Diagnostic accuracy of end-tidal carbon dioxide detection in determining correct placement of nasogastric tube: An updated systematic review with meta-analysis

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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Data supporting the use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review

Data in Brief ◽

10.1016/j.dib.2018.04.075 ◽

2018 ◽

Vol 18 ◽

pp. 1497-1508 ◽

Cited By ~ 4

Author(s):

Edison F. Paiva ◽

James H. Paxton ◽

Brian J. O’Neil

Keyword(s):

Carbon Dioxide ◽

Systematic Review ◽

Cardiac Arrest ◽

End Tidal Carbon Dioxide ◽

End Tidal

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Neonatal end-tidal carbon dioxide detection and waveform capnography

Anaesthesia ◽

10.1111/anae.14525 ◽

2018 ◽

Vol 74 (1) ◽

pp. 114-115 ◽

Cited By ~ 1

Author(s):

J. Fawke ◽

J. Wyllie

Keyword(s):

Carbon Dioxide ◽

End Tidal Carbon Dioxide ◽

Carbon Dioxide Detection ◽

End Tidal

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End-tidal carbon, dioxide detection in emergency intubation in four groups of patients

Journal of Emergency Medicine ◽

10.1016/0736-4679(94)90482-0 ◽

1994 ◽

Vol 12 (6) ◽

pp. 771-777 ◽

Cited By ~ 15

Author(s):

Kenneth C. Sanders ◽

Woodworth B. Clum ◽

Steve S. Nguyen ◽

Subramaniam Balasubramaniam

Keyword(s):

Carbon Dioxide ◽

Emergency Intubation ◽

End Tidal Carbon Dioxide ◽

Carbon Dioxide Detection ◽

End Tidal

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Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device

Annals of Emergency Medicine ◽

10.1016/s0196-0644(05)82517-x ◽

1992 ◽

Vol 21 (5) ◽

pp. 518-523 ◽

Cited By ~ 98

Author(s):

Joseph P Ornato ◽

Joshua B Shipley ◽

Edward M Racht ◽

Corey M Slovis ◽

Keith D Wrenn ◽

...

Keyword(s):

Carbon Dioxide ◽

Multicenter Study ◽

Hand Size ◽

End Tidal Carbon Dioxide ◽

Carbon Dioxide Detection ◽

End Tidal

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Carbon Monoxide and Nonquantitative Carbon Dioxide Detection

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00043120 ◽

1996 ◽

Vol 11 (4) ◽

pp. 276-279 ◽

Cited By ~ 2

Author(s):

Georg Petroianu ◽

Wolfgang Maleck ◽

Wolfgang Bergler ◽

Roderich Ruefer

Keyword(s):

Carbon Dioxide ◽

Carbon Monoxide ◽

Endotracheal Tube ◽

Reliable Method ◽

Hospital Setting ◽

Infrared Spectrometry ◽

End Tidal Carbon Dioxide ◽

Tube Position ◽

Carbon Dioxide Detection ◽

End Tidal

AbstractIntroduction:The capnometric demonstration of end-tidal carbon dioxide (CO2) is a reliable method of differentiating between a correct endotracheal tube position and an accidental misplacement of the tube into the esophagus. Recently, several CO2 detectors have been introduced for monitoring end-tidal CO2 in the “out-of-hospital” setting, where quantitative capnometry with capnography is not yet available.Hypothesis:These devices are not influenced by carbon monoxide (CO) present in lethal concentration.Methods:A heated (37°C) 2.3 L reservoir bag filled one-third full with water (representing the stomach in esophageal misintubation) was machine ventilated (tidal volume: 450 ml; frequency: 16/min) with the following mixtures for three minutes each: 1) 95% O2, 5% CO; 2) 45% O2 5% CO, 50% N2O; and 3) 44% O2 5% CO, 50% N2O, 1% halothane. The presence of end-tidal CO2 was monitored with each of the following devices: 1) MiniCAP™ III CO2 Detector; 2) StatCAP™ CO2 Detector; 3) EasyCAP™ CO2 Detector; PediCAP™ CO2 Detector; and 5) Colibri™ CO2 Detector.Results:In none of the cases was the presence of CO2 signaled by the detector.Conclusion:The presence of 5% CO does not interfere with infrared spectrometry detection (MiniCAP™ and StatCAP™) or chemical detection (EasyCAP™, PediCAP™, and Colibri™) of CO2. The devices can be used safely in patients with CO poisoning for monitoring of endotracheal tube position.

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