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Utility of non-invasive monitoring of exhaled carbon dioxide and perfusion index in adult patients in the emergency department.
López-Izquierdo, Raúl; Zalama-Sánchez, Daniel; Rodrigo Enríquez, de Salamanca Gambara; Ana Ramos, Rodríguez; Laura Fadrique, Millán; Mario Rodil, Muñoz; Virginia Carbajosa, Rodríguez; Rubén Pérez, García; Sanz-García, Ancor; Del Pozo Vegas, Carlos; Martín-Rodríguez, Francisco.
Afiliação
  • López-Izquierdo R; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
  • Zalama-Sánchez D; Servicio de Urgencias Hospital Universitario Virgen de la Victoria, Malaga, Spain.
  • Rodrigo Enríquez SG; Gerencia de atención primaria, Valladolid Oeste, Spain.
  • Ana Ramos R; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
  • Laura Fadrique M; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
  • Mario Rodil M; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
  • Virginia Carbajosa R; Gerencia de atención primaria, Valladolid Oeste, Spain.
  • Rubén Pérez G; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
  • Sanz-García A; Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain. Electronic address: ancor.sanz@gmail.com.
  • Del Pozo Vegas C; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario. Valladolid, Spain.
  • Martín-Rodríguez F; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain.
Am J Emerg Med ; 79: 85-90, 2024 May.
Article em En | MEDLINE | ID: mdl-38401230
ABSTRACT

BACKGROUND:

Several noninvasive solutions are available for the assessment of patients at risk of deterioration. Capnography, in the form of end-tidal exhaled CO2 (ETCO2) and perfusion index (PI), could provide relevant information about patient prognosis. The aim of the present project was to determine the association of ETCO2 and PI with mortality of patients admitted to the emergency department (ED).

METHODS:

Multicenter, prospective, cohort study of adult patients with acute disease who needed continuous monitoring in the ED. The study included two tertiary hospitals in Spain between October 2022 and June 2023. The primary outcome of the study was in-hospital mortality (all-cause). Demographics, vital signs, ETCO2 and PI were collected.

RESULTS:

A total of 687 patients were included in the study. The in-hospital mortality rate was 6.8%. The median age was 79 years (IQR 69-86), and 63.3% were males. The median ETCO2 value was 30 mmHg (26-35) in survivors and 23 mmHg (16-30) in nonsurvivors (p = 0.001). For the PI, the medians were 4.7% (2.8-8.1) for survivors and 2.5% (0.98-4-4) for nonsurvivors (p < 0.001). The model that presented the best AUC was age (odds ratio (OR) 1.02 (1.00-1.05)), the respiratory rate (OR 1.06 (1.02-1.11)), and the PI (OR 0.83 (0.75-0.91)), with a result of 0.840 (95% CI 0.795-0.886); the model with the respiratory rate (OR 1.05 (1.01-1.10)), the PI (OR 0.84 (0.76-0.93)), and the ETCO2 (no statistically significant OR), with an AUC of 0.838 (95% CI 0.787-0.889).

CONCLUSIONS:

The present study showed that the PI and respiratory rate are independently associated with in-hospital mortality. Both the PI and ETCO2 are predictive parameters with improved prognostic performance compared with that of standard vital signs.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dióxido de Carbono / Índice de Perfusão Limite: Adult / Aged / Female / Humans / Male Idioma: En Revista: Am J Emerg Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Espanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dióxido de Carbono / Índice de Perfusão Limite: Adult / Aged / Female / Humans / Male Idioma: En Revista: Am J Emerg Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Espanha