The Evaluation of End Tidal Carbon Dioxide Values in Intubated Patients with COVID-19: End Tidal Carbon Dioxide and COVID-19

The Evaluation of End Tidal Carbon Dioxide Values in Intubated Patients with COVID-19

End Tidal Carbon Dioxide and COVID-19

Authors

  • Rezan Karaali
  • Adem Çakır
  • Ejder Saylav Bora a:1:{s:5:"en_US";s:49:"İZMİR ATATURK RESEARCH AND TRAİNİNG HOSPİTAL";}
  • Pınar Yeşim Akyol
  • Cemil Kavalcı
  • Hüseyin Acar

Keywords:

capnography, COVID-19, Emergency, intubation

Abstract

Background: The aim of this study is to establish the value of PETCO2 in COVID-19 patients intubated in emergency department, and its effects on mortality. 

Objectives: Between May 15, 2020 and January 15, 2021, The patients aged ≥18 years and diagnosed COVID-19, scheduled for urgent intubation in the emergency department were included.

Method: Single-center, prospective and observational study. Age, gender, vital signs, laboratory findings are recorded. Immediately after intubation as measured by the capnography, the initial PETCO2_1 and at post-ventilation 15 min, PETCO2_2 and first, second arterial blood gas analysis are recorded.

Results: The mean age of the 48 patients was 74 years. The PETCO2_1 and PETCO2_2 measurements were statistically significantly different between the patients who survived and those who died (p=0.014, p=0.015). The patients with a high first PETCO2_1 value and a decrease to the normal level survived, but those with a low PETCO2_1 value that could not increase to a normal value died (p=0.038, p=0.031). Increased levels of SpO2, PETCO2_1, PETCO2_2 and PaCO2_2 decreased the risk of mortality, while an increased level of PaO2_2 increased the risk of mortality.

Conclusion: Capnography is non-invasive and provides continuous measurement. Assessment of changes in PETCO2 value would contribute to patient survival.

References

Çinar O. Capnography use in the emergency department. Tr J Emerg Med 2011;11(2):80-9.

Krauss B, Hess DR. Capnography for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007;50(2):172-81.

Shah R, Streat DA, Auerbach M, Shabanova V, Langhan ML, Improving Capnography Use for Critically Ill Emergency Patients: An Implementation Study. J Patient Saf 2020;12. D

Kupnik D, Skok P. Capnometry in the prehospital setting: are we using its potential? Emerg Med J 2007;24(9):614-7.

Katja Lah, Štefek Grmec. The role of end-tidal carbon dioxide monitoring in rapid sequence intubation Journal of Paramedic Practice 2013;2(11).

Wenlong Y, Tingting W, Bailing J, et al. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth 2020;125(1):28-37.

Patwa A, Shah A, Garg R, et al. All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic. Indian J Anaesth 2020;64(2):107-15.

Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia 2020;75: 785–99.

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507-13.

Brewster DJ, Chrimes NC, Do Thy BT, et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J 2020;212(10):472-81.

Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 Outbreak: Wuhan's experience. Anesthesiology 2020;132(6):1317-32.

covid19.who.int[internet].WHO Health Emergency Dashboard. WHO (COVID-19) Homepage.

https://covid19.saglik.gov.tr/TR-66113/covid-19.html.

Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert consensus statement on reporting chest ct findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic ImagingVol. 2, No. 2.

Zuo MZ, Huang YG, Ma WH, et al. Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019. Chin Med Sci J 2020 27;35(2):105-9.

Zhang L, Li J, Zhou M, Chen Z. Summary of 20 trachealintubation by anesthesiologists for patientswith severe COVID-19 pneumonia: retrospectivecaseseries. J Anesth 2020;34(4):599-606.

Dufour DG, Larose DL, Clement SC. Rapıd Sequence Intubatıon In The Emergency Department. The Journal of Emergency Medicine, 1995;13(5):705-10.

Walsh BK, Crotwell DN, Restrepo RD. Capnography/Capnometry during mechanical ventilation. Respir Care 2011;56 (4): 503-9.

Gattinoni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not? Critical Care 2020; 24:154.

Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020 Apr;80(4):388-393.

Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307:2526-33.

Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.

Deakin CD, Sado DM, Coats TJ, Davies G. Prehospital end-tidal carbon dioxide concentration and outcome in major trauma. J Trauma 2004;57(1): 65–8.

Grmec Š, Križmari M, Mally Š, Koželj A, Špindler M, Lešnik B. Utstein style analysis of out-of-hospital cardiac arrest-Bystander CPR and end expired carbon dioxide. Resuscitation 2007;72(3):404-14.

Thompson JE, Jaffe MB. Capnographic waveforms in the mechanically ventilated patient. Respir Care 2005 Jan;50(1):100-8.

Wang J, Lu F, Zhou M, Qi Z, Zhijun Chen Z. Tracheal intubation in patients with severe and critical COVID-19: analysis of 18 cases. Journal of Southern Medical University 2020;40(3):337-41.

Page D, Ablordeppey E, Wessman BT, et al. Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study. Critical Care 2018;22:9.

Jouffroy R, Saade A, Saint Martin LC, Philippe P, Carli P, Vivien B, Prognosis value of partial arterial oxygen pressure in patients with septic shock subjected to pre-hospital invasive ventilation. Am J Emerg Med 2019;37(1):56-60.

Suzuki S, Eastwood GM, Peck L, Glassford NJ, Bellomo R. Current oxygen management in mechanically ventilated patients: A prospective observational cohort study. Journal of Critical Care 2013;28:647–54.

De Jonge E, Peelen L, Keijzers PJ, Joore H, De Lange D, van der Voort PHJ. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care 2008;12(6):156.

Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019(COVID-19). Crit Care Med 2020; 48: e440-69.

Downloads

Published

14-03-2022

Issue

Section

ORIGINAL INVESTIGATIONS/COMMENTARIES - SPECIAL COVID19

How to Cite

1.
Karaali R, Çakır A, Bora ES, Akyol PY, Kavalcı C, Acar H. The Evaluation of End Tidal Carbon Dioxide Values in Intubated Patients with COVID-19: End Tidal Carbon Dioxide and COVID-19. Acta Biomed [Internet]. 2022 Mar. 14 [cited 2024 Jul. 18];93(1):e2022032. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/11989