In Brief | Agreement between arterial and end-tidal carbon dioxide in adult patients admitted with serious traumatic brain injury
Estimated read time: 1 minute, 18 seconds
Originally Published: 2 February 2024
Sourced: PLOS One
Type of article: In Brief
MedED Catalogue Reference: MCCIB0010
Category: Critical Care, Anaesthetics & Emergency Medicine
Cross Reference: Respiratory, Neurology
Keywords: TBI, brain injury, ventilation, polytrauma
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Originally published PLOS one
In the acute phase of traumatic brain injury (TBI), low to normal arterial carbon dioxide levels (PaCO2) are recommended to optimise O2 and CO2 tension and maintain cerebral perfusion. Where arterial sampling is not readily available, end-tidal CO2 ( ETCO2) is frequently used as a surrogate for PaCO2.
Nonetheless, according to researchers Sardesai & Hibberd et al., while limited, the data that exists points towards low levels of Agreement between the PaCO2 and ETCO2, suggesting that in head-injured or polytrauma patients, the use of the ETCO2 alone is not adequate to guide ventilation.
The objective of their study was, therefore, to…” describe the correlation and agreement between PaCO2 and ETCO2 in intubated adult trauma patients with TBI.”
A retrospective analysis was conducted on prospectively collected data from 695 adult trauma patients with serious TBI. Liner regression and Welch’s test assessed the correlation between PaCO2 and ETCO2 (3812 paired data points) at 24-hour intervals for 120 hours after admission.
On admission, the median PaCO2 - ETCO2 gradient was 0.8 [0.4–1.4] kPa, with a correlation of R2 0.149. Patients who had a TBI and a concomitant injury evidenced significantly greater gradients than those patients with TBI only (0.9 [0.4–1.5] kPa vs 0.7 [0.3–1.1] kPa, p<0.05). The gradient reduced in both groups over time.
Patients with a larger PaCO2 -ETC02 gradient on admission exhibited an increased mortality rate at the 30 days compared to those who survived (1.2 [0.7–1.9] kPa and 0.7 [0.3–1.2] kPa, p<0.005.)
The researchers concluded that the PaCO2 - ETCO2 gradient was more significant than previously reported in patients with traumatic brain injury, particularly in the early stages and when associated with a concomitant chest injury.
Access the original article
Sardesai, N., Hibberd, O., Price, J., Ercole, A., & Barnard, E. B. G. (2024). Agreement between arterial and end-tidal carbon dioxide in adult patients admitted with serious traumatic brain injury. PloS one, 19(2), e0297113. https://doi.org/10.1371/journal.pone.0297113?
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