en
Scientific article
English

Volumetric or time-based capnography for excluding pulmonary embolism in outpatients?

Published inJournal of thrombosis and haemostasis, vol. 8, no. 1, p. 60-67
Publication date2010
Abstract

BACKGROUND: Volumetric capnography is technically more demanding but theoretically better than the time-based alveolar deadspace fraction (P(a)CO(2) - EtCO(2))/P(a)CO(2) as a bedside diagnostic tool for excluding pulmonary embolism (PE) in outpatients. OBJECTIVE: We compared both diagnostic accuracy in patients with a suspected PE and positive D-dimer enzyme-linked immunosorbent assay results. PATIENTS AND METHODS: In this clinical multicenter trial with prospective inclusion and 3-month follow-up, alveolar deadspace fraction was compared by receiver operating characteristic (ROC) analysis with other parameters derived from volumetric capnography. RESULTS: Capnography was performed in 239 patients, and 205 tests (86%) were conclusive. The incidence of PE was 33%. The alveolar deadspace fraction accuracy expressed with ROC curve analysis was 0.73 +/- 0.04. The diagnostic performances of parameters from volumetric capnography were not significantly better. Sixteen per cent [95% confidence interval (CI) 12-21%] of patients presented a (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratio under the cut-off value of 0.15, with a low clinical probability. This combination excluded PE, with a sensitivity of 96% (95% CI 89-99%) and a negative likelihood ratio of 0.17 (95% CI 0.09-0.33%). CONCLUSION: Volumetric capnography failed to show superiority to alveolar deadspace fraction measurements [(P(a)CO(2) - EtCO(2))/P(a)CO(2)] for exclusion of PE in outpatients with positive D-dimer test results. Future studies should clarify the safety of excluding PE in patients combining low clinical probability with positive D-dimer results and (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratios below the cut-off value of 0.15.

Keywords
  • Aged
  • Aged, 80 and over
  • *Capnography
  • Carbon Dioxide/*metabolism
  • Enzyme-Linked Immunosorbent Assay
  • Europe
  • Fibrin Fibrinogen Degradation Products/metabolism
  • Humans
  • Likelihood Functions
  • Middle Aged
  • *Outpatients
  • *Point-of-Care Systems
  • Predictive Value of Tests
  • Prospective Studies
  • Pulmonary Embolism/blood/*diagnosis/metabolism
  • ROC Curve
  • *Respiratory Dead Space
  • Sensitivity and Specificity
  • Time Factors
Citation (ISO format)
VERSCHUREN, F. et al. Volumetric or time-based capnography for excluding pulmonary embolism in outpatients? In: Journal of thrombosis and haemostasis, 2010, vol. 8, n° 1, p. 60–67. doi: 10.1111/j.1538-7836.2009.03667.x
Main files (1)
Article
accessLevelRestricted
Identifiers
ISSN of the journal1538-7836
495views
0downloads

Technical informations

Creation05/23/2012 8:58:35 AM
First validation05/23/2012 8:58:35 AM
Update time03/14/2023 5:36:22 PM
Status update03/14/2023 5:36:22 PM
Last indexation02/12/2024 8:21:00 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack