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The correlation and level of agreement between end-tidal and blood gas pCO2 in children with respiratory distress: a retrospective analysis.

Moses JM, Alexander JL, Agus MS - BMC Pediatr (2009)

Bottom Line: The mean bias +/- SD between EtCO2 and vpCO2 was -3.68 +/- 4.70 mmHg.The 95% level of agreement ranged from -12.88 to +5.53 mmHg.EtCO2 was found to be more accurate when vpCO2 was 35 mmHg or lower.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Children's Hospital Boston, 300 Longwood Ave, AU-522, Boston, MA 02115, USA. james.moses@bmc.org

ABSTRACT

Background: To investigate the correlation and level of agreement between end-tidal carbon dioxide (EtCO2) and blood gas pCO2 in non-intubated children with moderate to severe respiratory distress.

Methods: Retrospective study of patients admitted to an intermediate care unit (InCU) at a tertiary care center over a 20-month period with moderate to severe respiratory distress secondary to asthma, bronchiolitis, or pneumonia. Patients with venous pCO2 (vpCO2) and EtCO2 measurements within 10 minutes of each other were eligible for inclusion. Patients with cardiac disease, chronic pulmonary disease, poor tissue perfusion, or metabolic abnormalities were excluded.

Results: Eighty EtCO2-vpCO2 paired values were available from 62 patients. The mean +/- SD for EtCO2 and vpCO2 was 35.7 +/- 10.1 mmHg and 39.4 +/- 10.9 mmHg respectively. EtCO2 and vpCO2 values were highly correlated (r = 0.90, p < 0.0001). The correlations for asthma, bronchiolitis and pneumonia were 0.74 (p < 0.0001), 0.83 (p = 0.0002) and 0.98 (p < 0.0001) respectively. The mean bias +/- SD between EtCO2 and vpCO2 was -3.68 +/- 4.70 mmHg. The 95% level of agreement ranged from -12.88 to +5.53 mmHg. EtCO2 was found to be more accurate when vpCO2 was 35 mmHg or lower.

Conclusion: EtCO2 is correlated highly with vpCO2 in non-intubated pediatric patients with moderate to severe respiratory distress across respiratory illnesses. Although the level of agreement between the two methods precludes the overall replacement of blood gas evaluation, EtCO2 monitoring remains a useful, continuous, non-invasive measure in the management of non-intubated children with moderate to severe respiratory distress.

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Regression of EtCO2 and vpCO2 Values with Line of Unity. The equation for the regression line is EtCO2 = .832904(vpCO2) + 2.905448, r2 = 0.8161.
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Figure 3: Regression of EtCO2 and vpCO2 Values with Line of Unity. The equation for the regression line is EtCO2 = .832904(vpCO2) + 2.905448, r2 = 0.8161.

Mentions: Further analysis was conducted in order to identify the range of EtCO2 values in which accuracy would be maximized in relation to vpCO2. Figure 3 illustrates the regression of EtCO2 and vpCO2, which deviated significantly from the line of unity (F(2,78) = 35.5, p < 0.001). The regression line and the line of unity were within 3 mmHg of each other for vpCO2 values under 35 mmHg but parted increasingly in the higher range, differing by 5 mmHg above vpCO2 of 47 mmHg. This suggests that maximum EtCO2 accuracy is achieved when vpCO2 is 35 mmHg or below.


The correlation and level of agreement between end-tidal and blood gas pCO2 in children with respiratory distress: a retrospective analysis.

Moses JM, Alexander JL, Agus MS - BMC Pediatr (2009)

Regression of EtCO2 and vpCO2 Values with Line of Unity. The equation for the regression line is EtCO2 = .832904(vpCO2) + 2.905448, r2 = 0.8161.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2662856&req=5

Figure 3: Regression of EtCO2 and vpCO2 Values with Line of Unity. The equation for the regression line is EtCO2 = .832904(vpCO2) + 2.905448, r2 = 0.8161.
Mentions: Further analysis was conducted in order to identify the range of EtCO2 values in which accuracy would be maximized in relation to vpCO2. Figure 3 illustrates the regression of EtCO2 and vpCO2, which deviated significantly from the line of unity (F(2,78) = 35.5, p < 0.001). The regression line and the line of unity were within 3 mmHg of each other for vpCO2 values under 35 mmHg but parted increasingly in the higher range, differing by 5 mmHg above vpCO2 of 47 mmHg. This suggests that maximum EtCO2 accuracy is achieved when vpCO2 is 35 mmHg or below.

Bottom Line: The mean bias +/- SD between EtCO2 and vpCO2 was -3.68 +/- 4.70 mmHg.The 95% level of agreement ranged from -12.88 to +5.53 mmHg.EtCO2 was found to be more accurate when vpCO2 was 35 mmHg or lower.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Children's Hospital Boston, 300 Longwood Ave, AU-522, Boston, MA 02115, USA. james.moses@bmc.org

ABSTRACT

Background: To investigate the correlation and level of agreement between end-tidal carbon dioxide (EtCO2) and blood gas pCO2 in non-intubated children with moderate to severe respiratory distress.

Methods: Retrospective study of patients admitted to an intermediate care unit (InCU) at a tertiary care center over a 20-month period with moderate to severe respiratory distress secondary to asthma, bronchiolitis, or pneumonia. Patients with venous pCO2 (vpCO2) and EtCO2 measurements within 10 minutes of each other were eligible for inclusion. Patients with cardiac disease, chronic pulmonary disease, poor tissue perfusion, or metabolic abnormalities were excluded.

Results: Eighty EtCO2-vpCO2 paired values were available from 62 patients. The mean +/- SD for EtCO2 and vpCO2 was 35.7 +/- 10.1 mmHg and 39.4 +/- 10.9 mmHg respectively. EtCO2 and vpCO2 values were highly correlated (r = 0.90, p < 0.0001). The correlations for asthma, bronchiolitis and pneumonia were 0.74 (p < 0.0001), 0.83 (p = 0.0002) and 0.98 (p < 0.0001) respectively. The mean bias +/- SD between EtCO2 and vpCO2 was -3.68 +/- 4.70 mmHg. The 95% level of agreement ranged from -12.88 to +5.53 mmHg. EtCO2 was found to be more accurate when vpCO2 was 35 mmHg or lower.

Conclusion: EtCO2 is correlated highly with vpCO2 in non-intubated pediatric patients with moderate to severe respiratory distress across respiratory illnesses. Although the level of agreement between the two methods precludes the overall replacement of blood gas evaluation, EtCO2 monitoring remains a useful, continuous, non-invasive measure in the management of non-intubated children with moderate to severe respiratory distress.

Show MeSH
Related in: MedlinePlus