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End-tidal CO2-derived values during emergency trauma surgery correlated with outcome: a prospective study
James G Tyburski1, Julianne D Collinge, Robert F Wilson
1Department of Surgery, Wayne State University, Detroit, Michigan, USA. jtybursk@med.wayne.edu
Background:
The purpose of this study was to determine whether end-tidal carbon dioxide (PETCO) derived variables assist in evaluating the adequacy of resuscitation during emergency surgery for trauma.
Methods:
This was a prospective study of end-tidal derived variables and outcome in 106 trauma patients in an urban Level I trauma center.
Results:
The patients who lived (compared with those who died) had higher final end-tidal Pco levels, lower arterial-end tidal CO differences (Pa-ET)CO, and a decreased alveolar dead space ratio (p < 0.001). The best survival rates were with a PETCO > 27 mm Hg, a (Pa-ET)CO < or = 9 mm Hg, and 96% (56 of 58) for an alveolar dead space ratio < or = 0.20 (p < 0.001). An inappropriately high or "excess Paco also correlated with a decreased (Pa-ET)CO and poorer prognosis. If, after the initial resuscitation, the PETCO -derived values did not achieve these "optimal" levels, survival was significantly reduced.
Conclusion:
During emergency trauma surgery, the PETCO and its derived values help to predict outcome and may be used to identify patients needing more aggressive resuscitation.