Anesthesia & Clinical Research
Open Access

Abstract

Correlation of End Tidal CO₂ (ETCO₂) Level with Hyperlactatemia in Patient with Hemodynamic Disturbance

Made Wiryana, I Ketut Sinardja, I GedeBudiarta, IMG Widnyana, Wayan Aryabiantara and AA Ayu Wulan Paramasari

Background: Critically ill and hemodynamically unstable patients usually have perfusion disturbance that causes anerobic metabolism, causing increased lactate production. Hyperlactatemia induces metabolic acidosis, which then compensated by hyperventilation. Decreased PaCO2 as the consequence of hyperventilation can be measured as end-tidal CO2 (ETCO2). High ETCO2 was hypothesized as related to hyperlactatemia, thus monitoring of ETCO2 could be a non-invasive monitoring in hemodynamically unstable patients.
Objective: This study aimed to search the correlation between ETCO2 level and hyperlactatemia in patients with hemodynamic disturbance.
Method: This was observational, cross sectional study conducted on January to February 2017 in Sanglah General Hospital, Bali, Indonesia. Subjects were hemodinamicaly unstable patients aged 13-90 years old without primary pulmonary diseases recruited by consecutive sampling. ETCO2 measurement by capnograph, lactate level measurement, and blood good analysis were done to all eligible patients. We did an association test to determine ther relation between ETCO2 level and lactate level in such patients.
Results: There were 70 subjects analyzed with median age 55 years old. Subjects’ case was 35.7% called for resuscitation, 32.9% was septic shock with surgery, 17.1% was septic shock without surgery, and 14.3% was hypovolemic shock with surgery. Most of most of the patients had compensated metabolic acidosis (82.9%). Correlation analysis between ETCO2 and lactate level showed significantly strong negative correlation (correlation coefficient [r]=-0.852, p=0.001). Linear regression analysis of correlation showed that an increase of 1 mmol/L lactate was associated with decrease of 3.42 mmol/L ETCO2 (p<0.001).
Conclusion: ETCO2 was related to serum lactate level in patients with hemodynamic