Dataset Information

End-Tidal Carbon Dioxide as a Prognostic Feature in Pulmonary Arterial Hypertension.

ABSTRACT:

Rationale

Pulmonary arterial hypertension (PAH) is characterized in part by increased dead space ventilation, which can be estimated noninvasively at the bedside by measurement of end-tidal CO₂ (ETco₂).

Objectives

Prior work has demonstrated that ETco₂ is lower in patients with PAH than in control patients, but whether ETco₂ has prognostic value is unknown. We hypothesized that lower measurements of ETco₂ in patients with PAH correlate with worse long-term outcomes.

Methods

Patients with PAH seen in our referral clinic were prospectively recruited for ETco₂ measurement between September 2009 and February 2010. Vital status as of July 2015 was documented using medical records and the Social Security Death Index.

Results

Eighty-two patients were followed for a median of 60 months. Twenty-six patients died, and two were lost to follow-up. Patients who died were more likely to be older (58.5?±?14.9 vs. 47.6?±?12.2 yr; P?2 in survivors was 30.5?±?4.8 mm Hg, whereas mean ETco₂ in patients who died was 27.1?±?4.2 mm Hg (P?=?0.004). After stratification by median baseline ETco₂ of 29 mm Hg, survival in each group was analyzed. Patients with lower ETco₂ had shorter survival (P?=?0.006). Cox regression analysis with ETco₂ as a continuous variable revealed the hazard ratio to be 0.88 (95% confidence interval, 0.80-0.97; P?=?0.006). In 52 patients with more than one measurement a median of 17 months apart, ETco₂ was unchanged.

Conclusions

Our single-center data suggest that lower ETco₂ is associated with shorter survival and that ETco₂ is stable over time in patients with PAH.

SUBMITTER: Welch CE

PROVIDER: S-EPMC6850742 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Publications

End-Tidal Carbon Dioxide as a Prognostic Feature in Pulmonary Arterial Hypertension.

Welch Caitlin E CE Brittain Evan L EL Newman Alexander L AL Robbins Ivan M IM Pugh Meredith E ME Newman John H JH Hemnes Anna R AR

Annals of the American Thoracic Society 20170601 6

<h4>Rationale</h4>Pulmonary arterial hypertension (PAH) is characterized in part by increased dead space ventilation, which can be estimated noninvasively at the bedside by measurement of end-tidal CO<sub>2</sub> (ETco<sub>2</sub>).<h4>Objectives</h4>Prior work has demonstrated that ETco<sub>2</sub> is lower in patients with PAH than in control patients, but whether ETco<sub>2</sub> has prognostic value is unknown. We hypothesized that lower measurements of ETco<sub>2</sub> in patients with PAH ...[more]

PMID: 28345964

Similar Datasets

Project description:BackgroundLow-normal levels of arterial carbon dioxide (PaCO2) are recommended in the acute phase of traumatic brain injury (TBI) to optimize oxygen and CO2 tension, and to maintain cerebral perfusion. End-tidal CO2 (ETCO2) may be used as a surrogate for PaCO2 when arterial sampling is less readily available. ETCO2 may not be an adequate proxy to guide ventilation and the effects on concomitant injury, time, and the impact of ventilatory strategies on the PaCO2-ETCO2 gradient are not well understood. The primary objective of this study was to describe the correlation and agreement between PaCO2 and ETCO2 in intubated adult trauma patients with TBI.MethodsThis study was a retrospective analysis of prospectively-collected data of intubated adult major trauma patients with serious TBI, admitted to the East of England regional major trauma centre; 2015-2019. Linear regression and Welch's test were performed on each cohort to assess correlation between paired PaCO2 and ETCO2 at 24-hour epochs for 120 hours after admission. Bland-Altman plots were constructed at 24-hour epochs to assess the PaCO2-ETCO2 agreement.Results695 patients were included, with 3812 paired PaCO2 and ETCO2 data points. The median PaCO2-ETCO2 gradient on admission was 0.8 [0.4-1.4] kPa, Bland Altman Bias of 0.96, upper (+2.93) and lower (-1.00), and correlation R2 0.149. The gradient was significantly greater in patients with TBI plus concomitant injury, compared to those with isolated TBI (0.9 [0.4-1.5] kPa vs. 0.7 [0.3-1.1] kPa, p<0.05). Across all groups the gradient reduced over time. Patients who died within 30 days had a larger gradient on admission compared to those who survived; 1.2 [0.7-1.9] kPa and 0.7 [0.3-1.2] kPa, p<0.005.ConclusionsAmongst adult patients with TBI, the PaCO2-ETCO2 gradient was greater than previously reported values, particularly early in the patient journey, and when associated with concomitant chest injury. An increased PaCO2-ETCO2 gradient on admission was associated with increased mortality.

