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Available online 1 May 2024
Can end-tidal CO2 measurement replace arterial partial CO2 in emergency department respiratory distress management?
¿Puede la medición del CO2 al final de la espiración reemplazar el CO2 parcial arterial en el tratamiento de la dificultad respiratoria en el departamento de urgencias?
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Kudret Selki, Mehmet Cihat Demir, Erdinç Şengüldür, Emre Erdem, Hatice Güldal, Murat Taşdemir, Alp Kaan Furkan Kıcıroğlu, Mustafa Boğan
Corresponding author
mustafabogan@duzce.edu.tr

Corresponding author.
Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey
This item has received
Received 05 November 2023. Accepted 30 March 2024
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Tables (3)
Table 1. Descriptive data of patients with respiratory distress (n = 97).
Table 2. Comparison of end-tidal carbon dioxide (EtCO2) values of patients with respiratory distress according to hospitalization status.
Table 3. Correlation analyses of EtCO2 and PaCO2 and PvCO2 measurements.
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Abstract
Objective

To assess the feasibility of using end-tidal carbon dioxide (EtCO2) as a non-invasive substitute for partial pressure of arterial carbon dioxide (PaCO2) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO2) as an alternative to PaCO2.

Design

Prospective cross-sectional study.

Setting

Tertiary university hospital.

Patients or participants

97 patients presenting with acute respiratory distress to the ED.

Interventions

EtCO2, arterial blood gases, and venous blood gases measured at admission (0 min), 60 min, and 120 min.

Main variables of interest

CO2 levels.

Results

Among 97 patients (mean age: 70.93 ± 9.6 years; 60.8% male), EtCO2 > 45 mmHg at admission showed strong positive correlations with PaCO2 and PvCO2 (r = 0.844, r = 0.803; p < 0.001, respectively). Significant positive correlation was observed between 60-min EtCO2 and PaCO2 (r = 0.729; p < 0.001). Strong correlation between PaCO2 and PvCO2 at 120 min when EtCO2 > 45 mmHg (r = 0.870; p < 0.001). EtCO2 was higher in hospitalized patients compared to discharged ones.

Conclusions

EtCO2 appears promising as a substitute for PaCO2 in ED patients with acute respiratory distress within the initial two hours of treatment. Venous blood gas sampling offers a less invasive alternative to arterial sampling, facilitating simultaneous blood tests.

Keywords:
End-tidal carbon dioxide
Respiratory distress
Arterial carbon dioxide
Venous carbon dioxide
Emergency department
Resumen
Objetivo

Evaluar la viabilidad de utilizar el dióxido de carbono al final de la espiración (EtCO2) como un sustituto no invasivo de la presión parcial de dióxido de carbono arterial (PaCO2) en el triaje y seguimiento en el departamento de emergencias (ED), y explorar el potencial de la presión parcial de dióxido de carbono venoso (PvCO2) como alternativa a PaCO2.

Diseño

Estudio prospectivo transversal.

Ámbito

Hospital universitario terciario.

Pacientes o participantes

97 pacientes que se presentaron con dificultad respiratoria en el ED.

Intervenciones

Se midieron EtCO2, gases en sangre arterial y gases en sangre venosa al ingreso (0 min), 60 min y 120 min.

Principales variables de interés

Niveles de CO2.

Resultados

Entre 97 pacientes (edad media: 70,93 ± 9,6 años; 60,8% hombres), EtCO2 > 45 al ingreso mostró correlaciones positivas fuertes con PaCO2 y PvCO2 (r = 0,844, r = 0,803; p < 0,001, respectivamente). Se observó una correlación positiva significativa entre EtCO2 a los 60 min y PaCO2 (r = 0,729; p < 0,001). Fuerte correlación entre PaCO2 y PvCO2 a los 120 min cuando EtCO2 > 45 (r = 0,870; p < 0,001). EtCO2 fue mayor en los pacientes hospitalizados en comparación con los dados de alta.

Conclusiones

EtCO2 parece prometedor como sustituto de PaCO2 en pacientes del ED con dificultad respiratoria dentro de las dos primeras horas de tratamiento. La toma de muestras de gases en sangre venosa ofrece una alternativa menos invasiva a la toma de muestras arterial, facilitando pruebas de sangre simultáneas.

Palabras clave:
Dióxido de carbono al final de la espiración
Insuficiencia respiratoria
Dióxido de carbono arterial
Dióxido de carbono venoso
Departamento de emergencias

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