scholarly journals Assessing the Utility of End-Tidal Carbon Dioxide as a Marker for Fluid Responsiveness in Cardiogenic Shock

Cureus ◽  
2021 ◽  
Author(s):  
Komal Baloch ◽  
Aziz Rehman Memon ◽  
Urwah Ikhlaq ◽  
Madiha Umair ◽  
Muhammad Imran Ansari ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiogenic Shock ◽  
Fluid Responsiveness ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

scholarly journals 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 ◽  
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.

scholarly journals 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

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.

scholarly journals Pulse pressure and end-tidal carbon dioxide for monitoring low native cardiac output during veno-arterial ECLS: a prospective observational study

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Marc Mourad ◽  
Jacob Eliet ◽  
Norddine Zeroual ◽  
Marine Saour ◽  
Pierre Sentenac ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Output ◽  
Observational Study ◽  
Cardiogenic Shock ◽  
Pulse Pressure ◽  
Life Support ◽  
Operating Characteristics ◽  
Predictive Values ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Abstract Background Veno-arterial extracorporeal life support (VA-ECLS) results in cardiopulmonary shunting with reduced native cardiac output (NCO). Low NCO occurrence is common and associated with risk of thromboembolic and pulmonary complications. Practical tools for monitoring NCO during VA-ECLS would therefore be valuable. Pulse pressure (PP) and end-tidal carbon dioxide (EtCO2) are known to be related to cardiac output. We have designed a study to test whether PP and EtCO2 were efficient for the monitoring of NCO during VA-ECLS. Methods In this prospective single-center observational study, patients who underwent a VA-ECLS for cardiogenic shock from January 2016 to October 2017 were included, provided low NCO was suspected by a PP < 20 mmHg. NCO was measured with pulmonary artery catheter or echocardiography and compared to PP and EtCO2. The ability of PP and EtCO2 to predict NCO < 1 L/min was evaluated with receiver operating characteristics (ROC) curves. Results Among the 106 patients treated with VA-ECLS for cardiogenic shock during the study period, 26 were studied, allowing the collection of 196 study points. PP and EtCO2 relationships with NCO were nonlinear and showed strong correlations for NCO < 2 L/min (r = 0.69 and r = 0.78 respectively). A PP < 15 mmHg and EtCO2 < 14 mmHg had good predictive values for detecting NCO < 1 L/min (area under ROC curve 0.93 [95% CI 0.89–0.96] and 0.97 [95% CI 0.94–0.99] respectively, p = 0.058). Conclusions PP and EtCO2 may offer an accurate real-time monitoring of low NCO events during VA-ECLS support. Further studies are needed to show if their utilization may help to implement therapeutic strategies in order to prevent thromboembolic and respiratory complications associated with VA-ECLS, and to improve patients’ prognosis. Trial registration NCT03323268, July 12, 2016

scholarly journals Effect of positive end-expiratory pressure value on change in end-tidal carbon dioxide as a predictor of fluid responsiveness in Patients Undergoing Passive Leg Raising Maneuver

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Lutfi Nur Farid ◽  
Hardiono Hardiono ◽  
Pesta Parulian Maurid Edwar
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Output ◽  
Fluid Responsiveness ◽  
Passive Leg Raising ◽  
Positive End Expiratory Pressure ◽  
Mechanically Ventilated ◽  
Resuscitation Room ◽  
End Tidal Carbon Dioxide ◽  
Before And After ◽  
End Tidal

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]

Sign in / Sign up

Export Citation Format

Share Document