To what extent is end-tidal carbon dioxide a predictor of sepsis?

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major cause of death worldwide; 245 000 cases are reported in the UK annually with a mortality rate of 20.3%. Rapid diagnosis and rapid treatment of sepsis can significantly reduce mortality but sepsis can be difficult to diagnose. End-tidal carbon dioxide (EtCO<sub>2</sub>) is the measurement of expired CO<sub>2</sub> using capnometry and waveform capnography. For CO<sub>2</sub> to be exhaled, it must be metabolised and transported before being exhaled by effective ventilation; EtCO<sub>2</sub> can therefore provide an indication of metabolism, circulation and ventilation. EtCO<sub>2</sub> has already been shown to be an indicator of other metabolic acidosis conditions so this review aims to identify the usefulness of EtCO<sub>2</sub> in identifying sepsis. Methods: A systematic literature search was conducted between March and April 2021 using the CINAHL Plus and MEDLINE databases. The results were screened and evaluated. Results: Of the 44 papers identified in the original search, seven were included in this review. Conclusion: This review suggests an EtCO<sub>2</sub> of ≤25 mmHg (3.3 kPa) in patients with a suspected infection is diagnostic of sepsis and therefore could be used to increase the speed and accuracy of diagnosis and potentially reduce sepsis mortality. It also identifies gaps in research around UK practice and in comparing EtCO<sub>2</sub> against UK sepsis guidelines and diagnostic tools such as the UK Sepsis Trust guidelines.

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