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

Emergency Medicine Australasia : EMA
Amith ShettyJonathan Iredell

Abstract

The arterial to end-tidal carbon dioxide tension difference (CO2 gap) correlates with physiologic dead space. The prognostic value of increased CO2 gap in trauma and respiratory distress patients is documented. Transpulmonary arteriovenous shunting is identified as a predictor of mortality in non-pulmonary sepsis. We set out to investigate the prognostic value of the CO2 gap in a pilot study of patients with suspected sepsis from non-respiratory causes. Patients presenting to tertiary Australian ED with suspected sepsis (n = 215) underwent near-simultaneous end-tidal carbon dioxide and partial pressure of carbon dioxide measurements. We investigated the correlation of CO2 gap levels with the primary outcome of in-hospital mortality (IHM) and secondary outcomes of sepsis (ΔSOFA ≥2) and IHM and/or intensive care unit stay ≥72 h (IHM/ICU72h) in patients with sepsis because of non-respiratory causes. Among patients included in the analysis (n = 165), the CO2 gap showed modest positive correlation with qSOFA (ρ = 0.39) and weak positive correlation with SOFA scores (ρ = 0.29) (both P < 0.01). The CO2 gap had modest predictive value for primary outcome (IHM), area under receiver operating curve (AUROC 0.85, 95% confidence interval [C...Continue Reading

References

Oct 24, 2002·The Journal of Trauma·James G TyburskiChristopher P Steffes
May 4, 2004·British Journal of Anaesthesia·J D Young
Jan 15, 2005·Journal of Applied Physiology·Sara L S MenezesPatricia R M Rocco
Dec 15, 2010·Emergency Medicine Australasia : EMA·Amith L ShettyKaren Byth
Apr 18, 2013·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Robert BrowningCatriona Graham
May 31, 2013·Annals of Intensive Care·Romain SonnevilleTarek Sharshar
Nov 30, 2014·The American Journal of Emergency Medicine·Julie ContentiJacques Levraut
Apr 12, 2016·Tuberculosis and Respiratory Diseases·Won-Young Kim, Sang-Bum Hong

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Citations

Aug 7, 2021·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Li DongYosuke Yamamoto
Sep 17, 2021·Critical Care : the Official Journal of the Critical Care Forum·Paola Lecompte-OsorioJohn P Kress

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