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Biofilm Removal Using Carbon Dioxide Aerosols without Nitrogen Purge
Published on: November 6, 2016
End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to
Eric M Campion1, Caitlin K Robinson, Nicholson Brant
1From the Department of Surgery (E.M.C., C.K.R., N.B., E.E.M., M.J.C., C.C.B.), Denver Health Medical Center; Department of Surgery (L.F., R.M., S.U.), University of Colorado Anschutz, Denver, Colorado; Department of Surgery (B.B., H.A.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (R.C., S.M., A.C., E.R., B.N.G.), University of California, San Francisco; Zuckerberg San Francisco General Hospital (R.C., S.M., A.C., E.R., B.N.G.), San Francisco, California; Department of Surgery (B.P., M.M.M.), LSU Health Science Center New Orleans, New Orleans, Louisiana; Department of Surgery (J.N., A.G., S.A.), University of California, Irvine, Irvine, California; Department of Surgery (S.D., L.B., J.D., O.A.), Medical Center of the Rockies, Loveland; Department of Surgery (T.S., J.R., Z.S., C.D., H.H.), UCHealth Memorial Hospital, Colorado Springs, Colorado; Department of Surgery (D.S., J.B.), University of California, Davis, Davis, California; Department of Surgery (M.C.S., T.W.W., J.S.B.), Grant Medical Center, Columbus, Ohio; Department of Surgery (A.R.P., E.E.), Medical University of South Carolina Health, Charleston, South Carolina; Department of Surgery (S.L.S., A.P.), Dell Seton Medical Center at the University of Texas, Austin, Texas; Department of Surgery (S.M.M., A.L.S., P.O.U., M.N., A.D.), Wakemed, Raleigh, North Carolina; and, School of Public Health (A.S.), University of Colorado, Boulder, Colorado.
Background:
End-tidal carbon dioxide (ETCO2) is routinely used during elective surgery to monitor ventilation. The role of ETCO2 monitoring in emergent trauma operations is poorly understood. We hypothesized that ETCO2 values underestimate plasma carbon dioxide (pCO2) values during resuscitation for hemorrhagic shock.
Methods:
Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels.
Results:
Two hundred fifty-six patients resulted in 587 matched pairs of ETCO2 and pCO2. Correlation between these two values was very poor with an R of 0.04. 40.2% of patients presented to the operating room acidotic and hypercarbic with a pH less than 7.30 and a pCO2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO2 and pCO2. A pH less than 7.30 was predictive of an ETCO2 to pCO2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders.
Conclusion:
Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10 mm Hg discordant from their PCO2 level. Reliance on the discordant values may have contributed to the 40% of patients in the operating room that were both acidotic and hypercarbic. Early blood gas analysis is warranted, and a lower early goal of ETCO2 should be considered.
Level Of Evidence:
Therapeutic, level IV.
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