The Sensitivity and Specificity of Pulmonary Carbon Dioxide Elimination for Noninvasive Assessment of Fluid Responsiveness

Tusman, Gerardo; Groisman, Iván; Maidana, Gustavo A.; Ballarin, Virginia L.; Arca, Jorge Martinez; Böhm, Stephan H.; Suárez-Sipmann, Fernando

doi:10.1213/ane.0000000000001047

Cited by 31 publications

(20 citation statements)

References 37 publications

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“…Patients with multiple sources of pulmonary blood flow, including patients with significant collateral blood flow, were excluded due to potential inaccuracy in the assessment of Q P . Patients with passive pulmonary blood flow (bidirectional Glenn or Fontan physiology) were also excluded due to potential inaccuracies in the assessment pulmonary blood flow resulting from variable contributions from systemic to pulmonary collateral flow . Finally, patients on extracorporeal membrane oxygenation (ECMO) at the time of cardiac catheterization, and patients with non‐English‐speaking parent/guardian were also excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Fontan physiology) were also excluded due to potential inaccuracies in the assessment pulmonary blood flow resulting from variable contributions from systemic to pulmonary collateral flow. 20 Finally, patients on extracorporeal membrane oxygenation (ECMO) at the time of cardiac catheterization, and patients with non-English-speaking parent/guardian were also excluded. metric capnography by the respiratory rate.…”

Section: Patients With Passive Pulmonary Blood Flow (Bidirectional Glmentioning

confidence: 99%

See 1 more Smart Citation

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

Al‐Subu

Jooste

Hornik

et al. 2018

Pediatric Anesthesia

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Section: Methodsmentioning

confidence: 99%

Section: Patients With Passive Pulmonary Blood Flow (Bidirectional Glmentioning

confidence: 99%

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

Al‐Subu

Jooste

Hornik

et al. 2018

Pediatric Anesthesia

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show abstract

“…In a recent study in patients undergoing cardiac surgery, fluid responsiveness was predicted by the haemodynamic effects of a sudden increase in positive end-expiratory pressure from 5 to 10 cmH 2 O. The effects were measured through CO 2 elimination, which was used as a surrogate of cardiac output in these patients who were well sedated [78]. The respiratory systolic variation test (RSVT) quantifies the decrease in systolic pressure in response to a standardised manoeuvre consisting of three consecutive mechanical breaths with increasing airway pressure.…”

Section: … and Other Tests Using Heart–lung Interactionsmentioning

confidence: 99%

Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

458

359

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In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other “static” markers of preload has been used for decades, but they are not reliable. Robust evidence suggests that this traditional use should be abandoned. Over the last 15 years, a number of dynamic tests have been developed. These tests are based on the principle of inducing short-term changes in cardiac preload, using heart–lung interactions, the passive leg raise or by the infusion of small volumes of fluid, and to observe the resulting effect on cardiac output. Pulse pressure and stroke volume variations were first developed, but they are reliable only under strict conditions. The variations in vena caval diameters share many limitations of pulse pressure variations. The passive leg-raising test is now supported by solid evidence and is more frequently used. More recently, the end-expiratory occlusion test has been described, which is easily performed in ventilated patients. Unlike the traditional fluid challenge, these dynamic tests do not lead to fluid overload. The dynamic tests are complementary, and clinicians should choose between them based on the status of the patient and the cardiac output monitoring technique. Several methods and tests are currently available to identify preload responsiveness. All have some limitations, but they are frequently complementary. Along with elements indicating the risk of fluid administration, they should help clinicians to take the decision to administer fluids or not in a reasoned way.

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“…It has been shown that P ET CO 2 directly correlates to CO and can sufficiently predict fluid responsiveness when combined with PLR testing [70,71]. Tusman et al [72] introduced a further method based on volumetric CO 2 measurements by quantifying the amount of exhaled CO 2 instead of the concentration. To detect a lack of intravascular fluids, the pa-tient´s fluid responsiveness was provoked with an elevation of PEEP from 5 to 10 cmH 2 O for one minute.…”

Section: Novel Physiological Tests For Predicting Fluid Responsivenessmentioning

confidence: 99%

“…Furthermore, a ROC-analysis revealed a high predictive performance that was superior to the change of end-tidal CO 2 concentration and PPV. Even though this method is only available in ventilated patients, it offers a non-invasive and accurate approach for predicting fluid responsiveness that is worthy of further validation [72,73].…”

Section: Novel Physiological Tests For Predicting Fluid Responsivenessmentioning

confidence: 99%

Management of perioperative volume therapy – monitoring and pitfalls

Sander

Schneck

Habicher

2020

Korean J Anesthesiol

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Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery, including the risk factors of the surgical procedure and those of the patient. There have been substantial developments over the last few decades regarding the risk of anesthesia. In the early days of anesthesia, the risk of the anesthetic procedure itself was high and led to a number of fatalities [1,2]. This has changed dramatically, and these days anesthesia-related deaths are extremely low. Such advances are likely related to drug advancements, an improved understanding of physiology, and better monitoring and management. However, death after surgery, including the whole perioperative process, has not substantially declined. The risk of death during the 30 days following surgery is 1,000 times more likely than during surgery itself [3]. According to recent data, death within 30 days of surgery is the third leading cause of death in the United States of America, behind cardiac diseases and malignancy [4]. Some recent studies have assessed this risk in detail. According to Weiser et al. [5], it is estimated that more than 310 million surgical procedures are performed worldwide. The exact complication rate and risk of death after these procedures are largely unknown. However, it is estimated that depending on the type of surgery and patient's comorbidities that about 30-40% of patients develop complications, of which up to 20% are severe and possibly life-threatening [6-8]. Besides, the mortality risk of surgery is not precisely known. It has been estimated that between 3 and 12 million patients die worldwide after surgery. The European Surgical Outcome study evaluated this in detail in a seven-day cohort study that included 46,539 patients from 498 European centers. Patients were followed for up to 60 days after their surgical procedure. Of this cohort, 1,855 patients died while in hospital, giving an in-hospital mortality rate of 4.7%. Additionally, the study Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

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The Sensitivity and Specificity of Pulmonary Carbon Dioxide Elimination for Noninvasive Assessment of Fluid Responsiveness

Abstract: PEEP-induced changes in VCO2 predicted fluid responsiveness with accuracy in patients undergoing cardiac surgery.

Cited by 31 publications

References 37 publications

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

Prediction of fluid responsiveness: an update

Management of perioperative volume therapy – monitoring and pitfalls

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