Pulmoner Tromboemboli Tanısında Kapnografinin Yeri

Abstract

ABSTRACT Yücel Z., The Importance of Capnogragh in Diagnosis of Pulmonary Embolism, Hacettepe University Faculty of Medicine, Thesis of Emergency Medicine, Ankara, 2017. Pulmonary thromboembolism (PTE) is one of the thromboembolic disorders that can confront with mild symptoms or severe clinical conditions such as right heart failure. The aim of this study is; using end-tidal carbon dioxide (ETCO2) and calculated alveolar dead space fraction (AVDSf) measured by a non-invasive, inexpensive and simple capnograph in algorithm with clinical prediction rules and D-dimer measurement; to exclude PTE or to estimate PTE without imaging techniques. The study was performed prospectively and observationally on 100 patients. Patients‟ Wells and Modified Geneva clinical scorings were calculated. Pulmonary embolism rule out criteria were evaluated. In the case of PTE suspicion at emergency department, patients were recorded for 2 minutes with the 'Covidien' capnograph. The patients‟ ETCO2 and AVDSf values were evaluated. p <0.05 was considered statistically significant. ETCO2 value was lower, AVDSf value was higher and statistically significant in patients with PTE. In the case of PTE, the cut-off value for ETCO2 was found to be 28.5 mmHg with 75% sens, 64,1% spes, 82% NPV and 54% PPV. AUC for the diagnosis of PTE using ETCO2 values alone was 75.8%. In the case of PTE, the cutoff value for AVDSf was 0,128 with 80.6% sens, 62.5% spes, 85.1% NPV and 54.7% PPV. AUC for the diagnosis of PTE using AVDSf values alone was 73,4%. In our study with using ETCO2; patients with low risk according to Wells scoring and Modified Geneva, PTE were excluded respectively 95% and 100%. According to both scoring systems, in low-risk patients PTE was excluded 100%, ın high-risk patients PTE was confirmed 100% with the measurement of AVDSf. When ETCO2 and AVDSf values were used together; PTE was excluded 100% in patients at low risk according to both two scoring systems and PTE was 100% confirmed in patients at high risk of any of these scoring systems.