Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study
Abstract Objective The bias of capnometry (ETCO2) and venous carbon dioxide (vpCO2) among pediatric emergency department (PED) patients triaged to critical care areas is unknown. We aimed to explore correlations and bias between ETCO2 and vpCO2¸and identify predictors of bias. Methods This was an ob...
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Elsevier
2024-06-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13170 |
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| author | Michael Stratton Kevin Overmann Yin Zhang Richard Ruddy |
| author_facet | Michael Stratton Kevin Overmann Yin Zhang Richard Ruddy |
| author_sort | Michael Stratton |
| collection | DOAJ |
| description | Abstract Objective The bias of capnometry (ETCO2) and venous carbon dioxide (vpCO2) among pediatric emergency department (PED) patients triaged to critical care areas is unknown. We aimed to explore correlations and bias between ETCO2 and vpCO2¸and identify predictors of bias. Methods This was an observational, video‐based, retrospective study comparing ETCO2 and vpCO2. Pediatric patients with simultaneous ETCO2 and vpCO2 data were included. Our primary aim utilized linear regressions to determine correlations and Bland–Altman analysis to assess bias. Our secondary aim utilized multiple regression to identify clinical covariates contributing to bias. Covariates included age, respiratory rate, heart rate, mean arterial blood pressure, capnometry interface, PED diagnosis, and PED disposition. Results A total of 200 PED patients with ETCO2 and vpCO2 data were included. The median (interquartile range [IQR]) ETCO2, vpCO2, and ΔCO2 in mmHg were 38 (32, 46), 49 (41, 61), and 11 (4, 20), respectively. ETCO2 (r = 0.76) and ΔCO2 (r = 0.71) were highly correlated with vpCO2. The mean bias between ETCO2 and vpCO2 was −14.1 mmHg (95% confidence interval [CI], −41.9 −13.7). The bias between ETCO2 and vpCO2 increased at higher values of each measure. ETCO2 sampling interface was the only independent predictor of vpCO2 in our multivariate analysis. Patients requiring bag‐valve mask (BVM) ventilation had the highest median bias between ETCO2 and vpCO2 (29 mmHg, IQR 15, 37). Conclusion ETCO2 and vpCO2 were highly correlated. However, bias increased at higher levels of both ETCO2 and vpCO2. Among PED patients, ETCO2’s ability to approximate vpCO2 diminishes with worsening hypercarbic respiratory failure. |
| format | Article |
| id | doaj-art-0822d395df494083a7e99dbaa28aa4d3 |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-0822d395df494083a7e99dbaa28aa4d32025-08-20T01:59:26ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522024-06-0153n/an/a10.1002/emp2.13170Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based studyMichael Stratton0Kevin Overmann1Yin Zhang2Richard Ruddy3Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USADivision of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USADivision of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USADivision of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USAAbstract Objective The bias of capnometry (ETCO2) and venous carbon dioxide (vpCO2) among pediatric emergency department (PED) patients triaged to critical care areas is unknown. We aimed to explore correlations and bias between ETCO2 and vpCO2¸and identify predictors of bias. Methods This was an observational, video‐based, retrospective study comparing ETCO2 and vpCO2. Pediatric patients with simultaneous ETCO2 and vpCO2 data were included. Our primary aim utilized linear regressions to determine correlations and Bland–Altman analysis to assess bias. Our secondary aim utilized multiple regression to identify clinical covariates contributing to bias. Covariates included age, respiratory rate, heart rate, mean arterial blood pressure, capnometry interface, PED diagnosis, and PED disposition. Results A total of 200 PED patients with ETCO2 and vpCO2 data were included. The median (interquartile range [IQR]) ETCO2, vpCO2, and ΔCO2 in mmHg were 38 (32, 46), 49 (41, 61), and 11 (4, 20), respectively. ETCO2 (r = 0.76) and ΔCO2 (r = 0.71) were highly correlated with vpCO2. The mean bias between ETCO2 and vpCO2 was −14.1 mmHg (95% confidence interval [CI], −41.9 −13.7). The bias between ETCO2 and vpCO2 increased at higher values of each measure. ETCO2 sampling interface was the only independent predictor of vpCO2 in our multivariate analysis. Patients requiring bag‐valve mask (BVM) ventilation had the highest median bias between ETCO2 and vpCO2 (29 mmHg, IQR 15, 37). Conclusion ETCO2 and vpCO2 were highly correlated. However, bias increased at higher levels of both ETCO2 and vpCO2. Among PED patients, ETCO2’s ability to approximate vpCO2 diminishes with worsening hypercarbic respiratory failure.https://doi.org/10.1002/emp2.13170capnometrypediatrics |
| spellingShingle | Michael Stratton Kevin Overmann Yin Zhang Richard Ruddy Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study Journal of the American College of Emergency Physicians Open capnometry pediatrics |
| title | Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study |
| title_full | Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study |
| title_fullStr | Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study |
| title_full_unstemmed | Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study |
| title_short | Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study |
| title_sort | bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients a video based study |
| topic | capnometry pediatrics |
| url | https://doi.org/10.1002/emp2.13170 |
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