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End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis.
MedLine Citation:
PMID:  22867820     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Exhaled end-tidal carbon dioxide (Etco(2)) concentration is associated with lactate levels in febrile patients. We assessed the association of Etco(2) with mortality and lactate levels in patients with suspected sepsis. METHODS: This was a prospective observational study. We enrolled 201 adult patients presenting with suspected infection and 2 or more systemic inflammatory response syndrome criteria. Lactate and Etco(2) were measured and analyzed with patient outcomes. RESULTS: The area under the receiver operator characteristics curve (AUC) was 0.75 (confidence interval [CI], 0.65-0.86) for lactate and mortality and 0.73 (CI, 0.61-0.84) for Etco(2) and mortality. When analyzed across the different categories of sepsis, the AUCs for lactate and mortality were 0.61 (CI, 0.36-0.87) for sepsis, 0.69 (CI, 0.48-0.89) for severe sepsis, and 0.74 (CI, 0.55-0.93) for septic shock. The AUCs for Etco(2) and mortality were 0.60 (CI, 0.37-0.83) for sepsis, 0.67 (CI, 0.46-0.88) for severe sepsis, and 0.78 (CI, 0.59-0.96) for septic shock. There was a significant inverse relationship between Etco(2) and lactate in all categories, with correlation coefficients of -0.421 (P < .001) in the sepsis group, -0.597 (P < .001) in the severe sepsis group, and -0.482 (P = .011), respectively. Adjusted odds ratios were calculated, demonstrating 3 significant predictors of mortality: use of vasopressors 16.4 (95% CI, 1.80-149.2), mechanical ventilation 16.4 (95% CI, 3.13-85.9), and abnormal Etco(2) levels 6.48 (95% CI, 1.06-39.54). CONCLUSIONS: We observed a significant association between Etco(2) concentration and in-hospital mortality in emergency department patients with suspected sepsis across a range of disease severity.
Christopher L Hunter; Salvatore Silvestri; Matthew Dean; Jay L Falk; Linda Papa
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-3
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  -     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL 32806.
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