중증 뇌손상 환자에게 비침습적 과호흡 감시로서 호기말 이산화탄소의 이용The Clinical Utility of End-tidal Carbon Dioxide as a Non-invasive Monitoring of Hyperventilation in Severe Brain Injury
- Other Titles
- The Clinical Utility of End-tidal Carbon Dioxide as a Non-invasive Monitoring of Hyperventilation in Severe Brain Injury
- Authors
- 한철; 홍윤식; 정동민; 이선범; 최성혁; 문성우; 이성우
- Issue Date
- 2008
- Publisher
- 대한응급의학회
- Keywords
- End-tidal carbon dioxide; Arterial carbon dioxide; Brain injuries
- Citation
- 대한응급의학회지, v.19, no.4, pp.392 - 397
- Indexed
- KCI
- Journal Title
- 대한응급의학회지
- Volume
- 19
- Number
- 4
- Start Page
- 392
- End Page
- 397
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/124967
- ISSN
- 1226-4334
- Abstract
- Purpose: Hyperventilation is no longer recommended as a
prophylactic intervention during the first 24 hours after
severe head injury. The vasoconstriction caused by reducing
carbon dioxide (CO2) levels leads to cerebral ischemia,
and multiple arterial punctures may be required in order to
monitor hyperventilation in severe brain injury. However,
end-tidal CO2 (Petco2) reflects arterial CO2 (Paco2) noninvasively.
The aim of this study was to determine whether
Petco2 can be successfully used instead of Paco2 to monitor
hyperventilation in brain injury patients.
Methods: From July 1, 2006 to June 30, 2007, 71 patients
who visited the emergency department of a hospital after
severe brain injury (trauma or acute cerebral disorder) were
enrolled. Ten patients with chest trauma, 6 patients who
received CPR in the emergency department (ED), and 1
patient who had COPD were excluded. Hemodynamic variables
(Glasgow coma scale, mean arterial pressure, heart
rate, respiration rate, body temperature, emergency operation,
serum lactate concentration) under mechanical ventilation
support were measured. The concordance between
Petco2 and Paco2 was analyzed by employing a Bland-
Altman plot. We defined the normal range for Paco2 and
Petco2 [P(a-et)co2] is -5~5 mmHg. We compared the normal
and high P(a-et)co2 groups to identify factors affecting
the P(a-et)co2.
Results: Excepting 17 patients under exclusion criteria, we
analyzed 54 of the total of 71 patients. Thirteen patients
(24.1%) were seen to be below 30 mmHg for Paco2. The
Pearson correlation coefficient between Paco2 and Petco2
is 0.834 (p < 0.001), and the concordance between Paco2
and Petco2 was similarly high. The patients with high P(aet)
co2 showed significantly lower mean arterial pressure
and lower arterial pH than patients with normal P(a-et)co2.
Conclusion: Petco2 shows high concordance with Paco2 in
severe brain injury. However, patients with high P(a-et)co2
showed evidence of poor tissue perfusion. Therefore, the
hemodynamic and tissue perfusion state should be considered
when attempting to monitor hyperventilation in severe
brain injury patients using Petco2.
- Files in This Item
- There are no files associated with this item.
- Appears in
Collections - College of Medicine > Department of Medical Science > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.