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Comparison of End-Tidal Carbon Dioxide (ETCO2) Gradient and Vena Cava Collapsibility Index (VCCI) in Response to Intravenous Fluid Therapy in Patients with Moderate and Severe Dehydration and Acute Gastroenteritis

Published online by Cambridge University Press:  25 May 2022

Gülin İnan Open the ORCID record for Gülin İnan [Opens in a new window] ,
Pınar Hanife Kara Çetіnbіlek  and
Hayriye Gönüllü
Gülin İnan*
Affiliation:
Diyarbakır Selahaddin Eyyubi State Hospital, Department of Emergency Medicine, Diyarbakır, Turkey
Pınar Hanife Kara Çetіnbіlek
Affiliation:
Izmir Bozyaka Training and Research Hospital, Department of Emergency Medicine, İzmir, Turkey
Hayriye Gönüllü
Affiliation:
Department of Emergency Medicine, Faculty of Medicine, İzmir Bakırçay University, Izmir, Turkey
*
Correspondence: Gülin İnan, MD Dr. Şeref İnal Öz Street 21100 Yenişehir/Diyarbakır, Turkey E-mail: [email protected]
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Abstract

Introduction and Objective:

Acute gastroenteritis (AGE) is one of the most common clinical diagnoses globally, and dehydration in severe AGE cases can cause severe morbidity and mortality. Depending on the metabolic acidosis that occurs in dehydration, the respiratory rate per minute is increased, and the carbon dioxide pressure in the arterial blood is decreased. This condition correlates with end-tidal carbon dioxide (ETCO2). Therefore, this study primarily aims to evaluate whether ETCO2 measurement has a role in detecting metabolic fluid deficit, dehydration level, and regression in dehydration level after fluid replacement and its correlation with Vena Cava Collapsibility Index (VCCI).

Material and Method:

This study included spontaneously breathing patients admitted to the emergency department of a tertiary training and research hospital with symptoms of AGE and were thought to be moderately (6.0%-9.0%) and severely (>10.0%) dehydrated according to the Primary Options of Acute Care (POAC) Clinical Dehydration Scale. After the first evaluation, the patients’ vital signs, ETCO2 values, diameters of the inferior vena cava (IVC) in inspiration and expiration, and VCCI were measured and recorded. These measurements were repeated after intravenous (IV) fluid replacement, and finally, a comparison was made between the measurements.

Results:

A total of 49 patients, as 16 male (32.7%) and 33 female (67.3%), were included in the study. The mean fluid replacement value was calculated as 664.29 (SD = 259.41) ml. The mean increase in ETCO2 was 3.653 (SD = 2.554) mmHg (P <.001). The mean increase in inferior vena cava expirium (IVCexp) was calculated as 0.402 (SD = 0.280) cm (P <.001) and the mean increase in inferior vena cava inspirium (IVCinsp) as 0.476 (SD = 0.306) cm (P <.001). The VCCI (%) decreased by 12.556 (SD = 13.683) (P <.001). Post-replacement vital signs, ETCO2, and VCCI correlations of the patients were examined and no significant correlation was found between ETCO2 and VCCI (%). As a result of this study, a receiver operating characteristic (ROC) curve was established for the ETCO2 values predicting the level of dehydration and fluid response, and the area under the curve was calculated as 0.748. However, to classify the patient as moderately dehydrated, the ETCO2 cutoff value was determined as 28.5mmHg.

Conclusion:

The sensitivity and specificity of ETCO2 levels were 71.43% and 74.29% in evaluating the level of dehydration, and no correlation was found with VCCI, which is known to have high sensitivity and specificity in previous studies in determining the level of dehydration and fluid response. Hence, VCCI measurement made through ultrasonography (USG) is a method that should be preferred more in determining the level of dehydration. Nevertheless, as per the results of this study, swift ETCO2 measurements may be helpful in monitoring the change in the degree of dehydration with treatment in patients who were admitted to the emergency department with dehydration findings and were administered IV fluid replacement therapy.

Keywords

acute gastroenteritisdehydrationend-tidal carbon dioxide (ETCO2)fluid responsivenessVena Cava Collapsibility Index (VCCI)
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 4 , August 2022 , pp. 474 - 479
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Gangarosa, RE, Glass, RI, Lew, JF, Boring, JR. Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly. Am J Epidemiol. 1992;135(3):281–290.CrossRefGoogle ScholarPubMed
Stone, D, Mitchell, S, Packham, B, Williams, J. Prevalence and first-line treatment of diarrheal symptoms in the community. Public Health. 1994;108(1):61–68.CrossRefGoogle Scholar
van Berkestijn, LG, Kastein, MR, Lodder, A, de Melker, RA, Bartelink, M-L. How well are patients treated in family practice? Quality of consultations for non-acute abdominal complaints. Int J Qual Health Care. 1998;10(3):221–233.CrossRefGoogle ScholarPubMed
Roland, D, Clarke, C, Borland, M, Pascoe, E. Adequately assessing dehydration: a holy grail of pediatric emergency medicine. Int J Emerg Med. 2011;4(1):71.CrossRefGoogle Scholar
Kinlin, LM, Freedman, SB. Evaluation of a clinical dehydration scale in children requiring intravenous rehydration. Pediatrics. 2012;129(5):e1211–e1219.CrossRefGoogle ScholarPubMed
Bresee, JS, Duggan, C, Glass, RI, King, CK. Managing acute gastroenteritis among children; oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003;52(RR-16):1–16.Google Scholar
Freedman, SB, Vandermeer, B, Milne, A, et al. Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis. J Pediatr. 2015;166(4):908–916.CrossRefGoogle ScholarPubMed
Pringle, K, Shah, SP, Umulisa, I, et al. Comparing the accuracy of the three popular clinical dehydration scales in children with diarrhea. Int J Emerg Med. 2011;4(1):58.CrossRefGoogle ScholarPubMed
Nagler, J, Wright, RO, Krauss, B. End-tidal carbon dioxide as a measure of acidosis among children with gastroenteritis. Pediatrics. 2006;118(1):260–267.CrossRefGoogle ScholarPubMed
Corl, KA, George, NR, Romanoff, J, et al. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients. J Crit Care. 2017;41:130–137.CrossRefGoogle ScholarPubMed
Preau, S, Bortolotti, P, Colling, D, et al. Diagnostic accuracy of the inferior vena cava collapsibility to predict fluid responsiveness in spontaneously breathing patients with sepsis and acute circulatory failure. Crit Care Med. 2017;45(3):e290–e297.CrossRefGoogle ScholarPubMed
Sawe, HR, Haeffele, C, Mfinanga, JA, Mwafongo, VG, Reynolds, TA. Predicting fluid responsiveness using bedside ultrasound measurements of the inferior vena cava and physician gestalt in the emergency department of an urban public hospital in Sub-Saharan Africa. PloS One. 2016;11(9).CrossRefGoogle ScholarPubMed
Orso, D, Guglielmo, N, Federici, N, et al. Accuracy of the caval index and the expiratory diameter of the inferior vena cava for the diagnosis of dehydration in elderly. J Ultrasound. 2016;19(3):203–209.CrossRefGoogle Scholar
Uzunosmanoğlu, H, Emektar, E, Dağar, S, Çorbacıoğlu, ŞK, Çevik, Y. Predictive value of capnography for severity of acute gastroenteritis in the emergency department. Am J Emerg Med. 2020;38(6):1159–1162.CrossRefGoogle ScholarPubMed