응급 중환자에서 동맥혈 이산화탄소 분압과 호기말 이산화탄소 분압의 상관성
Relationship of End tidal PCO_(2) and arterial PCO_(2) in Acute Critically Ⅲ Patients
응급 중환자 동맥혈 이산화탄소 호기말 분압;
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Background: The CO_(2) concentration in exhaled gases is intrinsically linked to tissue metabolism, ventilation and pulmonary circulation. In hemodynamically stable patients, the end-tidal CO_(2)(PetCO_(2)) is known as a good index of the arterial CO_(2)(PaCO_(2)). However, the PetCO_(2) has some limitations to predict PaCO_(2) in emergent patients with unstable vital signs. Objective: We evaluated the relationship of PetCO_(2) and PaCO_(2) and validity of the gradient between PetCO_(2) and PaCO_(2)(PaCO_(2)-PetCO_(2)) according to the clinical situations. Material and Method: A prospective analysis was performed in endotracheally intubated patients, who presented at the Korea University Emergency Medical center during a 14-month period from January 2003 to February 2004. Patients were divided into three groups; Group A: respiratory insufficiency of cardiopulmonary cause, Group B: respiratory insufficiency of extra-cardiopulmonary cause, Group C: cardiac arrest with any cause. Group A was subdivided into two groups; A1: with chronic lung disease history, A2: without chronic lung disease history. In each group, the mean of PaCO_(2)-PetCO_(2) is calculated and multiple comparison is performed in each groups with one way ANOVA test, and the 95% confidence interval of PaCO_(2)-PetCO_(2) is calculated. PaCO_(2) and PetCO_(2) was evaluated by linear regression analysis. The calculation was performed using the SPSS for windows version 10.0, and p valus less than 0.05 was considered significant. Result: Total fifty-nine patients were included in this study. Twenty- five Patients were in Group A, (eighteen in A1, seven in A2) twenty-six in Group B, and eight in Group C. For the evaluation of PaCO_(2) and PetCO_(2), the linear regression data showed the relation is statistically significant in the Group A2, B and C. The difference of PaCO_(2)-PetCO_(2) were 22.1±3.26mmHg in group A, 33.7±7.21mmHg in group A1, 17.6±3.06mmHg in group A2, 5.3±1.45mmHg in group B, 21.2±4.73mmHg in group C. In group A, the 95% confidence interval of PaCO_(2)-PetCO_(2) was 15.37-28.81mmHg, in group A1, 16.07-51.35mmHg, in group A2 11.11mmHg-24.03mmHg, in group B, 2.33-8.31mmHg. in group C, 10.03-32.42mmHg. Conclusion: In the endotracheally intubated patients for assisted ventilation with chronic pulmonary disease, the PetCO_(2) do not reflect the PaCO_(2) and also the value of PaCO_(2)-PetCO_(2) is not good parameters of these pathological status. However, in patients with acute cardiopulmonary disease and during cardiopulmonary resusciatation, the PetCO_(2) do not reflect the quantitative value of PaCO_(2), but may be used in prediction of the tendency of increment. In the endotracheally intubated patients with extracardiopulmonary cause, PetCO_(2) reflects the quantitative index of PaCO_(2) and the value of PaCO_(2)-PetCO_(2) may be good monitoring index of pathological conditions.