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Volumetric capnography and CO/NO diffusion to exclude pulmonary embolism at the emergency room

Fabius, T.M. (2015) Volumetric capnography and CO/NO diffusion to exclude pulmonary embolism at the emergency room.

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Abstract:Rationale: The existing screening tools for pulmonary embolism (PE), such as D-dimer and Wells-score, have low positive predictive values. The use of volumetric capnography or CO/NO diffusion, might result in a more specific exclusion tool for PE. Methods:CO/NO diffusion and volumetric capnography measurements were performed on subsequent patients suspected for PE. Results: A total of 31 patients were included, PE was found on CTPA in 13. Median TL,NO/TL,CO ratio was 4.09 (IQR 3.83 – 4.40) in the no PE group versus 4.00 (IQR 3.78 – 4.32) in the PE group (p=0.959). Median PETCO2 was 4.37 kPa (IQR 4.00 – 4.83) in the no PE group versus 4.07 kPa (IQR 3.37 – 4.38) in the PE group (p=0.075). Median of the novel parameter VCO2xSlopeIII/RR was 1.85 min.kPa /L (IQR 1.21 – 3.00) in the no PE group versus 1.18 min.kPa/L (IQR 0.61 – 1.38) in the PE group (p=0.006). Using a threshold for the new parameter of 1.90 min.kPa/L or higher to exclude PE resulted in a sensitivity of 100% with a specificity of 47%. Conclusion: The TL,NO/TL,CO ratio and PETCO2 alone cannot be used to exclude PE. The novel developed parameter VCO2xSlopeIII/RR seems promising and needs to be validated.
Item Type:Essay (Master)
Clients:
Medisch Spectrum Twente, Enschede, the Netherlands
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/68124
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