End-tidal CO2-derived values during emergency trauma surgery correlated with outcome: a prospective study.
BACKGROUND
The purpose of this study was to determine whether end-tidal carbon dioxide (PETCO) derived variables assist in evaluating the adequacy of resuscitation during emergency surgery for trauma.


METHODS
This was a prospective study of end-tidal derived variables and outcome in 106 trauma patients in an urban Level I trauma center.


RESULTS
The patients who lived (compared with those who died) had higher final end-tidal Pco levels, lower arterial-end tidal CO differences (Pa-ET)CO, and a decreased alveolar dead space ratio (p < 0.001). The best survival rates were with a PETCO > 27 mm Hg, a (Pa-ET)CO < or = 9 mm Hg, and 96% (56 of 58) for an alveolar dead space ratio < or = 0.20 (p < 0.001). An inappropriately high or "excess Paco also correlated with a decreased (Pa-ET)CO and poorer prognosis. If, after the initial resuscitation, the PETCO -derived values did not achieve these "optimal" levels, survival was significantly reduced.


CONCLUSIONS
During emergency trauma surgery, the PETCO and its derived values help to predict outcome and may be used to identify patients needing more aggressive resuscitation.
Tyburski
James G
JG
Department of Surgery, Wayne State University, Detroit, Michigan, USA. jtybursk@med.wayne.edu
Collinge
Julianne D
JD
Wilson
Robert F
RF
Carlin
Arthur M
AM
Albaran
Renato G
RG
Steffes
Christopher P
CP
D000136:Acid-Base Equilibrium; D000328:Adult; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000032:analysis* / Q000097:blood; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012126:Respiratory Dead Space; D012151:Resuscitation; D015996:Survival Rate; D013990:Tidal Volume; D014947:Wounds and Injuries / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*
D002245:Carbon Dioxide