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Research ArticleOriginal Research

End-Tidal and Arterial Carbon Dioxide Measurements Correlate Across All Levels of Physiologic Dead Space

S David McSwain, Donna S Hamel, P Brian Smith, Michael A Gentile, Saumini Srinivasan, Jon N Meliones and Ira M Cheifetz
Respiratory Care March 2010, 55 (3) 288-293;
S David McSwain
Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
Department of Pediatrics, University of South Carolina, Charleston, South Carolina.
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  • For correspondence: [email protected]
Donna S Hamel
Duke University Medical Center—Clinical Research Unit
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P Brian Smith
Duke Clinical Research Institute—Statistics Unit
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Michael A Gentile
Division of Pulmonary and Critical Care Medicine
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Saumini Srinivasan
Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
Le Bonheur Children's Medical Center, Memphis, Tennessee.
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Jon N Meliones
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
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Ira M Cheifetz
Division of Pediatric Critical Care Medicine
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Abstract

BACKGROUND: End-tidal carbon dioxide (PETCO2) is a surrogate, noninvasive measurement of arterial carbon dioxide (PaCO2), but the clinical applicability of PETCO2 in the intensive care unit remains unclear. Available research on the relationship between PETCO2 and PaCO2 has not taken a detailed assessment of physiologic dead space into consideration. We hypothesized that PETCO2 would reliably predict PaCO2 across all levels of physiologic dead space, provided that the expected PETCO2-PaCO2 difference is considered.

METHODS: Fifty-six mechanically ventilated pediatric patients (0–17 y old, mean weight 19.5 ± 24.5 kg) were monitored with volumetric capnography. For every arterial blood gas measurement during routine care, we measured PETCO2 and calculated the ratio of dead space to tidal volume (VD/VT). We assessed the PETCO2-PaCO2 relationship with Pearson's correlation coefficient, in 4 VD/VT ranges.

RESULTS: VD/VT was ≤ 0.40 for 125 measurements (25%), 0.41–0.55 for 160 measurements (32%), 0.56–0.70 for 154 measurements (31%), and > 0.7 for 54 measurements (11%). The correlation coefficients between PETCO2 and PaCO2 were 0.95 (mean difference 0.3 ± 2.1 mm Hg) for VD/VT ≤ 0.40, 0.88 (mean difference 5.9 ± 4.3 mm Hg) for VD/VT 0.41–0.55, 0.86 (mean difference 13.6 ± 5.2 mm Hg) for VD/VT 0.56–0.70, and 0.78 (mean difference 17.8 ± 6.7 mm Hg) for VD/VT > 0.7.

CONCLUSIONS: There were strong correlations between PETCO2 and PaCO2 in all the VD/VT ranges. The PETCO2-PaCO2 difference increased predictably with increasing VD/VT.

  • capnography
  • artificial respiration
  • blood gas analysis
  • pediatric
  • infant
  • mechanical ventilation
  • carbon dioxide

Footnotes

  • Correspondence: S David McSwain MD, Medical University of South Carolina, 135 Rutledge Avenue, MSC 566, Charleston SC 29425. Email: mcswains{at}musc.edu.
  • The authors have disclosed a relationship with Philips-Respironics.

  • See the Related Editorial on Page 350

  • Copyright © 2010 by Daedalus Enterprises Inc.
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Respiratory Care: 55 (3)
Respiratory Care
Vol. 55, Issue 3
1 Mar 2010
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End-Tidal and Arterial Carbon Dioxide Measurements Correlate Across All Levels of Physiologic Dead Space
S David McSwain, Donna S Hamel, P Brian Smith, Michael A Gentile, Saumini Srinivasan, Jon N Meliones, Ira M Cheifetz
Respiratory Care Mar 2010, 55 (3) 288-293;

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End-Tidal and Arterial Carbon Dioxide Measurements Correlate Across All Levels of Physiologic Dead Space
S David McSwain, Donna S Hamel, P Brian Smith, Michael A Gentile, Saumini Srinivasan, Jon N Meliones, Ira M Cheifetz
Respiratory Care Mar 2010, 55 (3) 288-293;
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Keywords

  • capnography
  • artificial respiration
  • blood gas analysis
  • pediatric
  • infant
  • mechanical ventilation
  • carbon dioxide

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