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An end-tidal CO2 (ETCO2) monitor (capnometer) is used most often as a noninvasive substitute for PaCO2 in anesthesia, anesthetic recovery and intensive care. However, the utility and accuracy of the portable capnometer in spontaneously breathing patients with or without chronic pulmonary diseases has received little recognition. To determine the utility of the portable capnometer in general wards and in in-home care, we examined the correlation between ETCO2 measured by a portable capnometer and simultaneous PaCO2 measured in 41 spontaneously breathing patients. TV-ETCO2 (ETCO2 measured by tidal volume maneuver) was lower than PaCO2 by an average of 9.0 mmHg and VC-ETCO2 (ETCO2 measured by vital capacity maneuver) was lower than PaCO2 by an average of 0.5 mmHg. The mean difference between PaCO2 and VC-ETCO2 was not statistically significant. Regression analysis showed a close correlation between VC-ETCO2 and PaCO2 (r = 0.91, P < 0.0001). Thus,VC-ETCO2 was highly correlated with PaCO2. Furthermore, a close correlation between VC-ETCO2 and PaCO2 was also observed in patients with compromised pulmonary function (r = 0.88, P < 0.0001 in patients with below 70% of FEV(1.0)%; r = 0.89, P < 0.0001 in patients with below 80% of %VC). Our studies show that VC-ETCO2 measured by the portable capnometer gives a reliable pointestimate of PaCO2, and can be useful to evaluate the respiratory condition of spontaneously breathing patients in general wards and in in-home care.

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To determine prognostic factors of nosocomial pneumonia in general wards, we performed prospective clinical study using multivariate statistical analysis. Eighty patients with nosocomial pneumonia in our units were enrolled in the study between December, 1996 and January 1998. Clinical setting and severity of pneumonia were evaluated, and laboratory data were collected at the occurrence of nosocomial pneumonia. Death due to nosocomial pneumonia occurred in 29 of 80 patients (mortality rate 36%). Univariate analysis showed the following factors associated with mortality: the presence of an ultimately or rapidly fatal underlying condition, prior antibiotics use, use of antacids, presence of 'high-risk' micro-organisms, sepsis, respiratory failure, multiple organ failure, bilateral chest X-ray infiltrates, a Simplified Acute Physiology Score (SAPS) index > or = 11, albumin < 3.0 g dl(-1), and lactate dehydrogenase (LDH) > or = 796 IUI(-1). Furthermore, multivariate analysis identified three factors significantly associated with mortality: the presence of an ultimately or rapidly fatal underlying condition [odds ratio (OR)=7.0; 95% confidence interval (CI)=1.2-41.1; P=0.03]; SAPS index > or = 11 (OR=7.6; 95% CI=1.1-51.9, P=0.04); LDH > or = 796 IUI(-1) (OR=28.2; 95% CI=2.0-406, P=0.01). Our study indicates that host factors and disease severity factors are important prognostic factors of nosocomial pneumonia in general wards.

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