Correlation of PaCO2 and ETCO2 in COPD Patients with Exacerbation on Mechanical Ventilation

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Sateesh Chandra
2. Sushmitha Jakka
3. Dhruva Chaudhry
4. Diksha Tyagi
ISSN
0972-5229
DOI
10.5005/jp-journals-10071-23762
Volume
25
Issue
3
Publishing Year
2021
Pages
5
Author Affiliations
    1. Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
    1. Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
    1. Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
  • Article keywords

    Abstract

    Introduction: Chronic obstructive pulmonary disease (COPD) patients in hypercapnic respiratory failure require multiple arterial blood gas (ABG) analysis for monitoring. It is a painful, invasive, and expensive investigation. This study was aimed at finding an agreement between end-tidal carbon dioxide (ETCO2, a noninvasive modality) and arterial carbon dioxide (PaCO2) in COPD patients with acute exacerbation on mechanical ventilation. Materials and methods: A prospective observational study was conducted in COPD patients who required mechanical ventilation. ETCO2 was recorded by mainstream capnography along with ABG analysis. An agreement between PaCO2 and ETCO2 was assessed. The effect of various factors on correlation was also studied. Results: A total of 100 patients with COPD in hypercapnic respiratory failure were included. Seventy-three percentage of patients were managed on invasive mechanical ventilation (IMV). The mean ETCO2 and PaCO2 were 48.66 ± 15.57 mm Hg and 75.52 ± 21.9 mm Hg, respectively. There was a significant correlation between PaCO2 and ETCO2 values (r = 0.82, 95% confidence interval of r = 0.78–0.86, p <0.0001). The Bland-Altman analysis shows the mean bias as −19.4 (95% limits of agreement = −40.0–1.1). Pearson's correlation coefficient was 0.84 in intubated patients and 0.58 in patients on noninvasive ventilation (NIV). Pearson's correlation coefficient between PaCO2 and ETCO2 in subjects with consolidation, cardiomegaly, hypotension, and raised pulmonary artery pressures was 0.78, 0.86, 0.85, and 0.86, respectively. Conclusion: Mainstream ETCO2 measurement accurately predicts the PaCO2 in COPD patients on IMV. However, for patients on NIV, ETCO2 is insufficient in monitoring PaCO2 levels due to weak correlation. Clinical significance: ETCO2 can be used as a noninvasive modality in intensive care unit for monitoring the PaCO2 in COPD patients on IMV. This can reduce the requirement of arterial blood sampling to a minimum number, in turn, reducing the cost of the treatment and discomfort to the patients.

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