Early Recognition Value Of PetCO₂ For Dyspnea Caused By ALHF And AECOPD

Background:Acute dyspnea is one of the common causes of emergency treatment in the emergency department.Acute heart failure and chronic obstructive pulmonary disease are the two most common causes of acute dyspnea,often occurring abruptly,not timely intervention and treatment in a short period of time can endanger life.Therefore,early and correct judgment and timely treatment are extremely important.PetCO₂ is an early,rapid,continuous,noninvasive monitoring of exhaled carbon dioxide（CO₂）pressure index,which has been widely used in intensive care,can not only monitor lung ventilation,pulmonary blood flow and reaction can the body blood circulation function and other characteristics,can provide fast and effective condition information for emergency pHysicians.Therefore,early detection of PetCO2 in patients with dyspnea of ALHF and AECOPD may have important reference value for early diagnosis and treatment of patients.Objective:Emergency ALHF and AECOPD patients with acute dyspnea were examined by PetCO2,and the reference value of PetCO2 detection for early diagnosis of ALHF and AECOPD patients was discussed.Method:In this study,a prospective single center and parallel control method was used.The clinical data of patients with acute cardiogenic and pulmonary dyspnea treated in resuscitation room,emergency department of North Sichuan Medical College were collected:name,sex,age,dyspnea attack time and vital signs（body temperature,heartbeat,respiratory rate,systolic blood pressure and diastolic blood pressure）.Are the first time to improve PetCO₂ measurement,blood gas analysis,B type natriuretic peptide（BNP）.The patients were divided into ALHF group and AECOPD group two groups according to the blood gas analysis of the partial pressure of carbon dioxide（PaCO₂）value and oxygen partial pressure value（PaO₂）of AECOPD were divided into type I respiratory failure group and type II respiratory failure group two subgroups.PetCO₂ were compared between the two groups of measured value and PaCO₂ value of blood gas analysis,to evaluate the correlation between two;statistical analysis ROC curve value of two groups of patients were measured by PetCO₂,the highest values of sensitivity,specificity and correct diagnosis index,to evaluate the PetCO₂ diagnostic value of determination of AECOPD type I AECOPD type II respiratory failure and respiratory failure,three high risk ALHF dyspnea;comparison of two groups of patients diagnosed in time,definitive treatment time,evaluation of PetCO2 determination to shorten the time of diagnosisResult:1.A total of 226 patients with acute dyspnea were included in this study,excluding 55 patients.76 cases in group ALHF were excluded,7 cases were automatically removed from hospital or transferred to hospital.In group AECOPD,95 cases were excluded,12 cases were automatically removed from hospital or transferred to hospital,and they were divided into 23 groups:I type of respiratory failure subgroup and 60 cases of II type of respiratory failure group.The two groups were not statistically significant（P>0.05）in age,sex,time of dyspnea,temperature,respiration and diastolic pressure（P>0.05）;heart rate,systolic pressure,NT-ProBNP,PaCO₂ and PetCO₂ were statistically significant（P<0.05）.2.The PetCO₂ value of the subjects and the PaCO₂ value of the blood gas analysis were analyzed by Pearson correlation:the ALHF group and the AECOPD group had a correlation with PaCO₂,r=0.99.In group ALHF,PetCO₂ was correlated with PaCO₂,r=0.90.There was a correlation between PetCO₂ and PaCO₂ value in type I respiratory failure subgroups,r=0.86.There was a correlation between PetCO₂ and PaCO₂ values in II respiratory failure subgroup,R=0.78).3.The ROC curve analysis of the PetCO₂ test value of the experimental object:the area of the ROC curve of the ALHF group PetCO₂ is 0.906,and PetCO₂ is 32mmHg as the critical value,the highest sensitivity value is 1,the highest value of the specificity is 0.78,and the maximum of Jorden finger value is 0.78.The area under the ROC curve of PetCO₂ in type I respiratory failure group was 0.445.The area of PetCO₂ in type II respiratory failure subgroup was 0.955,and PetCO₂ was the critical value of 53mmHg.The highest sensitivity value was 0.78,the highest specificity value was 0.94,and the highest value of the Jordan finger was 0.73.4.Analysis of the time evaluation index of the subjects:the area of the ROC curve under the ROC curve for patients with acute respiratory dyspnea（PetCO2 I）was 0.445 due to the determination of the ROC curve for the patients with acute dyspnea.Therefore,the time of quasi diagnosis for the I type respiratory failure group in the AECOPD group was not definite.The time of quasi diagnosis for the ALHF group was 5 min（3,10）lower than the diagnosis time 38 min（15.00,68.00）and the definite treatment time 40 min（18.00,72.00）（statistically significant,P<0.05）.The time of quasi diagnosis for the II type respiratory failure group in the AECOPD group was 6 min（4.00,10.00）lower than the diagnosis time 32 min（12.00,62.00）and the definite treatment time 35 min（16.00,70.00）（statistically significant,P<0.05）.5.The advantage of side stream PetCO2 test for emergency patients is:the operation time short（about 5min）and the paracrine flow PetCO₂ detection were both carried out at the same time with other diagnosis and treatment process and did not affect the diagnosis and treatment process,and the side flow PetCO₂ detection belonged to non-invasive operation.Conclusion:1.The PetCO₂ of ALHF and AECOPD is related to PaCO2.2.The application of side stream PetCO2 detection in emergency patients is simple,rapid and non-invasive in monitoring the condition of patients with ALHF and AECOPD.3.PetCO2≤32mmHg for ALHF、PetCO2≥53mmHg for AECOPD II type of respiratory failure,it is of reference value for early recognition.