160;9&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">EtCO<span class="elsevierStyleInf">2</span> at the first hour&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  """
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Correlation analyses of EtCO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> and PvCO<span class="elsevierStyleInf">2</span> measurements&#46;</p>"
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                      "titulo" => "Correlation of end-tidal CO<span class="elsevierStyleInf">2</span> measurements to arterial PaCO<span class="elsevierStyleInf">2</span> in nonintubated patients"
                      "autores" => array:1 [
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                      "doi" => "10.1016/s0196-0644(94)70078-8"
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                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "1994"
                        "volumen" => "23"
                        "numero" => "3"
                        "paginaInicial" => "560"
                        "paginaFinal" => "563"
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