Volumetric capnography as a bedside monitoring of thrombolysis in major pulmonary embolism

Intensive Care Medicine
Franck VerschurenGiuseppe Liistro

Abstract

To describe the use of volumetric capnography, a plot of expired CO(2) concentration against expired volume, in monitoring fibrinolytic treatment of major pulmonary embolism. Two case reports in the emergency department of a teaching hospital. Two conscious and spontaneously breathing patients (69- and 31-year-old women) with major pulmonary embolism requiring thrombolysis. Decision for thrombolysis was based on the association of right ventricular afterload on echocardiography, with respiratory failure and hypotension in the first patient, and dyspnea and hemodynamically stable parameters in the second one. Successive capnographic measurements were performed before, during, and after thrombolysis. Curves of volumetric capnography were obtained from a sidestream gas monitor with flow sensor and an arterial blood gas analysis for CO(2) partial pressure. We calculated late deadspace fraction, previously suggested as the most effective capnographic parameter in the diagnosis of pulmonary embolism. Late deadspace fraction decreased in the two patients, respectively, from 64.4% to 1.1% and from 25.6% to 5.7% after thrombolysis, with a concomitant disappearance of right heart dysfunction signs on echocardiography. Volumetric capnogra...Continue Reading

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Citations

May 2, 2012·Critical Care : the Official Journal of the Critical Care Forum·Laurent BrochardJean-Louis Vincent
Feb 17, 2010·Critical Care : the Official Journal of the Critical Care Forum·Franck Verschuren, Arnaud Perrier
May 14, 2009·Vascular Health and Risk Management·Marcos Mello MoreiraIlma Aparecida Paschoal
Jun 12, 2009·Journal of Clinical Monitoring and Computing·Gerardo TusmanFernando Clara
Apr 10, 2012·Journal of Clinical Monitoring and Computing·Gerardo TusmanStephan H Bohm
Feb 6, 2013·The American Journal of Emergency Medicine·Chan-Il ParkRobert F Bonvini
Aug 25, 2005·Clinical Physiology and Functional Imaging·Franck VerschurenGiuseppe Liistro
Mar 31, 2009·Journal of Critical Care·Melissa Langhan
Jun 24, 2016·Critical Care : the Official Journal of the Critical Care Forum·Sara VerscheureSheldon Magder
Jun 12, 2008·Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia·Marcos Mello MoreiraIlma Aparecida Paschoal
Oct 20, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Mirko BelliatoRoberto Lorusso
May 23, 2006·British Journal of Anaesthesia·P D Macnaughton

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