Monitoring of the End-tidal Carbon Dioxide (EtCO2) as a Severity Criterion in COPD Exacerbations

Although we know that these numbers are underestimated, Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease that affects between 8 and 12% of adults. According to a 2020 WHO report, it is the third most common cause of mortality in developed countries. This disease is punctuated by exacerbations associated with an 8% mortality of hospitalized patients, increased to 24% when the patient is admitted to intensive care unit. Early detection and treatment of these exacerbations appears to be essential to improve patient survival. End-tidal carbon dioxide (EtCO2) is used to assess a patient's respiratory and hemodynamic status. Indeed, EtCO2 is a non-invasive measure that could allow the estimation of arterial carbon dioxide (PaCO2) without performing blood gases, an arterial blood sampling, classically at the radial artery. This study aimed to find an EtCO2 value which at the time of the initial management, would be predictive of a severe COPD exacerbation, as well as PaCO2.

Inclusion Criteria:All patient presenting to the emergency department with acute dyspnea and with a history of COPD documented or reported by the patient and/or familyMale or female≥18 years old who did not oppose to participating in the studyExclusion Criteria:Hypotension (SBP < 90 mmHg or MBP < 65 mmHg)Patient already included in the study during a previous visit to the emergency departmentPatient already ventilated with invasive or NIV during admission to the emergency departmentCOPD exacerbation rejected after medical and additional examinationsNon-communicative or non-French speaking patients, or with impaired comprehension, or with impaired consciousnessProtected persons referred to in articles L1121-6 and L1121-8 of French public health code (deprived of liberty, tutorship or curatorship)