Abstract:
INTRODUCTION:End tidal CO2 (ETCO2) has been established as a standard for confirmation of an airway, but its role is expanding. In certain settings ETCO2 closely approximates the partial pressure of arterial CO2 (PaCO2) and has been described as a tool to optimize a patient's ventilatory status. ETCO2 monitors are increasingly being used by EMS personnel to guide ventilation in the prehospital setting. Severely traumatized and burn patients represent a unique population to which this practice has not been validated. HYPOTHESIS:The sole use of ETCO2 to monitor ventilation may lead to avoidable respiratory acidosis. METHODS:A consecutive series of patients with burns or trauma intubated in the prehospital setting over a 24-month period were evaluated. Prehospital arrests were excluded. Absence of ETCO2 transport data and patients without an arterial blood gas (ABG) within 15 minutes of arrival were also excluded. Data collected included demographics, place and time of intubation, service performing intubation, ETCO2 maintained en-route to hospital, and ABG upon arrival. Further data included length of stay, mortality, and injury severity scores. RESULTS:One hundred sixty patients met the inclusion criteria. Prehospital ETCO2 did not correlate with measured PaCO2 (R2 = 0.08). Mean ETCO2 was significantly lower than mean PaCO2 (34 mmHg vs 44 mmHg, P < .005). Patients arriving acidotic were more likely to die. Mean pH on arrival for survivors and decedents was 7.32 and 7.19 respectively (P < .001). Mortality, acidosis, higher base deficits, and more severe injury patterns were all predictors for a worse correlation between ETCO2 and PaCO2 and increased mean difference between the two values. Decedents and patients presenting with a pH <7.2 demonstrated the greatest discrepancy between ETCO2 and PaCO2. The data suggest that patients may be hypoventilated by prehospital providers in order to obtain a prescribed ETCO2. CONCLUSION:ETCO2 is an inadequate tool for predicting PaCO2 or optimizing ventilation in severely injured patients. Adherence to current ETCO2 guidelines in the prehospital setting may contribute to acidosis and increased mortality. Consideration should be given to developing alternate protocols to guide ventilation of the severely injured in the prehospital setting.
journal_name
Prehosp Disaster Medjournal_title
Prehospital and disaster medicineauthors
Cooper CJ,Kraatz JJ,Kubiak DS,Kessel JW,Barnes SLdoi
10.1017/S1049023X12001768subject
Has Abstractpub_date
2013-04-01 00:00:00pages
87-93issue
2eissn
1049-023Xissn
1945-1938pii
S1049023X12001768journal_volume
28pub_type
杂志文章abstract::This report is a summary of a study 1 conducted at the Royal Swedish Academy of War Sciences to evaluate collaboration during crisis management. The study includes relevant legal and regulatory dynamics, as well as conclusions and recommendations. Rules and regulations of international interest are presented in the Ap...
journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
doi:10.1017/S1049023X12000532
更新日期:2012-04-01 00:00:00
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
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更新日期:2007-05-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章,评审
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更新日期:2013-02-01 00:00:00
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journal_title:Prehospital and disaster medicine
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更新日期:2009-09-01 00:00:00
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更新日期:2012-10-01 00:00:00
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更新日期:2016-12-01 00:00:00
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更新日期:2016-12-01 00:00:00
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更新日期:2015-08-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1994-10-01 00:00:00
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更新日期:2013-02-01 00:00:00
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doi:10.1017/S1049023X12000945
更新日期:2012-08-01 00:00:00
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更新日期:2017-02-01 00:00:00
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更新日期:2006-11-01 00:00:00
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更新日期:2009-07-01 00:00:00
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更新日期:2020-04-01 00:00:00