Abstract
Background: End-Tidal CO2 (ETCO2) monitoring is valuable in the management of traumatic brain injury (TBI). In intubated patients it helps prevent hyper/over-ventilation. In non-intubated patients, placing a sensor in the nares allows accurate monitoring of respiratory rate and has other promising uses (e.g. monitoring ETCO2 trends in worsening TBI, COPD, etc). Study Objective: To identify how accurately EMS providers document ETCO2, we compared the values recorded in EMS patient care records (PCR) to monitor data in non-intubated TBI patients. Methods: Cases from 6 EMS agencies reporting continuous monitor data (Philips MRx) in the EPIC Study (NIH 1R01NS071049) were evaluated (4/13-3/17). All ETCO2 data available for this post-hoc review were displayed and accessible to the EMS providers during care. Concordance was defined in two ways (for both highest and lowest ETCO2): ≤5 and ≤3 mmHg difference between the monitor data and PCR-documented values. Results: 106 cases were included [median age: 47 (range: 9-91), 66% male]. The figure shows concordance between PCR documentation and monitor data for both the lowest and highest recorded ETCO2 values. Conclusion: The highest PCR-recorded vs monitor ETCO2 values had excellent concordance for a difference ≤5 mmHg (85.9%) and it was good (76.4%) even when defined at the limits of instrument precision (≤3 for ETCO2 compared to actual pCO2). However, for lowest ETCO2, concordance was very poor (only 42.5% for ≤5). The failure to accurately document low ETCO2 in a “passive-ventilation” setting may also have significant implications for improving ventilatory care among intubated patients because identifying and correcting hypocapnia/hyperventilation in actively-ventilated cases is extraordinarily important. The low concordance rates may be due to the emphasis on discreet, intermittent vital sign documentation rather than ongoing identification and documentation of significant ETCO2 variation.
Published Version
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