End Tidal Carbon Dioxide Underestimates Plasma Carbon Dioxide During Emergent Trauma Laparotomy Leading to Hypoventilation and Misguided Resuscitation: A Western Trauma Association Multicenter Study

The Journal of Trauma and Acute Care Surgery
Eric M CampionAdditional Study Group Members of the Western Trauma Association ETCO2 Study Group

Abstract

End tidal carbon dioxide(ETCO2) is routinely used during elective surgery to monitor ventilation. The role of ETCO2 monitoring in emergent trauma operations is poorly understood. We hypothesized that ETCO2 values underestimate plasma carbon dioxide(pCO2) values during resuscitation for hemorrhagic shock. Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels. 256 patients resulted in 587 matched pairs of ETCO2 and pCO2. Correlation between these two values was very poor with an R of 0.04. 40.2% of patients presented to the operating room acidotic and hypercarbic with a pH<7.30 and a pCO2>45mmHg. Correlation was worse in patients that were either acidotic or hypercarbic. 45% of patients have a difference of >10mmHg between ETCO2 and pCO2. A pH of <7.30 was predictive of an ETCO2 to pCO2 difference of >10mmHg. A difference of >10mmHg was predictive of mortality independent of confounders. Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10mmHg discordant from their PCO2 level. Reliance on the discordant values may have contributed to the 40% of patients in the operating room that were both acidotic and hypercarbic. Early blood gas analysis is warranted and a lower e...Continue Reading

References

Jul 11, 1998·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·K R Ward, D M Yealy
May 29, 1999·AACN Clinical Issues·J Mikhail
Oct 24, 2002·The Journal of Trauma·James G TyburskiChristopher P Steffes
Nov 11, 2003·The Journal of Trauma·James G TyburskiRobert F Wilson
Aug 31, 2004·Emergency Medicine Journal : EMJ·C YosefyL Reisin
Aug 22, 2006·Emergency Medicine Journal : EMJ·M J Donald, B Paterson
Jan 10, 2009·The Journal of Trauma·Keir J WarnerEileen M Bulger
Jul 9, 2010·Best Practice & Research. Clinical Anaesthesiology·Franco ValenzaLuciano Gattinoni
Apr 20, 2011·The Journal of Trauma·Daniel N DarlingtonMichael A Dubick
Apr 22, 2011·The British Journal of Surgery·K ThorsenK Søreide
Nov 30, 2016·Military Medical Research·Wenjun Z Martini
Aug 26, 2017·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Kelsey ChildressSalvatore Silvestri
Apr 25, 2018·The American Journal of Emergency Medicine·Yong Won KimKyoung-Chul Cha

❮ Previous
Next ❯

Citations

Jun 27, 2020·The Journal of Trauma and Acute Care Surgery·Eric M CampionClay Cothren Burlew
Apr 24, 2021·European Journal of Applied Physiology·Sole Lindvåg LieLars Øivind Høiseth
Aug 7, 2021·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Li DongYosuke Yamamoto

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.