Evaluating the use of end-tidal carbon dioxine in a sepsis code patient as a goal for the early resuscitation treatment in the emergency department

Abstract

Background: Sepsis is a major healthcare problem with high mortality and an increasing incidence (1). A huge progress reducing mortality has been made since the creation of the Surviving Sepsis Campaign in 2001 but there is still a long way to go. In the management of septic patients, blood lactate is one of the most important measures as a goal for the early resuscitation treatment (2). Because of its physiology (3), ETCO2 seems to be an ideal indicator and a reference goal for the sepsis management as well. Justification: ETCO2 could be a real-time, dependable, not invasive and easily obtained measurement of early resuscitation treatment in sepsis code patients, instead of invasive blood extractions for lactate measurements. Objectives: The goal of this study is to determine if there is a correlation between blood lactate levels and ETCO2 during early resuscitation treatment in patients with sepsis. Secondary objectives: A cut-off point of ETCO2 equivalent to lactate levels <2mmol/L as an early resuscitation goal and the relationship between ETCO2 values and in hospital mortality will also be evaluated. Methods: This study is an observational longitudinal prospective cohort study that will include 120 patients admitted to the Hospital Josep Trueta emergency department due to sepsis and older than 18 years. The sepsis code protocol must be activated, with the following criteria: Suspected infection and tachypnea, hypotension or mental status disorders. Exclusion criteria are vital prognosis <6 months, immunosuppression, asthma or chronic obstructive pulmonary disease and intubated patients. Patient’s recruitment will last 6 months. Main variables: Blood lactate and ETCO2 measurements will be taken during the first 6 hours of sepsis resuscitation treatment in order to evaluate the correlation between both measures