TY - JOUR
T1 - Arterial to end-tidal carbon dioxide gap and its characterization in mechanically ventilated adults in the emergency department
AU - Upchurch, Cameron P.
AU - Wessman, Brian T.
AU - Roberts, Brian W.
AU - Fuller, Brian M.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/11
Y1 - 2023/11
N2 - 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.
AB - 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.
KW - Acute respiratory failure
KW - Dead space
KW - Emergency department
KW - End-tidal carbon dioxide
KW - Mechanical ventilation
UR - http://www.scopus.com/inward/record.url?scp=85169907625&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2023.08.042
DO - 10.1016/j.ajem.2023.08.042
M3 - Article
C2 - 37683313
AN - SCOPUS:85169907625
SN - 0735-6757
VL - 73
SP - 154
EP - 159
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -