Utility of changes in end-tidal carbon dioxide after volume expansion to assess fluid responsiveness in the operating room: a prospective observational study

Courson, Hugues de; Gall, Lisa Le; Georges, Delphine; Boyer, Philippe; Verchère, Eric; Nouette‐Gaulain, Karine; Biais, Matthieu

doi:10.1016/j.bja.2020.07.018

Cited by 10 publications

(12 citation statements)

References 36 publications

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“…Con ict ing results have been found regarding the ability of PPV and SVV to predict uid responsiveness in the prone position and under protective ventilation [22,29,30,[37][38][39]. The present study indicated that the baseline values of PPV and SVV could not be used to predict uid responsiveness in conditions of low Vt ventilation in the prone position.…”

Section: Discussionmentioning

confidence: 60%

Respiratory variation in the internal jugular vein does not predict fluid responsiveness in adolescent idiopathic scoliosis surgery: a prospective cohort study

Wu,

Dai,

Liang

et al. 2023

Preprint

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Background: Respiratory variation in the internal jugular vein (IJVV) has not shown promising results in predicting volume responsiveness in ventilated patients with low tidal volume (Vt) in prone position. We aimed to determine whether the baseline respiratory variation in the IJVV value measured by ultrasound might predict fluid responsiveness in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with low Vt. Methods: According to the fluid responsiveness results, the included patients were divided into two groups: those who responded to volume expansion, denoted the responder group, and those who did not respond, denoted the non-responder group. The primary outcome was determination of the value of baseline IJVV in predicting ﬂuid responsiveness (≥15% increases in stroke volume index (SVI) after 7 ml·kg-1 colloid administration) in patients with AIS undergoing PSF during low Vt ventilation. Secondary outcomes were estimation of the diagnostic performance of pulse pressure variation (PPV), stroke volume variation (SVV), and the combination of IJVV and PPV in predicting fluid responsiveness in this surgical setting. Results: Fifty-six patients were included, 36 (64.29%) of whom were deemed ﬂuid responsive. No significant difference in baseline IJVV was found between responders and non-responders (25.89% vs. 23.66%, p = 0.73), and no correlation was detected between baseline IJVV and the increase in SVI after volume expansion (r = 0.14, p = 0.40). A baseline IJVV greater than 32.00%, SVV greater than 14.30%, PPV greater than 11.00%, and a combination of IJVV and PPV greater than 64.00% had utility in identifying ﬂuid responsiveness, with a sensitivity of 33.33%, 77.78%, 55.56%, and 55.56%, respectively, and a speciﬁcity of 80.00%, 50.00%, 65.00%, and 65.00%, respectively. The area under the receiver operating characteristic curve for the baseline values of IJVV, SVV, PPV, and the combination of IJVV and PPV was 0.52 (95% CI, 0.38–0.65), 0.54 (95% CI, 0.40–0.67), 0.58 (95% CI, 0.45–0.71), and 0.57 (95% CI, 0.43–0.71), respectively. Conclusions: Ultrasonic-derived IJVV lacked accuracy in predicting ﬂuid responsiveness in patients with AIS undergoing PSF during low Vt ventilation. In addition, the baseline values of PPV, SVV, and the combination of IJVV and PPV did not predict fluid responsiveness in this surgical setting. Trail Registration: This trial was registered at www.chictr.org (ChiCTR2200064947) on 24/10/2022. All data were collected through chart review.

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Section: Discussionmentioning

confidence: 60%

Respiratory variation in the internal jugular vein does not predict fluid responsiveness in adolescent idiopathic scoliosis surgery: a prospective cohort study

Wu,

Dai,

Liang

et al. 2023

Preprint

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“…However, dynamic indicators of fluid responsiveness, which are based on cardiopulmonary interactions in patients receiving mechanical ventilation, have been shown to be predictive [ 38 – 42 ]. The ΔEtCO 2 has been extensively studied with respect to its value in predicting fluid responsiveness, but the results are conflicting [ 13 – 18 , 30 – 33 , 43 – 45 ]. To the best of our knowledge, this is the first systematic review and meta-analysis to explore the diagnostic accuracy of ΔEtCO 2 in predicting fluid responsiveness during PLR test in patients with mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…End-tidal carbon dioxide (EtCO2) is the partial pressure of carbon dioxide (PCO2) in the exhaled air measured at the end of expiration. Measurement of EtCO2 using capnography provides a noninvasive estimate of cardiac output during cardiac arrest and can therefore be used to monitor the quality of cardiopulmonary resuscitation and predict return of spontaneous circulation [10][11][12].In recent years, the variation of EtCO2 (ΔEtCO2) during passive leg raising (PLR) test or fluid challenge has been considered as a tool to help guide fluid resuscitation [13][14][15][16][17][18][19], however, the results conflicting. Physiologically, EtCO2 depends on three variables: tissue CO2 production, pulmonary blood flow (i.e., cardiac output), and alveolar ventilation [20].…”

Section: Introductionmentioning

confidence: 99%

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

Huang

Shen

et al. 2022

Crit Care

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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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“…Measurement of EtCO2 using capnography provides a noninvasive estimate of cardiac output and organ perfusion during cardiac arrest and can therefore be used to monitor the quality of cardiopulmonary resuscitation and predict return of spontaneous circulation [8][9][10]. In recent years, the variation of EtCO2 (ΔEtCO2) during passive leg raising(PLR) test or uid challenge has been considered as a tool to help guide uid resuscitation [11][12][13][14][15][16][17]. Physiologically, EtCO2 depends on three variables: tissue CO2 production, pulmonary blood ow (i.e.…”

Section: Introductionmentioning

confidence: 99%

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

Huang¹,

Wu²,

Shen³

et al. 2021

Preprint

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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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Utility of changes in end-tidal carbon dioxide after volume expansion to assess fluid responsiveness in the operating room: a prospective observational study

Cited by 10 publications

References 36 publications

Respiratory variation in the internal jugular vein does not predict fluid responsiveness in adolescent idiopathic scoliosis surgery: a prospective cohort study

Respiratory variation in the internal jugular vein does not predict fluid responsiveness in adolescent idiopathic scoliosis surgery: a prospective cohort study

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

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

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