For years functional assessment of athletes’ fitness levels has included the assessment of serum levels and lactate levels for many different types of athletics. These levels are an indication of the degree of metabolic levels which are an indication of possible physiological wear on the cell. Normally these levels can be and are checked using capnography.
When we understand that serum lactate levels are a prime indicator of possible sepsis in the patient with suspected infections then we can understand that the use of capnography is a perfect way of identifying the possible severity of sepsis.
Capnography has been used for a long period of time in the EMS field. The measurement of exhaled end-tidal carbon dioxide (EtCO2) is a mandatory measurement tool for every cardiac arrest call the EMS personnel will run.
Abnormal levels of EtCO2 may indicate a derangement in perfusion, metabolism and/or gas exchange. Capnography, the waveform measurement of exhaled end-tidal carbon dioxide (EtCO2), is a well-known tool in EMS. EtCO2 is a continuous variable determined by basal metabolic rate, cardiac output, and ventilation. Thus, abnormal levels may reflect derangement in perfusion, metabolism or gas exchange. EtCO2 levels decline in the setting of both poor perfusion and metabolic acidosis. To compensate for metabolic acidosis, patients increase their minute ventilation. This increased respiratory rate “blows off” carbon dioxide and lowers EtCO2. At the same time, poor tissue perfusion decreases the amount of blood flow to the alveoli of the lungs, reducing the amount of carbon dioxide that can be exhaled—the most dramatic demonstration of this process is during cardiac arrest. Therefore, EtCO2 is inversely proportional to lactate: As lactate levels rise in septic patients, EtCO2 levels drop. (Hunter, 2014, p. 2)
In patients with suspected sepsis, any capnography reading of less than < 24 mmHg should be considered severe sepsis and possible septic shock. Furthermore, capnography can be monitored to assess the impact of therapies designed to improve perfusion.
Hunter, C. (2014, March 3 ). Use end-tidal carbon dioxide to diagnose sepsis. Journal of Emergency Medical Services, 1-5.
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