Simultaneously arterial puncture was performed for arterial blood gas analysis. Patients’ ET CO 2 values were measured using time versus waveform capnography before performing CT-angiography. 7,8 Pulmonary embolism was ruled out with normal d-dimer analysis (<0.55 mg/dl). In that study 1 one-hundred patients with suspected PE were included and evaluated using clinical prediction rules – Wells score – and the modified Geneva score. In the current issue of Pulmonology Yucel et al., 1 stated that the combined use of end-tidal carbon dioxide (ETCO 2) and alveolar dead space fraction (AVDSf) values is an important and valuable tool in diagnosing PE, a very important diagnosis in internal medicine, cardiology, pneumonolggy and other specialities in medicine. 3 Measuring end-tidal CO 2 tension was also used as a screening tool to exclude PE. Steady-state end-tidal alveolar dead space fraction and D-dimer were used also as bedside tests to exclude PE. A normal alveolar dead space fraction and a negative D-dimer shows a high sensitivity (100%) to excluding PE in outpatients, however specificity was only 65%. The ability to rule out PE was already demonstrated by Kline et al., 2 over 20 years ago by combining alveolar dead space fraction calculations and plasma D-dimer levels. Computed tomography (CT) pulmonary angiography is the gold standard for diagnosing PE. Mortality rates are high since 50% of patients with suspicious PE do not have any symptoms. The high variability of clinical symptoms or the lack of symptoms whatsoever helps to establish an exact diagnosis with or without suspicion as early as possible. It seems to be clear that mortality depends on early diagnosis followed by proper treatment by which mortality rates fall from over 39% to below 10%. Exact or nearly exact numbers only exist in the western hemisphere e.g.
Acute Pulmonary Embolism (PE) has been identified as one of the leading causes of deaths worldwide.
0 kommentar(er)
