Volumetric or time-based capnography for excluding pulmonary embolism in outpatients?

Franck Verschuren 1 Olivier Sanchez 2 Marc Righini 3, 4 E. Heinonen 5 Grégoire Le Gal 6, 7 Guy Meyer 2 Arnaud Perrier 3 F. Thys 1
1 FV - AMD - Acute Medicine Department, Accidents and Emergency Unit
2 HEGP
3 MR - Service d'angiologie et d'hémostase
4 SMIG - Service de médecine interne générale
5 EH - GE Healthcare Helsinki
6 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale
7 CIC - Brest - Centre d'Investigation Clinique
Abstract : BACKGROUND: Volumetric capnography is technically more demanding but theoretically better than the time-based alveolar deadspace fraction (P(a)CO(2) - EtCO(2))/P(a)CO(2) as a bedside diagnostic tool for excluding pulmonary embolism (PE) in outpatients. OBJECTIVE: We compared both diagnostic accuracy in patients with a suspected PE and positive D-dimer enzyme-linked immunosorbent assay results. PATIENTS AND METHODS: In this clinical multicenter trial with prospective inclusion and 3-month follow-up, alveolar deadspace fraction was compared by receiver operating characteristic (ROC) analysis with other parameters derived from volumetric capnography. RESULTS: Capnography was performed in 239 patients, and 205 tests (86%) were conclusive. The incidence of PE was 33%. The alveolar deadspace fraction accuracy expressed with ROC curve analysis was 0.73 +/- 0.04. The diagnostic performances of parameters from volumetric capnography were not significantly better. Sixteen per cent [95% confidence interval (CI) 12-21%] of patients presented a (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratio under the cut-off value of 0.15, with a low clinical probability. This combination excluded PE, with a sensitivity of 96% (95% CI 89-99%) and a negative likelihood ratio of 0.17 (95% CI 0.09-0.33%). CONCLUSION: Volumetric capnography failed to show superiority to alveolar deadspace fraction measurements [(P(a)CO(2) - EtCO(2))/P(a)CO(2)] for exclusion of PE in outpatients with positive D-dimer test results. Future studies should clarify the safety of excluding PE in patients combining low clinical probability with positive D-dimer results and (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratios below the cut-off value of 0.15.
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Article dans une revue
Journal of Thrombosis and Haemostasis, Wiley, 2010, 8 (1), pp.60-7. 〈10.1111/j.1538-7836.2009.03667.x〉
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http://hal.univ-brest.fr/hal-00677241
Contributeur : Ghislaine Calvez <>
Soumis le : mercredi 7 mars 2012 - 15:55:05
Dernière modification le : mercredi 10 janvier 2018 - 14:42:02

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Franck Verschuren, Olivier Sanchez, Marc Righini, E. Heinonen, Grégoire Le Gal, et al.. Volumetric or time-based capnography for excluding pulmonary embolism in outpatients?. Journal of Thrombosis and Haemostasis, Wiley, 2010, 8 (1), pp.60-7. 〈10.1111/j.1538-7836.2009.03667.x〉. 〈hal-00677241〉

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