Relationship between end-tidal carbon dioxide partial pressure (PETCO<sub>2</sub>) and PaCO<sub>2</sub> in ventilated patients _Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Jinrong , SHAO Liye , GUO Wei , YANG Xiaoya ,  CUI Zhaobo

Department of Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei 053000, P. R. China;

Corresponding author：

CUI Zhaobo, Email: zhaobocui2014@sina.com

Keywords：

End-tidal carbon dioxide partial pressure gradients; Arterial carbon dioxide pressure; Mechanical ventilation; Correlation analysis

DOI：

10.7507/1671-6205.201708009

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Objective To analyze the relationship between end-tidal carbon dioxide partial pressure (PETCO₂) and arterial CO₂ pressure (PaCO₂) in invasive ventilated patients. Methods An observational study was conducted in adult patients admitted to Intensive Care Unit (ICU) between June 2016 and March 2017. Samples were immediately analyzed for PaCO₂ using a blood gas analyzer. At the same time the arterial to end-tidal CO₂ gradient was determined. Relationship in different mechanical ventilation modes, disease categories and PaO₂/FiO₂ were analyzed in this study. Results A total of 225 arterial blood gases were obtained from the 104 patients. In each of these modes the PETCO₂ was generally lower than the PaCO₂. There was a positive correlation between PaCO₂ and PETCO₂ regardless of different mode (r=0.70, Y=11.08+0.77X). A positive correlation was found in SIMV and SPONT modes, but not in A/C mode. The relationship between PaCO₂ and PETCO₂ in COPD, trauma, cerebrovascular disease and severe pneumonia patients shown a positive correlation (r value was 0.76, 0.64, 0.53, and 0.56, respectively). There was a significant correlation whether PaCO₂/FiO₂<200 mm Hg (r=0.69, P<0.001) or ≥200 mm Hg (r=0.71, P<0.001). Conclusions The results of this study show that PETCO₂ monitoring accurately reflects PaCO₂ during mechanical ventilation. A positive correlation is found in different ventilation modes, regardless of disease categories or PaCO₂/FiO₂.

Citation： WANG Jinrong, SHAO Liye, GUO Wei, YANG Xiaoya, CUI Zhaobo. Relationship between end-tidal carbon dioxide partial pressure (PETCO₂) and PaCO₂ in ventilated patients . Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(1): 71-75. doi: 10.7507/1671-6205.201708009 Copy

