Arterial to end‐tidal carbon dioxide tension difference (CO<sub>2</sub> gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis

Shetty, Amith; Sparenberg, Sebastian; Adams, Kristian; Selvedran, Selwyn; Tang, Benjamin; Kim, Hanna; Iredell, Jonathan R.

doi:10.1111/1742-6723.13095

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…Post-hoc power analysis showed we had 63% power (alpha error of 5%) to detect ROSC in OHCA patients with this sample size. In the literature, it has been reported that ΔCO 2 cut-off values vary between 9 and 10.6 mmHg, according to different outcome measures (6,7,9,16). In our study, the optimal cutoff value for ΔCO 2 in predicting ROSC in OHCA patients was 51.4 mmHg.…”

Section: Discussionmentioning

confidence: 52%

“…Ischemia-reperfusion injury after cardiac arrest causes pulmonary and cardiovascular damage and increases the gap between pCO 2 and ETCO 2 . This gap, which should normally not exceed 3-5 mmHg, is called ΔCO 2 (5)(6)(7). A high ΔCO 2 was reported to have a significant relationship with mortality or poor outcomes in aspiration pneumonia, pulmonary edema, acute respiratory distress syndrome, trauma surgery, and pulmonary embolism (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…This gap, which should normally not exceed 3-5 mmHg, is called ΔCO 2 (5)(6)(7). A high ΔCO 2 was reported to have a significant relationship with mortality or poor outcomes in aspiration pneumonia, pulmonary edema, acute respiratory distress syndrome, trauma surgery, and pulmonary embolism (6)(7)(8)(9). However, there are no studies about the diagnostic accuracy of ΔCO 2 in predicting the return of spontaneous circulation (ROSC) and survival in patients who underwent CPR.…”

Section: Introductionmentioning

confidence: 99%

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Spontan Dolaşımın Geri Dönüşünü Tahmin Etmede Delta Karbondioksitin (ΔCO2) Tanısal Değerinin İncelenmesi: Prospektif Tek Merkezli Çalışma

İSLAM,

AKSEL,

EROĞLU

et al. 2023

Batı Karadeniz Tıp Dergisi

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Aim: The carbon dioxide gap or ΔCO2 is the difference between the partial pressure of carbon dioxide (pCO2 ) and end-tidal carbon dioxide (ETCO2 ), which should normally not exceed 3-5mmHg. In critically ill patients ΔCO2 increases as a result of decreased cardiac output and pulmonary blood flow compromise. The primary outcome of this study is to examine the diagnostic accuracy of ΔCO2 in predicting the return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients. Material and Methods: Non-traumatic OHCA patients over 18 years of age were included in this prospective observational study. ETCO2 values were recorded 1 minute after the intubation and arterial blood gas samples were acquired simutaneously. The difference between the initial ΔCO2 medians of the ROSC+ and ROSC- patient groups were analyzed and the diagnostic test performance in predicting ROSC of ΔCO2 was calculated. A regression model was performed to accurately predict ROSC in OHCA patients. Results: A total of 46 patients were included to the inal analysis. The ΔCO2 median of the ROSC+ group was significantly lower than the ROSC- group (p=0.026, 95%CI:-31 to-3). Area under the curve was calculated as 0.694 (95%CI: 0.532 to 0.855), sensitivity 76.19% (95%CI:52.83 to 91.78%), specificity 76% (95%CI:54.87 to 90.64), and accuracy 76.09% (95%CI:61.23% to87.41%) for the optimal cut-off value (51.4 mmHg). The regression model consists of age, initial ETCO2 , and initial cardiac rhythm showed good discrimination in predicting ROSC (AUC=0.846, 95%CI=0.735 to 0.956, p

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spontan Dolaşımın Geri Dönüşünü Tahmin Etmede Delta Karbondioksitin (ΔCO2) Tanısal Değerinin İncelenmesi: Prospektif Tek Merkezli Çalışma

İSLAM,

AKSEL,

EROĞLU

et al. 2023

Batı Karadeniz Tıp Dergisi

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“…Shetty et al evaluated 215 patients presenting to the emergency department (ED) and the arterial-ET difference modestly predicted adverse outcomes in patients presenting with suspected sepsis due to non-respiratory causes. Those with normal arterial-ET differences were noted to have much lower risk for hospital mortality and prolonged ICU length of stay [ 23 ]. Yamanaka et al [ 24 ] studied 17 patients requiring endotracheal intubation and mechanical ventilation using an average of exhaled PCO 2 at the end of several breaths over a duration of 30 s and found that the difference between arterial and exhaled CO 2 correlated closely with physiological dead space ( r = 0.80, P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS

