End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation: A Western Trauma Association Multicenter Study

Additional Study Group Members of the Western Trauma Association ETCO2 Study Group

Research output: Contribution to journalArticle

Abstract

BACKGROUND: 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. METHODS: Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels. RESULTS: Two hundred fifty-six 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 less than 7.30 and a pCO2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO2 and pCO2. A pH less than 7.30 was predictive of an ETCO2 to pCO2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders. CONCLUSION: Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10 mm Hg 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 early goal of ETCO2 should be considered. LEVEL OF EVIDENCE: Therapeutic, level IV.

Original languageEnglish (US)
Pages (from-to)1119-1124
Number of pages6
JournalThe journal of trauma and acute care surgery
Volume87
Issue number5
DOIs
StatePublished - Nov 1 2019

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Hypoventilation
Carbon Dioxide
Resuscitation
Laparotomy
Multicenter Studies
Wounds and Injuries
Operating Rooms
Blood Gas Analysis
Hemorrhagic Shock
Ventilation
Mortality

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation : A Western Trauma Association Multicenter Study. / Additional Study Group Members of the Western Trauma Association ETCO2 Study Group.

In: The journal of trauma and acute care surgery, Vol. 87, No. 5, 01.11.2019, p. 1119-1124.

Research output: Contribution to journalArticle

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title = "End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation: A Western Trauma Association Multicenter Study",
abstract = "BACKGROUND: 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. METHODS: Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels. RESULTS: Two hundred fifty-six 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 less than 7.30 and a pCO2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO2 and pCO2. A pH less than 7.30 was predictive of an ETCO2 to pCO2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders. CONCLUSION: Nearly one half (45{\%}) of patients were found to have an ETCO2 level greater than 10 mm Hg 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 early goal of ETCO2 should be considered. LEVEL OF EVIDENCE: Therapeutic, level IV.",
author = "{Additional Study Group Members of the Western Trauma Association ETCO2 Study Group} and Campion, {Eric M.} and Robinson, {Caitlin K.} and Nicholson Brant and Lisa Ferrigno and Robert McIntyre and Ben Biesterveld and Hasan Alam and Rachael Callcut and Somya Mishra and Blake Platt and Moore, {Margaret M.} and Jeffry Nahmias and Areg Grigorian and Sarah Dance and Linda Britton and Thomas Schroeppel and Jennifer Rodriquez and David Shatz and James Becker and Spalding, {M. Chance} and Wolff, {Timothy W.} and Privette, {Alicia R.} and Evert Eriksson and Sahi, {Saad Liaqat} and Anish Patel and Moore, {Scott M.} and Stiles, {Anquonette L.} and Moore, {Ernest E.} and Cohen, {Mitchell J.} and Angela Sauaia and Burlew, {Clay Cothren} and Shane Urban and {Osi Udekwu}, Pascal and Megan Nguyen and Ashley Dibbert and Amanda Conroy and Erin Ross and {Nunez Garcia}, Brenda and Spencer Albertson and Julie Dunn and Omar Alnachaoukati and Zachery Stillman and Cassandra Decker and Holly Heise and Burton, {Josh S.}",
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T1 - End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation

T2 - A Western Trauma Association Multicenter Study

AU - Additional Study Group Members of the Western Trauma Association ETCO2 Study Group

AU - Campion, Eric M.

AU - Robinson, Caitlin K.

AU - Brant, Nicholson

AU - Ferrigno, Lisa

AU - McIntyre, Robert

AU - Biesterveld, Ben

AU - Alam, Hasan

AU - Callcut, Rachael

AU - Mishra, Somya

AU - Platt, Blake

AU - Moore, Margaret M.

AU - Nahmias, Jeffry

AU - Grigorian, Areg

AU - Dance, Sarah

AU - Britton, Linda

AU - Schroeppel, Thomas

AU - Rodriquez, Jennifer

AU - Shatz, David

AU - Becker, James

AU - Spalding, M. Chance

AU - Wolff, Timothy W.

AU - Privette, Alicia R.

AU - Eriksson, Evert

AU - Sahi, Saad Liaqat

AU - Patel, Anish

AU - Moore, Scott M.

AU - Stiles, Anquonette L.

AU - Moore, Ernest E.

AU - Cohen, Mitchell J.

AU - Sauaia, Angela

AU - Burlew, Clay Cothren

AU - Urban, Shane

AU - Osi Udekwu, Pascal

AU - Nguyen, Megan

AU - Dibbert, Ashley

AU - Conroy, Amanda

AU - Ross, Erin

AU - Nunez Garcia, Brenda

AU - Albertson, Spencer

AU - Dunn, Julie

AU - Alnachaoukati, Omar

AU - Stillman, Zachery

AU - Decker, Cassandra

AU - Heise, Holly

AU - Burton, Josh S.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: 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. METHODS: Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels. RESULTS: Two hundred fifty-six 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 less than 7.30 and a pCO2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO2 and pCO2. A pH less than 7.30 was predictive of an ETCO2 to pCO2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders. CONCLUSION: Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10 mm Hg 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 early goal of ETCO2 should be considered. LEVEL OF EVIDENCE: Therapeutic, level IV.

AB - BACKGROUND: 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. METHODS: Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels. RESULTS: Two hundred fifty-six 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 less than 7.30 and a pCO2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO2 and pCO2. A pH less than 7.30 was predictive of an ETCO2 to pCO2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders. CONCLUSION: Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10 mm Hg 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 early goal of ETCO2 should be considered. LEVEL OF EVIDENCE: Therapeutic, level IV.

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U2 - 10.1097/TA.0000000000002469

DO - 10.1097/TA.0000000000002469

M3 - Article

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VL - 87

SP - 1119

EP - 1124

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -