Relationship between end-tidal carbon dioxide and arterial carbon dioxide in critically ill patients on mechanical ventilation: A cross-sectional study

Jinrong Wang, Jianjun Zhang, Yajing Liu, Huimian Shang, Li Peng, Zhaobo Cui, Jinrong Wang, Jianjun Zhang, Yajing Liu, Huimian Shang, Li Peng, Zhaobo Cui

Abstract

So far, only a few studies have examined and confirmed the correlation between end-expiratory carbon dioxide partial pressure (PETCO2) and arterial carbon dioxide tension (PaCO2) during invasive mechanical ventilation in critically ill patients. This study aimed to observe the correlation between PaCO2 and PETCO2 in patients on invasive mechanical ventilation.This was a cross-sectional study of adult patients on invasive mechanical ventilation enrolled between June 2018 and March 2019. Patients requiring invasive mechanical ventilation underwent one of the following mechanical ventilation modes: assisted/controlled ventilation, synchronized intermittent mandatory ventilation, and spontaneous breathing. Subsequently, the difference and correlation between PETCO2 and PaCO2 were analyzed.A total of 184 patients with 298 pairs of PETCO2-PaCO2 data were included in the analysis. Without distinguishing the ventilator mode, there was significant positive correlation between PETCO2 and PaCO2. In different ventilator modes, the correlation coefficient was 0.81 for synchronized intermittent mandatory ventilation, 0.47 for assisted/controlled ventilation, and 0.55 for spontaneous breathing, respectively. In patients with chronic obstructive pulmonary disease (r = 0.80), multiple trauma (r = 0.64), severe pneumonia (r = 0.60), gastrointestinal surgery (r = 0.57), and cerebrovascular diseases (r = 0.53), PETCO2 and PaCO2 were positively correlated. For oxygenation index <200 mm Hg, correlation coefficient r = 0.69, P < .001; oxygenation index ≥200, r = 0.73, P < .001. Under different oxygenation indexes, there was no statistically significant difference between the 2 correlation coefficients. Among 116 pairs of data with oxygenation index <200 mm Hg, the difference of PaCO2-PETCO2 ≥10 mm Hg was found in 25 pairs (21.55%); in 182 pairs of data with oxygenation index ≥200 mm Hg, the difference of PaCO2-PETCO2 ≥10 mm Hg was found in 26 pairsIn patients on invasive mechanical ventilation, there was a good correlation between PETCO2 and PaCO2 in different ventilator modes, different disease types, and different oxygenation indexes, especially in synchronized intermittent mandatory ventilation mode and chronic obstructive pulmonary disease patients.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
Scatter diagram between PETCO2 and PaCO2 for all patients. The correlation coefficient was 0.72; the linear regression equation Y = 11.81 + 0.65x (Y: PETCO2; x: PaCO2). The solid blue line is the regression line; the blue dashed line is the 95% confidence interval. The majority of PETO2 and PaCO2 values are distributed in 20 to 60 mm Hg (black dotted frame). PaCO2 = arterial carbon dioxide tension, PETCO2 = end-expiratory carbon dioxide partial pressure.

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