et al. 2021

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Purpose In acute respiratory distress syndrome (ARDS), dead space fraction has been independently associated with mortality. We hypothesized that early measurement of the difference between arterial and end-tidal CO2 (arterial-ET difference), a surrogate for dead space fraction, would predict mortality in mechanically ventilated patients with ARDS. Methods We performed two separate exploratory analyses. We first used publicly available databases from the ALTA, EDEN, and OMEGA ARDS Network trials (N = 124) as a derivation cohort to test our hypothesis. We then performed a separate retrospective analysis of patients with ARDS using University of Chicago patients (N = 302) as a validation cohort. Results The ARDS Network derivation cohort demonstrated arterial-ET difference, vasopressor requirement, age, and APACHE III to be associated with mortality by univariable analysis. By multivariable analysis, only the arterial-ET difference remained significant (P = 0.047). In a separate analysis, the modified Enghoff equation ((PaCO2–PETCO2)/PaCO2) was used in place of the arterial-ET difference and did not alter the results. The University of Chicago cohort found arterial-ET difference, age, ventilator mode, vasopressor requirement, and APACHE II to be associated with mortality in a univariate analysis. By multivariable analysis, the arterial-ET difference continued to be predictive of mortality (P = 0.031). In the validation cohort, substitution of the arterial-ET difference for the modified Enghoff equation showed similar results. Conclusion Arterial to end-tidal CO2 (ETCO2) difference is an independent predictor of mortality in patients with ARDS.

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“…However, 95% ULA values of the P ET CO 2 –PaCO 2 gradient were determined in the range of 13.01–15.04 mmHg, and these results are quite high compared to the literature [ 19 ]. In diseases that cause hemodynamic instability, such as sepsis and shock, P ET CO 2 measurements tend to be higher than corresponding PaCO 2 measurements [ 41 ]. High 95% ULA values in our study may be associated with the presence of patients with hemodynamic instability (such as shock and multi-trauma diagnoses) in our study, and the analysis of the highest number of measurement values in the literature so far (1118 pairs).…”

Section: Discussionmentioning

confidence: 99%

Comparison of arterial CO2 estimation by end-tidal and transcutaneous CO2 measurements in intubated children and variability with subject related factors

Duyu

Caglar

Karakaya

et al. 2020

J Clin Monit Comput

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Transcutaneous PCO 2 (P TC CO 2 ) and end-tidal PCO 2 (P ET CO 2 ) measurement methods serve as alternatives to arterial PCO 2 (PaCO 2 ), providing continuous non-invasive monitoring. The objective of this study was to evaluate the P TC CO 2 and P ET CO 2 methods with actual PaCO 2 levels, and to assess the variability of measurements in relation to subject-related factors, such as skin and subcutaneous adipose tissue thickness and presence of pulmonary diseases. P TC CO 2 , P ET CO 2 and PaCO 2 were measured at the same time in intubated pediatric subjects. Subjects’ demographic characteristics, clinical features, laboratory parameters, skin and subcutaneous adipose tissue thickness were identified. The study was carried out on 102 subjects with a total of 1118 values for each method. In patients with non-pulmonary disease, the mean difference between P TC CO 2 and PaCO 2 was − 0.29 mmHg (± 6.05), while it was 0.44 mmHg (± 6.83) bias between P ET CO 2 and PaCO 2 . In those with pulmonary diseases, the mean difference between P TC CO 2 and PaCO 2 was − 1.27 mmHg (± 8.32), while it was − 4.65 mmHg (± 9.01) between P ET CO 2 and PaCO 2 . Multiple linear regression demonstrated that increased subcutaneous adipose tissue thickness, core body temperature and inotropic index were related with higher P TC CO 2 values relative to the actual PCO 2 values. Other factors, such as skin tissue thickness, presence of pulmonary disease, measurement location and measurement times were non-significant. The P TC CO 2 method has higher reliability than the P ET CO 2 method, and P TC CO 2 measurements are not influenced by most subject-related factors; however, core body temperature, inotropic index and subcutaneous adipose tissue thickness can lead to significant differences in PCO 2 measurement.

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Arterial to end‐tidal carbon dioxide tension difference (CO₂ gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis

Abstract: In this pilot study of patients with suspected sepsis from non-respiratory causes, an increased CO gap demonstrates value in risk stratification and needs to be further evaluated and compared to other existent biomarkers.

Cited by 6 publications

References 14 publications

Spontan Dolaşımın Geri Dönüşünü Tahmin Etmede Delta Karbondioksitin (ΔCO2) Tanısal Değerinin İncelenmesi: Prospektif Tek Merkezli Çalışma

Spontan Dolaşımın Geri Dönüşünü Tahmin Etmede Delta Karbondioksitin (ΔCO2) Tanısal Değerinin İncelenmesi: Prospektif Tek Merkezli Çalışma

Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS

Comparison of arterial CO2 estimation by end-tidal and transcutaneous CO2 measurements in intubated children and variability with subject related factors

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Arterial to end‐tidal carbon dioxide tension difference (CO2 gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis

Abstract: In this pilot study of patients with suspected sepsis from non-respiratory causes, an increased CO gap demonstrates value in risk stratification and needs to be further evaluated and compared to other existent biomarkers.

Cited by 6 publications

References 14 publications

Spontan Dolaşımın Geri Dönüşünü Tahmin Etmede Delta Karbondioksitin (ΔCO2) Tanısal Değerinin İncelenmesi: Prospektif Tek Merkezli Çalışma

Spontan Dolaşımın Geri Dönüşünü Tahmin Etmede Delta Karbondioksitin (ΔCO2) Tanısal Değerinin İncelenmesi: Prospektif Tek Merkezli Çalışma

Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS

Comparison of arterial CO2 estimation by end-tidal and transcutaneous CO2 measurements in intubated children and variability with subject related factors

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Arterial to end‐tidal carbon dioxide tension difference (CO₂ gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis