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ABSTRACT: Background
Methods to guide fluid therapy in spontaneously breathing patients are scarce. No studies have reported the accuracy of end-tidal CO2 (ET-CO2) to predict volume responsiveness in these patients. We sought to evaluate the ET-CO2 gradient (?ET-CO2) after a passive leg rise (PLR) maneuver to predict volume responsiveness in spontaneously breathing healthy adults.Methods
We conducted a prospective study in healthy adult human volunteers. A PLR maneuver was performed and cardiac output (CO) was measured by transthoracic echocardiography. ET-CO2 was measured with non-invasive capnographs. Volume responsiveness was defined as an increase in cardiac output (CO) >?12% at 90 s after PLR.Results
Of the 50 volunteers, 32% were classified as volume responders. In this group, the left ventricle outflow tract velocity time integral (VTILVOT) increased from 17.9?±?3.0 to 20.4?±?3.4 (p?=?0.0004), CO increased from 4.4?±?1.5 to 5.5?±?1.6 (p?=?0.0), and ET-CO2 rose from 32 ±?4.84 to 33 ±?5.07 (p?=?0.135). Within the entire population, PLR-induced percentage ?CO was not correlated with percentage ?ET-CO2 (R2?=?0.13; p?=?0.36). The area under the receiver operating curve for the ability of ET-CO2 to discriminate responders from non-responders was of 0.67?±?0.09 (95% CI 0.498-0.853). A ?ET-CO2???2 mmHg had a sensitivity of 50%, specificity of 97.06%, positive likelihood ratio of 17.00, negative likelihood ratio of 0.51, positive predictive value of 88.9%, and negative predictive value of 80.5% for the prediction of fluid responsiveness.Conclusions
?ET-CO2 after a PLR has limited utility to discriminate responders from non-responders among healthy spontaneously breathing adults.
SUBMITTER: Arango-Granados MC
PROVIDER: S-EPMC6066588 | biostudies-literature | 2018 Jul
REPOSITORIES: biostudies-literature
Intensive care medicine experimental 20180730 1
<h4>Background</h4>Methods to guide fluid therapy in spontaneously breathing patients are scarce. No studies have reported the accuracy of end-tidal CO<sub>2</sub> (ET-CO<sub>2</sub>) to predict volume responsiveness in these patients. We sought to evaluate the ET-CO<sub>2</sub> gradient (ΔET-CO<sub>2</sub>) after a passive leg rise (PLR) maneuver to predict volume responsiveness in spontaneously breathing healthy adults.<h4>Methods</h4>We conducted a prospective study in healthy adult human vol ...[more]