Diyabetik ketoasidoz tanısıyla izlenen hastaların end-tidal karbondioksit ve entegre pulmoner indeks takibinin diyabetik ketoasidoz yönetimine katkısı

Purpose: In this study, the contribution of this non-invasive follow-up method to the management of DKA and the reduction of the frequency of invasive procedures was investigated in patients diagnosed with diabetic ketoacidosis (DKA) in the pediatric emergency department and followed up with capnography Method: Our study is a prospective clinical study. Between October 2020- November 2022, EtCO2 and IPI follow-up of 0-18 year-old pediatric patients diagnosed with DKA in the Pediatric Emergency Service of Akdeniz University Medical Faculty Hospital was performed by capnography. DKA diagnosis, grading, clinical follow-up and treatment termination criteria of the patients were determined according to the ISPAD 2018 Diagnosis and Treatment Guidelines. In the study; During the clinical follow-up, changes in GCS, blood glucose, vital, blood gas and capnograph parameters were examined. Demographic data were analyzed in all patients and in groups of patients who underwent DKA grading. GCS, blood gas and capnograph parameters were compared in the patient groups with DKA grading. Diagnostic test performances of blood gas and capnograph parameters were compared to detect low GCS Results: 7 (12.7%) of our patients were mild; 20 (36.4%) were moderate; 28 (50.9%) of them were in severe DKA clinic; mean age was 10.5±4.1/year; in order of distribution by age; 9 (16.4%) were 0-6 years old, 23 (41.8%) were 7-12 years old, and 23 (41.8%) were >12 years old. The average of HbA1c was 12.3±2.4. 0- 12 of all patients. When the differences between clinical, laboratory and capnography findings are examined; 0-12 of HR, RR, EtCO2, IPI, glucose, pH, HCO3, BE, PaCO2 values. The changes between hours were statistically significant (p<0.001 for all parameters). It was observed that fever, RR, HR, pH, PaCO2, BD, EtCO2, IPI values tended to improve compared to baseline throughout the followup. A linear correlation was found between EtCO2 and PaCO2 (r= 0.603 p:<0.001). A linear correlation was found between IPI and pH (r= 0.632 p:<0.001). When the groups are compared; The incidence of ETCO2<25mmHg was higher in the severe 74 DKA group than in the mild-moderate DKA group (p:0.034). EtCO2 and IPI values were significantly lower in severe DKA (p:0.034; p:0.008, respectively). The incidence of GCS≤13 in the severe DKA group was found to be higher than in the mild-moderate DKA group (p:0.025). Diagnostic test performances were examined with the Roc Curve test to determine the cut-off for EtCO2, PaCO2, pH, HCO3 and IPI values according to the neurological clinical status of the patients. When diagnostic test performances were compared in identifying patients with GCS <13; pH, EtCO2, HCO3, IPI PaCO2 cut-off values were <7.09, <12, <5.5, <4, <12.1, respectively. pH (AUC, 1.0; sensitive, 100%; specificity 100%), EtCO2 (AUC, 0.907; sensitive, 78.57%; specificity 92.59%), HCO3 (AUC, 0.907; sensitive, 88.89%) ; specificity, 85.71%), IPI (AUC, 0.851; sensitive, 55.56%; specificity, 96.43%), PaCO2 (AUC, 0.665; sensitive, 25%; specificity, 100%) Conclusion: When we evaluate the findings in our study; We think that EtCO2 monitoring can give an idea about the clinical grading of DKA and may be useful in predicting and monitoring metabolic acidosis. We thought that both parameters could be useful as an indicator of clinical improvement, and that IPI could be helpful in detecting especially severe DKA patients. We think that IPI and EtCO2 may be useful in predicting mortal complications of DKA such as clinical or subclinical brain edema. We think that the use of capnography in DKA patients will be stimulating in terms of complications that may develop by providing dynamic follow-up. Thus, both patient safety will be ensured and it will provide convenience to the clinicians in the follow-up of critical patients. We think that this non-invasive method will increase patient comfort by contributing to the decrease in the frequency of invasive procedures in patients, provided that our study findings and results are supported by more and large-scale similar studies. Keywords: Type 1 diabetes mellitus (Type 1 DM), Diabetic Ketoacidosis (DKA), Capnography, Blood gas, Integrated Pulmonary Index/Integrated Pulmonary Index (IPI/EPE), Endtidal Carbon Dioxide (EtCO2