ABSTRACT
Introduction: Capnography, is an easy, fast and practical method which its application in the diagnosis of Pulmonary Thromboendarterectomy [PTE] has recently been studied. This study aimed to assess the diagnostic value of end-tidal CO2 [ETCO2] and the alveolar dead space [AVDS] in the diagnosis of patients suspected to PTE who have been referred to the emergency department
Materials and Methods: This cross-sectional study was conducted during one year in the emergency department of Ghaem Hospital on patients with suspected PTE who scored less than 4 for the Wells' criteria during the initial evaluation. After excluding other differential diagnoses, all patients underwent CT pulmonary angiography CTPA to confirm PTE. Following that, arterial blood gas sampling, ETCO2 and AVDS were requested for all the patients based on capnography. Data analysis was performed using descriptive statistical tests in SPSS software version 11.5. The sensitivity, specificity, and positive and negative predictive values of AVDS and ETCO2 were measured based on [CTPA] results
Results: The study was performed on 78 patients [mean age of 47.08 +/- 15.6 years, 43 males/35 females] suspected to PTE. According to the results of CTPA, 37 patients did not develop PTE while 41 patients were with PTE. There was no significant difference between the two groups in terms of age and gender [P=0.999], while a statistically significant difference was found between the mean values of ETCO2 and AVDS between the two groups [P<0.001]. The best cut-off points for PTE diagnosis were 0.17 [based on AVDS, with sensitivity and specificity of 78.0% and 56.8%, respectively], and 26.5 [based on ETCO2, with sensitivity and specificity of 67.6% and 75.6%, respectively]. In addition, the negative predictive values for AVDS and ETCO2 were estimated as 70.0% and 71.43%, respectively
Conclusion: According to the results of this study, capnography could be effective to promptly rule out PTE in emergency situations. Given its negative predictive value to rule out PTE, ETCO2 is considered as the most valid criterion among capnography parameters
ABSTRACT
Introduction: Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease [COPD] can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients
Materials and Methods: This cross- sectional study was performed in Ghaem hospital, Mashhad Iran. Twenty-five COPD patients [case group] were selected, based on the inclusion and exclusion criteria. The patients' demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms
Results: The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2 +/- 12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08 +/- 12.15mm and 73.28 +/- 15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them [P=0.02]. Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention
Conclusion: The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients