Evaluation of capnography in nonintubated emergency department patients with respiratory distress

M C Plewa, S Sikora, M Engoren, D Tome, J Thomas, A Deuster
Academic Emergency Medicine 1995, 2 (10): 901-8

OBJECTIVE: To evaluate the ability of noninvasive capnographic measurement of end-tidal CO2 tension (PetCO2) to predict arterial CO2 tension (PaCO2) in nonintubated ED patients with respiratory distress.

METHODS: A prospective, nonblind study was performed in a level I trauma center/community teaching hospital ED. Participants included all nonintubated adult patients with respiratory distress requiring measurement of arterial blood gases (ABGs); 29 patients were enrolled. PetCO2 was measured with a capnography monitor, using both baseline tidal volumes and forced expiratory volumes. The bias between PetCO2 values and simultaneous measurements of PaCO2 by ABG was assessed.

RESULTS: PetCO2, measured with forced expiration, and PaCO2 agreed well, with bias (i.e., average difference) = 0.44 +/- 0.52 kPa (3.3 +/- 3.9 torr). PetCO2 measured with the tidal volume breath produced an unacceptably high bias of 0.82 +/- 0.70 kPa (6.1 +/- 5.2 torr). Levels of agreement between PaCO2 were similar for smokers and nonsmokers and for men and women. The arterial-end-tidal CO2 tension (Pa-etCO2) difference was not related to PaCO2. Pa-etCO2 correlated with age (r = 0.473; p = 0.01), and was significantly higher in patients with pulmonary disease (1.32 +/- 0.56 kPa; 9.9 +/- 4.2 torr) than it was in those without pulmonary disease (0.46 +/- 0.55 kPa; 3.5 +/- 4.1 torr; p < 0.001).

CONCLUSIONS: Noninvasive PetCO2 monitoring may adequately predict PaCO2 in nonintubated ED patients with respiratory distress who are able to produce a forced expiration. PetCO2 is less accurate for PaCO2 with tidal volume breathing and in patients with pulmonary disease.

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