Document Detail


End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test.
MedLine Citation:
PMID:  22990869     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: In stable ventilatory and metabolic conditions, changes in end-tidal carbon dioxide (EtCO(2)) might reflect changes in cardiac index (CI). We tested whether EtCO(2) detects changes in CI induced by volume expansion and whether changes in EtCO(2) during passive leg raising (PLR) predict fluid responsiveness. We compared EtCO(2) and arterial pulse pressure for this purpose.
METHODS: We included 65 patients [Simplified Acute Physiology Score (SAPS) II = 57 ± 19, 37 males, under mechanical ventilation without spontaneous breathing, 15 % with chronic obstructive pulmonary disease, baseline CI = 2.9 ± 1.1 L/min/m(2)] in whom a fluid challenge was decided due to circulatory failure and who were monitored by an expiratory-CO(2) sensor and a PiCCO2 device. In all patients, we measured arterial pressure, EtCO(2), and CI before and after a fluid challenge. In 40 patients, PLR was performed before fluid administration. The PLR-induced changes in arterial pressure, EtCO(2), and CI were recorded.
RESULTS: Considering the whole population, the fluid-induced changes in EtCO(2) and CI were correlated (r (2) = 0.45, p = 0.0001). Considering the 40 patients in whom PLR was performed, volume expansion increased CI ≥ 15 % in 21 "volume responders." A PLR-induced increase in EtCO(2) ≥ 5 % predicted a fluid-induced increase in CI ≥ 15 % with sensitivity of 71 % (95 % confidence interval: 48-89 %) and specificity of 100 (82-100) %. The prediction ability of the PLR-induced changes in CI was not different. The area under the receiver-operating characteristic (ROC) curve for the PLR-induced changes in pulse pressure was not significantly different from 0.5.
CONCLUSION: The changes in EtCO(2) induced by a PLR test predicted fluid responsiveness with reliability, while the changes in arterial pulse pressure did not.
Authors:
Xavier Monnet; Aurélien Bataille; Eric Magalhaes; Jérôme Barrois; Marine Le Corre; Clément Gosset; Laurent Guerin; Christian Richard; Jean-Louis Teboul
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-09-19
Journal Detail:
Title:  Intensive care medicine     Volume:  39     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-04     Completed Date:  2013-06-07     Revised Date:  2013-09-24    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  93-100     Citation Subset:  IM    
Affiliation:
AP-HP, Hôpital de Bicêtre, Service de Réanimation Médicale, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France. xavier.monnet@bct.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Arterial Pressure*
Carbon Dioxide / analysis*
Cardiac Output / physiology*
Female
Humans
Lower Extremity / blood supply*
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive / physiopathology
Sensitivity and Specificity
Tidal Volume
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide
Comments/Corrections
Comment In:
Intensive Care Med. 2013 Jun;39(6):1164   [PMID:  23615700 ]
Intensive Care Med. 2013 Jun;39(6):1165   [PMID:  23615701 ]
Intensive Care Med. 2013 May;39(5):972   [PMID:  23344836 ]
Intensive Care Med. 2013 Sep;39(9):1668   [PMID:  23801383 ]

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