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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
Language
EN
Article de revue
This item was published in
British Journal of Anaesthesia. 2020-01-01, vol. 125, n° 5, p. 672-679
English Abstract
From a physiological viewpoint, changes in end-tidal carbon dioxide (EtCO) could be a simple, noninvasive, and inexpensive way to monitor changes in cardiac index. This study aimed to assess the utility of changes in EtCO ...Read more >
From a physiological viewpoint, changes in end-tidal carbon dioxide (EtCO) could be a simple, noninvasive, and inexpensive way to monitor changes in cardiac index. This study aimed to assess the utility of changes in EtCO as a marker of fluid responsiveness after volume expansion in the operating room. A prospective observational study was conducted in a tertiary university teaching hospital, from August 2018 to February 2019. A total of 109 non-consecutive, mechanically ventilated adults undergoing neurosurgery in the supine position with cardiac output monitors were included. Patients with major respiratory disease, arrhythmia, or heart failure were excluded. Volume expansion with 250 ml of saline 0.9% was performed over 10 min to maximise cardiac output during surgery, according to current guidelines. A positive fluid challenge was defined as an increase in stroke volume index of more than 10% from baseline. Changes in stroke volume index (monitored using pulse contour analysis) and EtCO were recorded before and after infusion. A total of 242 fluid challenges in 114 patients were performed, of which 26.9% were positive. Changes in EtCO > 1.1% induced by infusions had utility for identifying fluid responsiveness, with a sensitivity of 62.9% (95% confidence interval [CI], 62.5-63.3%) and a specificity of 77.8% (95% CI, 77.6-78.1%). The area under the receiver operating characteristic curve for changes in EtCO after volume expansion was 0.683 (95% CI, 0.680-0.686). Changes in EtCO induced by rapid infusion of 250 ml saline 0.9% lacked accuracy for identifying fluid responsiveness in mechanically ventilated patients in the operating room. NCT03635307.Read less <
English Keywords
Aged
Blood Volume
Carbon Dioxide
Female
Fluid Therapy
Hemodynamics
Humans
Male
Middle Aged
Neurosurgical Procedures
Operating Rooms
Predictive Value of Tests
Prospective Studies
Respiration
Artificial
Stroke Volume
Supine Position