Should capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? Observational case-series study

Darocha, Tomasz; Kosiński, Sylweriusz; Jarosz, Anna; Podsiadło, Paweł; Ziętkiewicz, Mirosław; Sanak, Tomasz; Gałązkowski, Robert; Piątek, Jacek; Konstanty-Kalandyk, Janusz; Drwiła, Rafał

doi:10.1186/s13049-017-0357-1

Cited by 17 publications

(9 citation statements)

References 11 publications

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“…Rigidity, and trismus in severely hypothermic patients can make intubation difficult [ 76 ]. End-tidal carbon dioxide (ETCO 2 ) is not reliable in severe hypothermia [ 84 ]. Patients should be ventilated using standard weight-based settings without relying on ETCO 2 .…”

Section: Treatmentmentioning

confidence: 99%

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Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

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Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

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Section: Treatmentmentioning

confidence: 99%

“…Some studies suggest that in severely hypothermic patients the PaCO 2 –ETCO 2 gradient is increased. This may help to confirm a diagnosis of accidental hypothermia in unclear circumstances [ 84 ]. Several tools have been developed to help predict outcome [ 132 ].…”

Section: Treatmentmentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

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“…It is further noteworthy, that in critical patients with failed TI, oxygenation could be restored in 14/15 patients with use of SGAs and BMV, but hypercapnia was observed after admission in 14/17 patients. Thus, tight control of end-tidal carbon dioxide levels is crucial, but operators must be aware that there is a significant and variable risk of mismatch between EtCO 2 and PaCO 2 measurements [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

Trimmel

Beywinkler

Hornung

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundPre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer’s qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program.MethodsIn this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems.ResultsFrom 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5–42.5) vs. 19.0 (15.0–27.0) during initial training; 62.0 (41.8–86.5) vs. 33.5 (18.0–54.5) during the first, and 64.0 (34.5–93.8) vs. 27 (12.5–56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0–14.8) TIs vs. 0.0 (0.0–0.0) SGA cases during the first, and 9.0 (7.0–13.8) TIs vs. 0.0 (0.0–0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%.DiscussionNumber of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to minimize failure rates. Thus, a fixed amount of working days in anesthesia seems crucial to maintain proficiency.ConclusionsIn-hospital training programs are mandatory for non-anesthetist EMS physicians to gain competence in airway management and emergency anesthesia.Our results might be helpful when discussing the need for regulation and financing with the authorities.

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“…The use of blood gas analysers is a prototype of a simple POC diagnostic drastically reducing turnaround time and resulting in a better control of ventilation, electrolytes and acid-base disorders [ 22 ]. Even if continuous pulse oximetry and capnometry could reduce need for blood gas analysis, the discrepancy in results of capnometry (end tidal CO 2 ) and blood gas analysis (PaCO 2 ) in critically ill patients can be disastrous if unrecognized, especially in neurosurgical patients [ 22 , 23 , 24 , 25 , 26 , 27 ]. Turnaround time for blood gas analysis was significantly longer if done in a centralised laboratory (27.3 min), in comparison to POC approach (6.8 min).…”

Section: Point-of-care Diagnosticmentioning

confidence: 99%

Diagnostic Modalities in Critical Care: Point-of-Care Approach

et al. 2021

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The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.

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Should capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? Observational case-series study

Cited by 17 publications

References 11 publications

Accidental Hypothermia: 2021 Update

Accidental Hypothermia: 2021 Update

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

Diagnostic Modalities in Critical Care: Point-of-Care Approach

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