Project description:Importance:Alterations in the partial pressure of carbon dioxide, arterial (Paco2) can affect cerebral perfusion after traumatic brain injury. End-tidal carbon dioxide (EtCO2) monitoring is a noninvasive tool used to estimate Paco2 values. Objective:To examine the agreement between Paco2 and EtCO2 and associated factors in children with traumatic brain injury. Design, Setting, and Participants:A secondary analysis was conducted using data from a prospective cohort study of 137 patients younger than 18 years with traumatic brain injury who were admitted to the pediatric intensive care unit of a level I trauma center between May 1, 2011, and July 31, 2017. Analysis was performed from December 17, 2018, to January 10, 2019. Main Outcomes and Measures:The closest EtCO2 value obtained within 30 minutes of a Paco2 value and the closest systolic blood pressure value obtained within 60 minutes prior to a Paco2 value during the first 24 hours after admission were recorded. The main outcome of Paco2-EtCO2 agreement was defined as Paco2 between 0 and 5 mm Hg greater than the paired EtCO2 value, and it was determined using Bland-Altman analysis, Passing and Bablok regression, and the Pearson correlation coefficient. Multivariable regression models determined which factors were associated with agreement. Results:The analysis included 137 patients (34 girls and 103 boys; mean [SD] age, 10.0 [6.3] years) and 445 paired Paco2-EtCO2 data points. On average, Paco2 was 2.7 mm Hg (95% limits of agreement, -11.3 to 16.7) higher than EtCO2. Overall, 187 of all Paco2-EtCO2 pairs (42.0%) agreed. There was larger variation in the Paco2-EtCO2 difference during the first 8 hours compared with 9 to 24 hours after admission to the pediatric intensive care unit. Development of pediatric acute respiratory distress syndrome within 24 hours of admission was associated with a lower likelihood of Paco2-EtCO2 agreement (adjusted odds ratio, 0.20; 95% CI, 0.08-0.51) compared with no development of pediatric acute respiratory distress syndrome. A diagnosis of pediatric acute respiratory distress syndrome 1 to 7 days after admission was associated with a larger first-day Paco2-EtCO2 difference compared with those who never developed pediatric acute respiratory distress syndrome (mean [SD] difference, 4.48 [3.70] vs 0.46 [5.50] mm Hg). Conclusions and Relevance:In this study of pediatric traumatic brain injury, Paco2-EtCO2 agreement was low, especially among patients with pediatric acute respiratory distress syndrome. Low Paco2-EtCO2 agreement early in hospitalization may be associated with future development of pediatric acute respiratory distress syndrome. Data on EtCO2 should not be substituted for data on Paco2 during the first 24 hours.

Dataset Information

End-Tidal Carbon Dioxide as a Prognostic Feature in Pulmonary Arterial Hypertension.

Rationale

Objectives

Methods

Results

Conclusions

Publications

End-Tidal Carbon Dioxide as a Prognostic Feature in Pulmonary Arterial Hypertension.

Similar Datasets

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