Pınar Yeşim AKYOL, Hüseyin ACAR, Rezan KARAALİ, Ejder Saylav BORA, Fatih TOPAL

Hastanede yatan COVID-19 hastalarında hastalığın ilerlemesini ve mortalite riskini tahmin etmede ETCO2 değerlerinin kullanılabilirliği

Amaç: End-tidal CO2 (ETCO2) seviyeleri, SpO2 değerlerinden bağımsız olarak hastanın solunum ve metabolik/perfüzyon durumunu yansıtır. Bu çalışma, hastanede yatan COVID-19 hastalarınıda entübasyon ihtiyacını, yoğun bakım ünitesine kabulünü ve mortaliteyi tahmin etmede ETCO2 değerlerinin faydasını araştırmayı amaçladı. Gereç ve Yöntem: COVID-19 pnömonisi olan toplam 108 hastanede yatan hasta dahil edildi. Solunum parametreleri (oksijen satürasyonu, ETCO2 ve solunum hızı [RR]- O2’li ve O2’siz [w/wo O2]) ve laboratuvar parametreleri ile ilgili veriler kaydedildi. Bulgular: COVİD-19 hastalarında yoğun bakım ünitesine yatış ihtiyacı, anlamlı olarak daha yüksek ETCO2 değerleri ile ilişkilendirildi. (wO2:27,9 (4,6) vs. 18,6(8,4), p=0.040; woO2: 30,1 (4,9) vs. 23,8 (6,9), p=0.040). Mortalite, daha yüksek RR olasılığı (wO2:32,4 (5,8)’e karşı 24,6 (6,8), p=0.002) ve daha düşük saturasyon (wO2:92,9 (3,8)’e karşı 95,5 (4,2), p=0.025; woO2: 87,1 (5,7) vs. 91,8(6,6), p=0.013) ile ilişkili bulundu. Sonuç: Bulgularımız, azalmış ETCO2 (w/wo O2) değerlerinin hastaneden taburcu olma olasılığının daha düşük ve yoğun bakım ünitesine transfer olasılığının artmasıyla ilişkisini ortaya koydu. Düşük oksijen satürasyon seviyeleri, hastanede yatan COVID-19 hastalarında hem entübasyon ihtiyacı hem de mortalite riskinin artmasıile ilişkili bulundu.

Anahtar Kelimeler:

yoğun bakım ünitesi, mortalite, acil servis, COVID-19,

The utility of ETCO2 value in predicting the progress of the disease and mortality risk in hospitalized patients with COVID-19 pneumonia

Aim: End-tidal CO2 (ETCO2) levels are reflective of the ventilatory and metabolic/perfusion status of a patient, regardless of his/her SpO2 values. This study aimed to investigate the utility of ETCO2values in predicting the need for intubation, ICU admission, and mortality in hospitalized patients with COVID-19 pneumonia. Material and Method: A total of 108 hospitalized patients with COVID-19 pneumonia were included. Data on respiratory parameters (oxygen saturation, ETCO2, and respiratory rate [RR]- with and without O2 [w/wo O2]) and laboratory parameters were recorded. Results: The need forintensive care unit(ICU) admission was associated with significantly higher ETCO2 values (wO2:27.9 (4.6) vs. 18.6(8.4), p=0.040; woO2: 30.1(4.9) vs. 23.8(6.9), p=0.040). Mortality was associated with higher likelihood of higher RR (wO2:32.4(5.8) vs. 24.6(6.8), p=0.002) and lower oxygen saturation (wO2:92.9(3.8) vs. 95.5(4.2), p=0.025; woO2:87.1(5.7) vs. 91.8(6.6), p=0.013). Presence vs. lack of intubation need was associated with significantly increased likelihood of saturation (wO2:93.1(5.3) vs. 95.9(3.8), p=0.013; woO2:87.6(8.3) vs. 92.3(5.9), p=0.007). Hospital discharge vs. ICU stay was associated with significantly higher ETCO2 values (wO2:27.9 (4.6) vs. 18.6(8.4), p=0.040; woO2: 30.1(4.9) vs. 23.8(6.9), p=0.040) Conclusion: Our findings revealed the association of decreased ETCO2 (w/wo O2) values with a lower likelihood of hospital discharge and increased likelihood of ICU transfer. Low oxygen saturation levels related the increased risk of both intubation need and mortality in hospitalized COVID-19 patients.

