Agreement Between Arterial Carbon Dioxide Levels With End-Tidal Carbon Dioxide Levels and Associated Factors in Children Hospitalized With Traumatic Brain Injury

Abstract Objectives: In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period. Methods: A literature search of PubMed, CINAHL, and SCOPUS identified studies from 2009 through 2019 addressing the effects of ventilation during the initial post-trauma resuscitation on patient outcomes. Results: The initial search yielded 899 articles, from which 13 were relevant and selected for full-text review. Six of the 13 articles met the inclusion criteria, all of which reported on patients with TBI. Either end-tidal carbon dioxide (ETCO2) or partial pressure carbon dioxide (PCO2) were the independent variables associated with mortality. Decreased rates of mortality were reported in patients with normal PCO2 or ETCO2. Conclusions: Normoventilation, as measured by ETCO2 or PCO2, is associated with decreased mortality in patients with TBI. Preventing hyperventilation or hypoventilation in patients with TBI during the early resuscitation phase could improve outcome after TBI.

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217 The end-tidal and arterial carbon dioxide gradient in serious traumatic brain injury after pre-hospital emergency anaesthesia: a retrospective observational study

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.43 ◽

2020 ◽

Vol 37 (12) ◽

pp. 847.1-847

Author(s):

James Price ◽

Daniel Sandbach ◽

Ari Ercole ◽

Alastair Wilson ◽

Ed Barnard

Keyword(s):

Carbon Dioxide ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Thoracic Injury ◽

Secondary Brain Injury ◽

Hospital Emergency ◽

Hospital Arrival ◽

Arterial Blood ◽

End Tidal ◽

Emergency Anaesthesia

Aims/Objectives/BackgroundIn the United Kingdom (UK), 20% of patients with severe traumatic brain injury (TBI) receive pre-hospital emergency anaesthesia (PHEA). Current guidance recommends an end-tidal carbon dioxide (ETCO2) of 4.0–4.5kPa to achieve a low-normal arterial partial pressure of CO2 (PaCO2), and reduce secondary brain injury. This recommendation assumes a 0.5kPa ETCO2-PaCO2 gradient. However, the gradient in the acute phase of TBI is unknown. Our primary aim was to report the ETCO2-PaCO2 gradient of TBI patients at hospital arrival.Methods/DesignA retrospective cohort study of adult patients with serious TBI, who received a PHEA by a pre-hospital critical care team in the East of England between 1st April 2015 to 31st December 2017. Linear regression was performed to test for correlation and reported as R-squared (R2). A Bland-Altman plot was used to test for paired ETCO2 and PaCO2 agreement and reported with 95% confidence intervals (95%CI). ETCO2-PaCO2 gradient data were compared with a two-tailed, unpaired, t-test.Results/Conclusions107 patients were eligible for inclusion. Sixty-seven patients did not receive a PaCO2 sample within 30 minutes of hospital arrival and were therefore excluded. Forty patients had complete data and were included in the final analysis; per protocol.The mean ETCO2-PaCO2 gradient was 1.7 (±1.0) kPa, with only moderate correlation of ETCO2 and PaCO2 at hospital arrival (R2=0.23, p=0.002). The Bland-Altman bias was 1.7 (95%CI 1.4–2.0) kPa with upper and lower limits of agreement of 3.6 (95%CI 3.0–4.1) kPa and -0.2 (95%CI -0.8–0.3) kPa respectively. There was no significant gradient correlation in patients with a co-existing serious thoracic injury (R2=0.13, p=0.10), and this cohort had a larger ETCO2-PaCO2 gradient, 2.0 (±1.1) kPa, p=0.01. Patients who underwent pre-hospital arterial blood sampling had an arrival PaCO2 of 4.7 (±0.2) kPa.Lower ETCO2 targets than previously recommended may be safe and appropriate. The use of pre-hospital PaCO2 measurement is advocated.

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Tu1038 Assessment of End-Tidal Carbon Dioxide and Partial Pressure of Arterial Carbon Dioxide During an Endoscopic Procedure Using Carbon Dioxide

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.1098 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB540

Author(s):

Nobuaki Azemoto ◽

Tomoyuki Ninomiya ◽

Teru Kumagi ◽

Kojiro Michitaka

Keyword(s):

Carbon Dioxide ◽

Partial Pressure ◽

Endoscopic Procedure ◽

Arterial Carbon Dioxide ◽

End Tidal Carbon Dioxide ◽

End Tidal

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Noninvasive monitoring of carbon dioxide: A comparison of the partial pressure of transcutaneous and end-tidal carbon dioxide with the partial pressure of arterial carbon dioxide

Journal of Clinical Monitoring and Computing ◽

10.1007/bf01695936 ◽

1987 ◽

Vol 3 (3) ◽

pp. 149-154 ◽

Cited By ~ 50

Author(s):

Can Q. Phan ◽

Kevin K. Tremper ◽

Steven E. Lee ◽

Steven J. Barker

Keyword(s):

Carbon Dioxide ◽

Partial Pressure ◽

Noninvasive Monitoring ◽

Arterial Carbon Dioxide ◽

End Tidal Carbon Dioxide ◽

End Tidal

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The Influence of CO2 Production and Physiological Deadspace on End-Tidal CO2 During Controlled Ventilation: A Study Using a Mechanical Model

Anaesthesia and Intensive Care ◽

10.1177/0310057x8901700415 ◽

1989 ◽

Vol 17 (4) ◽

pp. 482-486 ◽

Cited By ~ 8

Author(s):

M. A. Stockwell ◽

W. Bruce ◽

N. Soni

Keyword(s):

Carbon Dioxide ◽

Mechanical Model ◽

Carbon Dioxide Production ◽

Lung Model ◽

Co2 Production ◽

Controlled Ventilation ◽

End Tidal Carbon Dioxide ◽

Carbon Dioxide Levels ◽

End Tidal ◽

End Tidal Co2

A mechanical lung model was used to investigate the effect of varying carbon dioxide production and deadspace on the end-tidal carbon dioxide levels achieved during mechanical ventilation when using the Bain, Humphrey ADE, and circle systems. Both factors had significant influence on end-tidal cardon dioxide concentration and could result in values in excess of those considered acceptable in clinical practice. The implications of the results are discussed.

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