title: Volumetric capnography as a bedside monitoring of thrombolysis in major pulmonary embolism.
abstract: OBJECTIVE
  To describe the use of volumetric capnography, a plot of expired CO(2) concentration against expired volume, in monitoring fibrinolytic treatment of major pulmonary embolism.
  
  
  METHODS
  Two case reports in the emergency department of a teaching hospital.
  
  
  METHODS
  Two conscious and spontaneously breathing patients (69- and 31-year-old women) with major pulmonary embolism requiring thrombolysis. Decision for thrombolysis was based on the association of right ventricular afterload on echocardiography, with respiratory failure and hypotension in the first patient, and dyspnea and hemodynamically stable parameters in the second one.
  
  
  METHODS
  Successive capnographic measurements were performed before, during, and after thrombolysis. Curves of volumetric capnography were obtained from a sidestream gas monitor with flow sensor and an arterial blood gas analysis for CO(2) partial pressure.
  
  
  RESULTS
  We calculated late deadspace fraction, previously suggested as the most effective capnographic parameter in the diagnosis of pulmonary embolism. Late deadspace fraction decreased in the two patients, respectively, from 64.4% to 1.1% and from 25.6% to 5.7% after thrombolysis, with a concomitant disappearance of right heart dysfunction signs on echocardiography.
  
  
  CONCLUSIONS
  Volumetric capnography can monitor thrombolysis in major pulmonary embolism. Differences between volumetric capnography technology and the more traditional arterial to end-tidal CO(2) gradient are important to take into account for clinical application.
authors.affiliation: Emergency and Intensive Care Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium. Franck.verschuren@clin.ucl.ac.be
authors.forename: Franck
authors.initials: F
authors.lastname: Verschuren
authors.forename: Erkki
authors.initials: E
authors.lastname: Heinonen
authors.forename: Didier
authors.initials: D
authors.lastname: Clause
authors.forename: Jean
authors.initials: J
authors.lastname: Roeseler
authors.forename: Frédéric
authors.initials: F
authors.lastname: Thys
authors.forename: Philippe
authors.initials: P
authors.lastname: Meert
authors.forename: Eric
authors.initials: E
authors.lastname: Marion
authors.forename: Abdulwahed
authors.initials: A
authors.lastname: El Gariani
authors.forename: Jacques
authors.initials: J
authors.lastname: Col
authors.forename: Marc
authors.initials: M
authors.lastname: Reynaert
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liistro
mesh_terms: D000328:Adult; D000368:Aged; D019296:Capnography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D019095:Point-of-Care Systems; D011655:Pulmonary Embolism / Q000628:therapy*; D015912:Thrombolytic Therapy