Keywords:

COVID-19, intensive care unit, mortality, emergency medicine,

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Perlman S. Another decade, another coronavirus. N Engl J Med 2020; 382: 760-2.
Zhang T, Wu Q, Zhang Z. Probable Pangolin Origin of SARS-CoV-2 Associated with the COVID-19 outbreak. Curr Biol 2020; 30: 1578.
Sun S, Cai X, Wang H, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta 2020; 507: 174-80.
Kermali M, Khalsa RK, Pillai K, Ismail Z, Harky A. The role of biomarkers in diagnosis of COVID-19 – A systematic review. Life Sci 2020; 254: 117788.
Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. COVID-19 does not lead to a “typical” acute respiratory distress syndrome. Am J Respir Crit Care Med 2020; 201: 1299-300.
Liu X, Liu X, Xu Y, et al. Ventilatory ratio in hypercapnic mechanically ventilated patients with COVID-19-associated acute respiratory distress syndrome. Am J Respir Crit Care Med 2020; 201: 1297-9.
Pan C, Chen L, Lu C. Lung recruitability in COVID-19-associated acute respiratory distress syndrome: a single-center observational study. Am J Respir Crit Care Med 2020; 201: 1294-7.
Henderson WR, Chen L, Amato MBP, Brochard LJ. Fifty years of research in ARDS. Respiratory mechanics in acute respiratory distress syndrome. Am J Respir Crit Care Med 2017; 196: 822-33.
Xia J, Feng Y, Li M, et al. Increased physiological dead space in mechanically ventilated COVID-19 patients recovering from severe acute respiratory distress syndrome: a case report. BMC Infect Dis 2020; 20: 637.
Kallet RH, Lipnick MS. End-tidal-to-arterial PCO2 ratio as signifier for physiologic dead-space ratio and oxygenation dysfunction in acute respiratory distress syndrome. Respir Care 2021; 66: 263-8.
Kallet RH, Daniel BM, Garcia O, Matthay MA. Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care 2005; 50: 462-7.
Doorduin J, Nollet JL, Vugts MP, et al. Assessment of dead-space ventilation in patients with acute respiratory distress syndrome: a prospective observational study. Crit Care 2016; 20: 121.
Sinha P, Calfee CS, Beitler JR, et al. Physiologic analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome. Am J Respir Crit Care Med 2019; 199: 333-41.
Gattinoni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not? Crit Care 2020; 24: 154.
Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122: 640-56.
Cereceda-Sánchez FJ, Molina-Mula J. Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting. Rev Lat Am Enfermagem 2017; 25: e2885.
Aminiahidashti H, Shafiee S, Zamani Kiasari A, Sazgar M. Applications of end-tidal carbon dioxide (ETCO2) monitoring in emergency department; a narrative review. Emerg (Tehran) 2018; 6: e5.
EMS Products. https://www.ems1.com/ems-products/capnography/articles/etcO2-monitoring-youre-doing-the-right-thing-2WyB2s4MXPgA2Lw7/. Nowak T. Accessed 18 February 2021.
Hu D, Li J, Gao R, et al. Decreased CO2 Levels as indicators of possible mechanical ventilation-induced hyperventilation in COVID-19 patients: a retrospective analysis. Front Public Health 2021; 8: 596168.
The Turkish Ministry of Health (2020) Guidelines for the Management of Adults with COVID-19. https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19-Rehberi.pdf. Accessed 11 Januray 2021.
Robertson HT. Dead space: the physiology of wasted ventilation. Eur Respir J 2015; 45: 1704-16.
Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med 2002; 346: 1281-6.
Mauri T, Spinelli E, Scotti E, et al. Potential for lung recruitment and ventilation-perfusion mismatch in patients with the acute respiratory distress syndrome from coronavirus disease 2019. Crit Care Med 2020; 48: 1129-34.
Tang Y, Turner MJ, Baker AB. Effects of alveolar dead-space, shunt and V/Q distribution on respiratory dead-space measurements. Br J Anaesth 2005; 95: 538-48.
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020; 395: 1054-62.
Albarello F, Pianura E, Di Stefano F, et al. 2019-novel coronavirus severe adult respiratory distress syndrome in two cases in Italy: An uncommon radiological presentation. Int J Infect Dis 2020; 93: 192-7.
Anderson CT, Breen PH. Carbon dioxide kinetics and capnography during critical care. Crit Care 2000; 4: 207-15.
Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment. 7th ed. http://kjfy.meetingchina.org/msite/news/show/cn/3337.html. China national health commission. Accessed 25 February 2021.