Assessing the Utility of End-Tidal Carbon Dioxide as a Marker for Fluid Responsiveness in Cardiogenic Shock

Baloch, Komal; Memon, Aziz Rehman; Ikhlaq, Urwah; Umair, Madiha; Ansari, Muhammad Imran; Abubaker, Jawed; Salahuddin, Nawal

doi:10.7759/cureus.13164

Cited by 6 publications

(6 citation statements)

References 27 publications

(37 reference statements)

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“…In agreement with the current study, previous studies have revealed that ΔETCO2 ≥5% or ΔETCO2 >2 mmHg can predict fluid responsiveness to PLR in haemodynamically unstable patients. [ 2 , 5 , 15 ] The current study proved higher predictivity of FC-induced ΔETCO2 ≥2 mmHg (area under the ROC curve [AUC] 0.908) than that of Baloch et al .’s[ 16 ] study including cardiogenic shock patients (AUC 0.705) and Jacquet-Lagrèze et al .’s[ 17 ] study carried out for high-risk surgical patients (AUC 0.800). Heterogenicities between different studies assessing the predictivity of FC-induced ΔETCO2 for fluid responsiveness may be due to different standard references or fluid-loading techniques.…”

Section: Discussionmentioning

confidence: 99%

“…The current study is limited as the predictivity of ETCO2 variation for fluid responsiveness cannot be applied to either spontaneously breathing patients or in the presence of metabolic or ventilatory changes. [ 4 , 16 ] IJVDI is a priori predictor of fluid responsiveness, while ΔETCO2 is a posteriori predictor, and FC, which was used to induce CO 2 change, is not just a test, but it is a treatment option that, if repeated, can lead to volume overload. So, it is recommended to use FC-induced ΔETCO2 if fluid administration is strongly indicated (e.g.…”

Section: Discussionmentioning

confidence: 99%

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End-tidal carbon dioxide’s change to fluid challenge versus internal jugular vein dispensability index for predicting fluid responsiveness in septic patients: A prospective, observational study

Elnakera

Abdullah

Matar

2023

Indian Journal of Anaesthesia

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Background and Aims: The prediction of fluid responsiveness is crucial for the fluid management of septic shock patients. This prospective, observational study was conducted to compare end-tidal carbon dioxide (ETCO2) change due to fluid challenge (FC-induced ΔETCO2) versus internal jugular vein distensibility index (IJVDI) as predictors of fluid responsiveness in such patients. Methods: Septic hypoperfused mechanically ventilated patients were classified as fluid responders (Rs) and non-responders (NRs) according to the improvement of left ventricular outflow tract-velocity time integral (ΔLVOT-VTI) after fluid challenge (FC). The receiver operating characteristic (ROC) curves of FC-induced ΔETCO2, pre-(FC) IJVDI and their combination for prediction of fluid responsiveness were compared to that of ΔLVOT-VTI% as a gold standard. Results: Of 140 patients who completed the study, 51 (36.4%) patients were classified as Rs and 89 (63.6%) patients as NRs. With regard to the prediction of fluid responsiveness, no significant difference ( P . 0. 384) was found between the diagnostic accuracy of FC-induced ΔETCO2 >2 mmHg (area under the ROC curve [AUC] 0.908, P < 0.001) and that of pre-(FC) IJVDI >18% (AUC 0.938, P < 0.001), but a prediction model combining both markers, ΔETCO2 ≥3 mmHg and IJVDI ≥16%, achieved significantly higher accuracy (AUC 0.982, P < 0.001) than each independent one ( P < 0.05). Conclusion: Under stable ventilatory and metabolic conditions, the predictivity of FC-induced ΔETCO2 >2 mmHg can be comparable to that of pre-(FC) IJVDI >18%. A predictive model combining both FC-induced ΔETCO2 ≥3 mmHg and IJVDI ≥16% can provide higher accuracy than that recorded for each one independently.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

End-tidal carbon dioxide’s change to fluid challenge versus internal jugular vein dispensability index for predicting fluid responsiveness in septic patients: A prospective, observational study

Elnakera

Abdullah

Matar

2023

Indian Journal of Anaesthesia

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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%

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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“…EtCO 2 has also been shown to correlate with cardiac output after weaning from CPB and predicts adequate post-bypass cardiac output [ 12 ]. Changes in etCO 2 have also been studied as a way to identify changes in cardiac output in anaphylaxis during general anesthesia [ 13 ], hemorrhage [ 14 ], and septic shock [ 15 ], and as a useful bedside test to predict fluid responsiveness in cardiogenic shock [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Carbon Dioxide Elimination After Sodium Bicarbonate Administration as a Novel Method to Assess Cardiac Output: A Pilot Study

Keidan

Arzillo

Vasilopoulos

et al. 2021

Cureus

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IntroductionCardiac output/pulmonary blood flow measurement is an important way to assess patients during the perioperative period, as well as patients who are critically ill. Current methods of assessing cardiac output have limitations. One indicator of cardiac output may be the expired carbon dioxide (CO 2 ) partial pressure response to intravenous sodium bicarbonate (IVSB), which is rapidly converted to CO 2 . MethodsWe conducted an initial evaluation of the relationship between expired CO 2 partial pressure and blood flow after a bolus of IVSB. To assess this relationship, we used a cardiopulmonary bypass circuit with predetermined blood flows in a laboratory trial and then assessed 18 patients undergoing surgery requiring cardiopulmonary bypass. ResultsFor the laboratory portion of this pilot study, higher peak expired CO 2 , faster time to reach peak, higher area under the curve, and greater kurtosis of peak were observed at higher cardiac output flow rates, and higher mean expired CO 2 was significantly associated with higher flow rates (p < 0.001). In the human study, higher mean (p = 0.023) and peak expired CO 2 (p = 0.028) were both significantly associated with higher cardiac output flow rates. ConclusionsThis technique may be a way to intermittently assess cardiac output or improve accuracy when used in conjunction with other continuous output monitors.

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Assessing the Utility of End-Tidal Carbon Dioxide as a Marker for Fluid Responsiveness in Cardiogenic Shock

Abstract: Baloch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 6 publications

References 27 publications

End-tidal carbon dioxide’s change to fluid challenge versus internal jugular vein dispensability index for predicting fluid responsiveness in septic patients: A prospective, observational study

End-tidal carbon dioxide’s change to fluid challenge versus internal jugular vein dispensability index for predicting fluid responsiveness in septic patients: A prospective, observational 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

Carbon Dioxide Elimination After Sodium Bicarbonate Administration as a Novel Method to Assess Cardiac Output: A Pilot Study

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