title: PaCO(2)/ETCO(2) gradient: early indicator of thrombolysis efficacy in a massive pulmonary embolism.
abstract: End tidal CO(2) measurement may be helpful in detecting the efficacy of thrombolysis after a massive pulmonary embolism. We report the case of a 76-year-old man with a massive pulmonary embolism, who required early intubation and mechanical ventilation. Thrombolysis with rtpA (total dosage: 60 mg) was initiated. During this procedure, clinical data, arterial blood gases and end-tidal CO(2) with a capnograph were recorded. Before thrombolysis the P(a-ET)CO(2) gradient was raised to 25 mmHg. During thrombolysis, the clinical data improved and the P(a-ET) gradient fell to 14 mmHg. We postulate that the P(a-ET)CO(2) gradient seems to be a reasonable indicator of efficacy of thrombolysis in this setting. However, the gradient did not return to normal values (4-5 mmHg). The possible reasons for this may be that during mechanical ventilation there was a large ventilation-perfusion ratio and the cardiac output may have still reduced. With these limitations, we conclude that the P(a-ET)CO(2) gradient should be evaluated as an indicator of pulmonary reperfusion in massive pulmonary embolism.
authors.affiliation: Service des Urgences, Cliniques Universitaires Saint-Luc, Université de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Thys
authors.forename: A
authors.initials: A
authors.lastname: Elamly
authors.forename: E
authors.initials: E
authors.lastname: Marion
authors.forename: J
authors.initials: J
authors.lastname: Roeseler
authors.forename: P
authors.initials: P
authors.lastname: Janssens
authors.forename: A
authors.initials: A
authors.lastname: El Gariani
authors.forename: P
authors.initials: P
authors.lastname: Meert
authors.forename: F
authors.initials: F
authors.lastname: Verschuren
authors.forename: M
authors.initials: M
authors.lastname: Reynaert
mesh_terms: D000368:Aged; D002245:Carbon Dioxide / Q000502:physiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D012121:Respiration, Artificial; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D002245:Carbon Dioxide; D010959:Tissue Plasminogen Activator