Arterial to end-tidal carbon dioxide gap and its characterization in mechanically ventilated adults in the emergency department

Cameron P. Upchurch, Brian T. Wessman, Brian W. Roberts, Brian M. Fuller

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)154-159
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume73
DOIs
StatePublished - Nov 2023

Keywords

  • Acute respiratory failure
  • Dead space
  • Emergency department
  • End-tidal carbon dioxide
  • Mechanical ventilation

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