Assessment of fluid responsiveness with end-tidal carbon dioxide using a simplified passive leg-raising maneuver: a prospective observational study

Abstract Identification of patients’ fluid status in the emergency room should be made before giving fluid therapy. This study aimed to determine the effect of positive end-expiratory pressure on change in end-tidal carbon dioxide during passive leg raising maneuver to predict fluid responsiveness. Thirty subjects aged 18-65 years in the resuscitation room, all on the ventilator, were divided into three groups according to their positive end-expiratory pressure value: low (0-5 cmH2O), moderate (6-10 cmH2O), and high (>10 cmH2O). Every subject underwent passive leg raising to simulate fluid administration. Values of blood pressure, heart rate, cardiac output, and end-tidal carbon dioxide were recorded before and after the maneuver. Analysis of the three groups found a significant correlation between change in end-tidal carbon dioxide with a cut-off value of 5% and 1 mmHg with fluid responsiveness of subjects in the low (p = 0.028) and moderate (p = 0.013) but not in the high positive end-expiratory pressure group (p = 0.333). In conclusion, change in end-tidal carbon dioxide in mechanically ventilated patients undergoing passive leg raising maneuvers can be used as a predictor of fluid responsiveness, but this method cannot be used on patients with high positive end-expiratory pressure (> 10 cmH2O) Keywords : change in end tidal carbon dioxide, fluid responsiveness, positive end-expiratory pressure, passive leg raising, cardiac output surrogateCorrespondence : [email protected]

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Accuracy of Combining End-Tidal Carbon Dioxide and Pulse Pressure Variability Measurements in Predicting Fluid Responsiveness During Passive Leg Raising Test in Septic Shock Patient

10.21203/rs.3.rs-54099/v1 ◽

2020 ◽

Author(s):

Xiao-Fen Zhou ◽

Rong-Guo Yu ◽

Feng-Hui Lin ◽

Ting-Feng Huang ◽

Shu-Rong Gong ◽

...

Keyword(s):

Carbon Dioxide ◽

Septic Shock ◽

Fluid Responsiveness ◽

Pulse Pressure ◽

Passive Leg Raising ◽

Operating Characteristics ◽

Predict Fluid Responsiveness ◽

Volume Responsiveness ◽

End Tidal Carbon Dioxide ◽

End Tidal

Abstract Background It is essential to assess the patients’ volume responsiveness before fluid infusion in patients with circulatory failure. The hypothesis is that the combining of end-tidal carbon dioxide (EtCO2) and pulse pressure variability (PPV) measurements can non-invasively predict fluid responsiveness during passive leg raising (PLR) test. Methods Pulse indicates continuous cardiac output, right radial artery blood pressure, and EtCO2 were monitored in 71 septic shock patients with mechanical ventilation. A standard PLR test was performed; cardiac index (CI), arterial pressure, stroke volume variability (SVV), PPV, and EtCO2 were measured before and after the PLR test. Patients with an increase in CI greater than 15% after the PLR test were defined as fluid responders. Receiver-operating characteristics (ROC) curve analysis was carried out to assess the predictive performance of the measured parameters. Results PPV, △EtCO2 and △EtCO2 variation ratio (△EtCO2%) in fluid-responders were significantly greater than those in the non-responders. The AUC of △EtCO2% was 0.884 (95% CI, 0.785 to 0.948) with a cut-off value of > 5.88%; yielded a sensitivity of 91.89% (95% CI, 78.1–98.3%) and aspecificity of 76.47% (95% CI, 58.8–89.3%). The AUC of PPV was 0.852 (95% CI, 0.748 to 0.925) with a cut-off value of > 10%; yielded a sensitivity of 81.1% (95% CI, 64.8–92%) and specificity of 79.41% (95% CI, 62.1–91.3%). The AUC of PPV-△EtCO2% combination was 0.942 (95% CI, 0.86 to 0.984) with a cut-off value of > 0.666; yielded a sensitivity of 83.8% (95% CI, 68–93.8%) and aspecificity of 94.1% (95% CI, 80.3–99.3%). The AUC of PPV-△EtCO2% combination was significantly greater than either △EtCO2% or PPV. Conclusion The combination of PPV and △EtCO2 can better predict fluid responsiveness during PLR.

