The utility of early end-tidal capnography in monitoring ventilation status after severe injury

Keir J. Warner, Joseph Cuschieri, Brandon Garland, David Carlbom, David Baker, Michael K. Copass, Gregory Jurkovich, Eileen M. Bulger

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

An arterial CO 2 (PaCO 2) of 30 mm Hg to 39 mm Hg has been shown to be the ideal target range for early ventilation in trauma patients; however, this requires serial arterial blood gases. The use of end-tidal capnography (EtCO 2) has been recommended as a surrogate measure of ventilation in the prehospital arena. This is based on the observation of close EtCO 2 PaCO 2 correlation in healthy patients, yet trauma patients frequently suffer from impaired pulmonary ventilation/ perfusion. Thus, we hypothesize that EtCO 2 will demonstrate a poor reflection of actual ventilation status after severe injury. Methods: Prospective observational study on consecutive intubated trauma patients treated in our emergency department (ED) during 9 months. Arterial blood gas values and concomitant EtCO 2 levels were recorded. Regression was used to determine the strength of correlation among all trauma patients and subgroups based on injury severity (Abbreviated Injury Score and Injury Severity Score) and physiologic markers of perfusion status (lactate, shock index, and arterial base deficit). Results: During 9 months, 180 patients were evaluated. The EtCO 2 PaCO 2 correlation was poor at R 2 = 0.277. Patients ventilated in the recommended EtCO 2 (range, 35 to 40) were likely to be under ventilated (PaCO 2 > 40 mm Hg) 80% of the time, and severely under ventilated (PaCO 2 > 50 mm Hg) 30% of the time. Correlation was best for patients with isolated traumatic brain injury and worst for those with evidence of poor tissue perfusion. Conclusion: EtCO 2 has low correlation with PaCO 2, and therefore should not be used to guide ventilation in intubated trauma patients in the ED. Better strategies for guiding prehospital and ED ventilation are needed.

Original languageEnglish (US)
Pages (from-to)26-31
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Capnography
Ventilation
Wounds and Injuries
Hospital Emergency Service
Injury Severity Score
Perfusion
Gases
Pulmonary Ventilation
Carbon Monoxide
Observational Studies
Shock
Lactic Acid
Observation
Prospective Studies

Keywords

  • Emergency department
  • End-tidal capnography
  • Intubation
  • Prehospital
  • Trauma
  • Ventilation

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The utility of early end-tidal capnography in monitoring ventilation status after severe injury. / Warner, Keir J.; Cuschieri, Joseph; Garland, Brandon; Carlbom, David; Baker, David; Copass, Michael K.; Jurkovich, Gregory; Bulger, Eileen M.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 66, No. 1, 01.01.2009, p. 26-31.

Research output: Contribution to journalArticle

Warner, Keir J. ; Cuschieri, Joseph ; Garland, Brandon ; Carlbom, David ; Baker, David ; Copass, Michael K. ; Jurkovich, Gregory ; Bulger, Eileen M. / The utility of early end-tidal capnography in monitoring ventilation status after severe injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 66, No. 1. pp. 26-31.
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abstract = "An arterial CO 2 (PaCO 2) of 30 mm Hg to 39 mm Hg has been shown to be the ideal target range for early ventilation in trauma patients; however, this requires serial arterial blood gases. The use of end-tidal capnography (EtCO 2) has been recommended as a surrogate measure of ventilation in the prehospital arena. This is based on the observation of close EtCO 2 PaCO 2 correlation in healthy patients, yet trauma patients frequently suffer from impaired pulmonary ventilation/ perfusion. Thus, we hypothesize that EtCO 2 will demonstrate a poor reflection of actual ventilation status after severe injury. Methods: Prospective observational study on consecutive intubated trauma patients treated in our emergency department (ED) during 9 months. Arterial blood gas values and concomitant EtCO 2 levels were recorded. Regression was used to determine the strength of correlation among all trauma patients and subgroups based on injury severity (Abbreviated Injury Score and Injury Severity Score) and physiologic markers of perfusion status (lactate, shock index, and arterial base deficit). Results: During 9 months, 180 patients were evaluated. The EtCO 2 PaCO 2 correlation was poor at R 2 = 0.277. Patients ventilated in the recommended EtCO 2 (range, 35 to 40) were likely to be under ventilated (PaCO 2 > 40 mm Hg) 80{\%} of the time, and severely under ventilated (PaCO 2 > 50 mm Hg) 30{\%} of the time. Correlation was best for patients with isolated traumatic brain injury and worst for those with evidence of poor tissue perfusion. Conclusion: EtCO 2 has low correlation with PaCO 2, and therefore should not be used to guide ventilation in intubated trauma patients in the ED. Better strategies for guiding prehospital and ED ventilation are needed.",
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