1.	急诊呼气末二氧化碳监测专家共识组. 急诊呼气末二氧化碳监测专家共识. 中华急诊医学杂志, 2017, 26(5): 507-511.
2.	Kartal M, Goksu E, Eray O, et al. The value of ETCO₂ measurement for COPD patients in the emergency department. Eur J Emerg Med, 2011, 18(1):9-12.
3.	Delerme S, Freund Y, Renault R, et al. Concordance between capnography and capnia in adults admitted for acute dyspnea in an ED. Am J Emerg Med, 2010, 28(6):711-714.
4.	Prause G, Hetz H, Lauda P, et al. A comparison of the end-tidal-CO₂ documented by capnometry and the arterial PCO₂ in emergency patients. Resuscitation, 1997, 35(2):145-148.
5.	Lee SW, Hong YS, Han C, et al. Concordance of end-tidal carbon dioxide and arterial carbon dioxide in severe traumatic brain injury. J Trauma, 2009, 67(3):526-530.
6.	Yamanaka MK, Sue DY. Comparison of arterial-end-tidal PCO₂ difference and dead space/tidal volume ratio in respiratory failure. Chest, 1987, 92(5):832-835.
7.	Tusman G, Suarez-Sipmann F, Bohm SH, et al. Capnography reflects ventilation/perfusion distribution in a model of acute lung injury. Acta Anaesthesiol Scand, 2011, 55(5):597-606.
8.	Tusman G, Suarez-Sipmann F, Bohm SH, et al. Monitoring dead space during recruitment and PEEP titration in an experimental model. Intensive Care Med, 2006, 32(11):1863-1871.
9.	史雪, 杨国玲, 陈杨, 等. 呼气末二氧化碳分压评估特发性肺动脉高压与慢性血栓栓塞性肺动脉高压严重程度的价值. 中华结核和呼吸杂志, 2017, 40(1): 34-39.
10.	Fengmei G, Jin C, Songqiao L, et al. Dead space fraction changes during PEEP titration following lung recruitment in patients with ARDS. Respir Care, 2012, 57(10):1578-1585.
11.	蔡英丽, 詹红. 呼气末二氧化碳分压联合平台压监测在急性呼吸窘迫综合征机械通气中的应用进展. 医学综述, 2017, 23(6): 1210-1214.
12.	Razi E, Moosavi GA, Omidi K, et al. Correlation of end-tidal carbon dioxide with arterial carbon dioxide in mechanically ventilated patients. Arch Trauma Res, 2012, 1(2):58-62.
13.	中华医学会重症医学分会. 机械通气临床应用指南(2006). 中国危重病急救医学, 2007, 02(19): 65-72.
14.	Fletcher R, Jonson B. Deadspace and the single breath test for carbon dioxide during anaesthesia and artificial ventilation. Effects of tidal volume and frequency of respiration. Br J Anaesth, 1984, 56(2):109-119.
15.	杨相梅, 洪跃玲, 罗艳. 呼气末二氧化碳监测在慢性阻塞性肺疾病中的应用. 中华肺部疾病杂志(电子版), 2010, 3(4): 243-245.
16.	谭伟, 刘璠, 侯海佳, 等. 平静呼气法与延长呼气法测定呼气末二氧化碳分压在呼吸内科应用价值的比较. 中华危重病急救医学, 2013, 25(10): 608-613.
17.	Sivan Y, Eldadah MK, Cheah TE, et al. Estimation of arterial carbon dioxide by end-tidal and transcutaneous PCO₂ measurements in ventilated children. Pediatr Pulmonol, 1992, 12(3):153-157.
18.	Russell GB, Graybeal JM. The arterial to end-tidal carbon dioxide difference in neurosurgical patients during craniotomy. Anesth Analg, 1995, 81(4):806-810.
19.	Weinger MB, Brimm JE. End-tidal carbon dioxide as a measure of arterial carbon dioxide during intermittent mandatory ventilation. J Clin Monit, 1987, 3(2):73-79.
20.	Takki S, Aromaa U, Kauste A. The validity and usefulness of the end-tidal pCO₂ during anaesthesia. Ann Clin Res, 1972, 4(5):278-284.
21.	Whitesell R, Asiddao C, Gollman D, et al. Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference. Anesth Analg, 1981, 60(7):508-512.
22.	Hopper K. Respiratory Acid-Base Disorders in the Critical Care Unit. Vet Clin North Am Small Anim Pract, 2017, 47(2):351-357.
23.	Kerr ME, Zempsky J, Sereika S, et al. Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma. Crit Care Med, 1996, 24(5):785-790.
24.	Morley TF, Giaimo J, Maroszan E, et al. Use of capnography for assessment of the adequacy of alveolar ventilation during weaning from mechanical ventilation. Am Rev Respir Dis, 1993, 148(2):339-344.
25.	Barton CW, Wang ES. Correlation of end-tidal CO₂ measurements to arterial PaCO₂ in nonintubated patients. Ann Emerg Med, 1994, 23(3):560-563.
26.	Tobias JD, Meyer DJ. Noninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants: end-tidal versus transcutaneous carbon dioxide. Anesth Analg, 1997, 85(1):55-58.
27.	Thrush DN, Mentis SW, Downs JB. Weaning with end-tidal CO₂ and pulse oximetry. J Clin Anesth, 1991, 3(6):456-460.
28.	McDonald MJ, Montgomery VL, Cerrito PB, et al. Comparison of end-tidal CO₂ and PaCO₂ in children receiving mechanical ventilation. Pediatr Crit Care Med, 2002, 3(3):244-249.

1. 急诊呼气末二氧化碳监测专家共识组. 急诊呼气末二氧化碳监测专家共识. 中华急诊医学杂志, 2017, 26(5): 507-511.
2. Kartal M, Goksu E, Eray O, et al. The value of ETCO₂ measurement for COPD patients in the emergency department. Eur J Emerg Med, 2011, 18(1):9-12.
3. Delerme S, Freund Y, Renault R, et al. Concordance between capnography and capnia in adults admitted for acute dyspnea in an ED. Am J Emerg Med, 2010, 28(6):711-714.
4. Prause G, Hetz H, Lauda P, et al. A comparison of the end-tidal-CO₂ documented by capnometry and the arterial PCO₂ in emergency patients. Resuscitation, 1997, 35(2):145-148.
5. Lee SW, Hong YS, Han C, et al. Concordance of end-tidal carbon dioxide and arterial carbon dioxide in severe traumatic brain injury. J Trauma, 2009, 67(3):526-530.
6. Yamanaka MK, Sue DY. Comparison of arterial-end-tidal PCO₂ difference and dead space/tidal volume ratio in respiratory failure. Chest, 1987, 92(5):832-835.
7. Tusman G, Suarez-Sipmann F, Bohm SH, et al. Capnography reflects ventilation/perfusion distribution in a model of acute lung injury. Acta Anaesthesiol Scand, 2011, 55(5):597-606.
8. Tusman G, Suarez-Sipmann F, Bohm SH, et al. Monitoring dead space during recruitment and PEEP titration in an experimental model. Intensive Care Med, 2006, 32(11):1863-1871.
9. 史雪, 杨国玲, 陈杨, 等. 呼气末二氧化碳分压评估特发性肺动脉高压与慢性血栓栓塞性肺动脉高压严重程度的价值. 中华结核和呼吸杂志, 2017, 40(1): 34-39.
10. Fengmei G, Jin C, Songqiao L, et al. Dead space fraction changes during PEEP titration following lung recruitment in patients with ARDS. Respir Care, 2012, 57(10):1578-1585.
11. 蔡英丽, 詹红. 呼气末二氧化碳分压联合平台压监测在急性呼吸窘迫综合征机械通气中的应用进展. 医学综述, 2017, 23(6): 1210-1214.
12. Razi E, Moosavi GA, Omidi K, et al. Correlation of end-tidal carbon dioxide with arterial carbon dioxide in mechanically ventilated patients. Arch Trauma Res, 2012, 1(2):58-62.
13. 中华医学会重症医学分会. 机械通气临床应用指南(2006). 中国危重病急救医学, 2007, 02(19): 65-72.
14. Fletcher R, Jonson B. Deadspace and the single breath test for carbon dioxide during anaesthesia and artificial ventilation. Effects of tidal volume and frequency of respiration. Br J Anaesth, 1984, 56(2):109-119.
15. 杨相梅, 洪跃玲, 罗艳. 呼气末二氧化碳监测在慢性阻塞性肺疾病中的应用. 中华肺部疾病杂志(电子版), 2010, 3(4): 243-245.
16. 谭伟, 刘璠, 侯海佳, 等. 平静呼气法与延长呼气法测定呼气末二氧化碳分压在呼吸内科应用价值的比较. 中华危重病急救医学, 2013, 25(10): 608-613.
17. Sivan Y, Eldadah MK, Cheah TE, et al. Estimation of arterial carbon dioxide by end-tidal and transcutaneous PCO₂ measurements in ventilated children. Pediatr Pulmonol, 1992, 12(3):153-157.
18. Russell GB, Graybeal JM. The arterial to end-tidal carbon dioxide difference in neurosurgical patients during craniotomy. Anesth Analg, 1995, 81(4):806-810.
19. Weinger MB, Brimm JE. End-tidal carbon dioxide as a measure of arterial carbon dioxide during intermittent mandatory ventilation. J Clin Monit, 1987, 3(2):73-79.
20. Takki S, Aromaa U, Kauste A. The validity and usefulness of the end-tidal pCO₂ during anaesthesia. Ann Clin Res, 1972, 4(5):278-284.
21. Whitesell R, Asiddao C, Gollman D, et al. Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference. Anesth Analg, 1981, 60(7):508-512.
22. Hopper K. Respiratory Acid-Base Disorders in the Critical Care Unit. Vet Clin North Am Small Anim Pract, 2017, 47(2):351-357.
23. Kerr ME, Zempsky J, Sereika S, et al. Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma. Crit Care Med, 1996, 24(5):785-790.
24. Morley TF, Giaimo J, Maroszan E, et al. Use of capnography for assessment of the adequacy of alveolar ventilation during weaning from mechanical ventilation. Am Rev Respir Dis, 1993, 148(2):339-344.
25. Barton CW, Wang ES. Correlation of end-tidal CO₂ measurements to arterial PaCO₂ in nonintubated patients. Ann Emerg Med, 1994, 23(3):560-563.
26. Tobias JD, Meyer DJ. Noninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants: end-tidal versus transcutaneous carbon dioxide. Anesth Analg, 1997, 85(1):55-58.
27. Thrush DN, Mentis SW, Downs JB. Weaning with end-tidal CO₂ and pulse oximetry. J Clin Anesth, 1991, 3(6):456-460.
28. McDonald MJ, Montgomery VL, Cerrito PB, et al. Comparison of end-tidal CO₂ and PaCO₂ in children receiving mechanical ventilation. Pediatr Crit Care Med, 2002, 3(3):244-249.

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Relationship between end-tidal carbon dioxide partial pressure (PETCO₂) and PaCO₂ in ventilated patients

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Relationship between end-tidal carbon dioxide partial pressure (PETCO2) and PaCO2 in ventilated patients

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Relationship between end-tidal carbon dioxide partial pressure (PETCO₂) and PaCO₂ in ventilated patients