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Journal of Trauma and Injury 2014;27(4):133-138.
Usefulness of End-tidal Carbon Dioxide as a Predictor of Emergency Intervention in Major Trauma Patients
Sung Ho Kim, Seunghwan Kim, Jae Gil Lee, Sung Phil Chung, Seung Ho Kim
1Department of Emergency Medicine, Yonsei University College of Medicine, Korea.
2Center for Disaster Relief Training and Research, Yonsei University Severance Hospital, Korea. drshkim@yuhs.ac
3Department of Surgery, Yonsei University College of Medicine, Korea.
중증 외상 환자에서의 응급중재술 시행 예측 인자로서의 호기말 이산화탄소 분압의 유용성
김성호, 김승환1, 이재길2, 정성필, 김승호
연세대학교 의과대학 응급의학교실, 1연세대학교 세브란스병원 재난의료교육센터, 2연세대학교 의과대학 외과학교실
Received: 5 August 2014   • Revised: 12 October 2014   • Accepted: 14 October 2014
Abstract
PURPOSE
If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide (ETCO2) as a surrogate marker for predicting both the need for intervention and the prognosis.
METHODS
This is a prospective observational study. Nasal cannula was applied to measure ETCO2, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients.
RESULTS
A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), ETCO2 (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), HCO3 (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only ETCO2 (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, pvalue= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas ETCO2 (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)].
CONCLUSION
This study has revealed that ETCO2, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.
Key Words: Trauma; Carbon dioxide


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