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Value of variation of end-tidal carbon dioxide for predicting fluid responsiveness during the passive leg raising test in patients with mechanical ventilation: a systematic review and meta-analysis

Critical Care ◽

10.1186/s13054-022-03890-9 ◽

2022 ◽

Vol 26 (1) ◽

Author(s):

Haijun Huang ◽

Chenxia Wu ◽

Qinkang Shen ◽

Yixin Fang ◽

Hua Xu

Keyword(s):

Carbon Dioxide ◽

Mechanical Ventilation ◽

Sensitivity Analysis ◽

Fluid Responsiveness ◽

Meta Analysis ◽

End Tidal Carbon Dioxide ◽

Study Heterogeneity ◽

Meta Regression ◽

Meta Regression Analysis ◽

End Tidal

Abstract Background The ability of end-tidal carbon dioxide (ΔEtCO2) for predicting fluid responsiveness has been extensively studied with conflicting results. This meta-analysis aimed to explore the value of ΔEtCO2 for predicting fluid responsiveness during the passive leg raising (PLR) test in patients with mechanical ventilation. Methods PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched up to November 2021. The diagnostic odds ratio (DOR), sensitivity, and specificity were calculated. The summary receiver operating characteristic curve was estimated, and the area under the curve (AUROC) was calculated. Q test and I2 statistics were used for study heterogeneity and publication bias was assessed by Deeks’ funnel plot asymmetry test. We performed meta-regression analysis for heterogeneity exploration and sensitivity analysis for the publication bias. Results Overall, six studies including 298 patients were included in this review, of whom 149 (50%) were fluid responsive. The cutoff values of ΔEtCO2 in four studies was 5%, one was 5.8% and the other one was an absolute increase 2 mmHg. Heterogeneity between studies was assessed with an overall Q = 4.098, I2 = 51%, and P = 0.064. The pooled sensitivity and specificity for the overall population were 0.79 (95% CI 0.72–0.85) and 0.90 (95% CI 0.77–0.96), respectively. The DOR was 35 (95% CI 12–107). The pooled AUROC was 0.81 (95% CI 0.77–0.84). On meta-regression analysis, the number of patients was sources of heterogeneity. The sensitivity analysis showed that the pooled DOR ranged from 21 to 140 and the pooled AUC ranged from 0.92 to 0.96 when one study was omitted. Conclusions Though the limited number of studies included and study heterogeneity, our meta-analysis confirmed that the ΔEtCO2 performed moderately in predicting fluid responsiveness during the PLR test in patients with mechanical ventilation.

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Value of Variation of End-Tidal Carbon Dioxide for Predicting Fluid Responsiveness During the Passive Leg Raising Test in Patients with Mechanical Ventilation: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-1069765/v1 ◽

2021 ◽

Author(s):

Haijun Huang ◽

Chenxia Wu ◽

Qinkang Shen ◽

Yixin Fang ◽

Hua Xu

Keyword(s):

Carbon Dioxide ◽

Mechanical Ventilation ◽

Sensitivity Analysis ◽

Regression Analysis ◽

Fluid Responsiveness ◽

Meta Analysis ◽

End Tidal Carbon Dioxide ◽

Meta Regression ◽

Meta Regression Analysis ◽

End Tidal

Abstract Background: The variation of end-tidal carbon dioxide(ΔEtCO2) has have been extensively studied with respect to its value in predicting fluid responsiveness, but the results are conflicting. This meta-analysis aimed to explore the value of ΔEtCO2 for predicting fluid responsiveness during the passive leg raising(PLR) test in patients with mechanical ventilation. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched up to November 2021. The diagnostic odds ratio (DOR), sensitivity, and specificity were calculated. The summary receiver operating characteristic curve was estimated, and the area under the curve (AUROC) was calculated. We performed meta-regression analysis for heterogeneity exploration and sensitivity analysis for the publication bias.Results: Overall, 298 patients were included in this review, of whom 149 (50%) were fluid responsive. The cutoff values of ΔEtCO2 varied across studies, ranging from 5% to 5.8% or absolute increase 2mmHg. Heterogeneity between studies was assessed with an overall Q = 4.098, I2 = 51%, and P = 0.064. The pooled sensitivity and specificity for the overall population were 0.79 (95% CI: 0.72–0.85) and 0.90 (95% CI: 0.77–0.96), respectively. The DOR was 35 (95% CI: 12–107) (Fig. 4). The pooled AUROC was 0.81 (95% CI: 0.77–0.84). On meta-regression analysis, the number of patients was sources of heterogeneity. The sensitivity analysis showed that the pooled DOR ranged from 21 to 140 and the pooled AUC ranged from 0.92 to 0.96 when one study was omitted.Conclusions: This study was the first meta-analysis to evaluate the diagnostic accuracy of ΔEtCO2 in predicting fluid responsiveness during PLR test in patients with mechanical ventilation. This study confirmed that the ΔEtCO2 performed well in predicting fluid responsiveness in patients with mechanical ventilation.

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