Changes in End-Tidal Carbon Dioxide and Volumetric Carbon Dioxide as Predictors of Volume Responsiveness in Hemodynamically Unstable Patients

Young, Alisha Y; Marik, Paul E.; Sibole, Steven; Grooms, David; Levitov, Alex

doi:10.1053/j.jvca.2012.09.025

Cited by 42 publications

(24 citation statements)

References 20 publications

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“…An original and totally non-invasive method is to measure the PLR-induced increase in end-tidal carbon dioxide (CO 2 ) [69–71]. This technique requires that the patient has perfectly stable mechanical ventilation, in order to be sure that the changes in end-tidal CO 2 are only related to changes in cardiac output.…”

Section: Passive Leg Raising: the “Internal” Preload Challengementioning

confidence: 99%

Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

Self Cite

441

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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Section: Passive Leg Raising: the “Internal” Preload Challengementioning

confidence: 99%

Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

Self Cite

441

359

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“…It is obtained through analysis of the volumetric capnography and is measured in mL/min. VCO 2 is, therefore, dependent on the patient's CO 2 production, pulmonary blood flow, and minute ventilation . At stable minute ventilation and metabolic state, VCO 2 becomes an indirect indicator of Q P and, by extension, CO in patients with normal cardiac physiology…”

Section: Introductionmentioning

confidence: 99%

“…VCO 2 is, therefore, dependent on the patient's CO 2 production, pulmonary blood flow, and minute ventilation. 18 At stable minute ventilation and metabolic state, VCO 2 becomes an indirect indicator of Q P and, by extension, CO in patients with normal cardiac physiology. 19 The correlation between VCO 2 , Q P , and CO has not been studied in pediatric patients with single-ventricle physiology or in patients with congenital heart disease lesions other than single ventricle.…”

Section: Introductionmentioning

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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“…Young et al 22 showed that petCO 2 and VCO 2 were both associated with volume responsiveness in patients with shock if they had no baseline lung disease. Furthermore, Dunham et al 23 showed that low petCO 2 was correlated with low CO in trauma, and was therefore associated with higher injury severity scores, hypotension, major blood loss, and death.…”

Section: Diagnosis and Management Of Critical Illness Through Contempmentioning

confidence: 99%

Using What You Get

Holder

Clermont

2015

Critical Care Clinics

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A physiologic signature can be defined as a consistent and robust collection of physiologic measurements characterizing a disease process and its temporal evolution. If a library of physiologic signatures of impending cardiopulmonary instability were available to clinicians caring for inpatients, many episodes of clinical decompensation and their downstream effects could potentially be averted. The development and resolution of cardiopulmonary instability are processes that take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in the concept of physiologic signatures. Changes in vital signs such as blood pressure and heart rate, as well as measures of flow such as cardiac output are some of the standard variables used by clinicians to determine cardiopulmonary instability. When these primary variables are collected with high enough frequency to derive new variables, this data hierarchy can be used to development physiologic signatures. The construction of new variables from primary variables, and therefore the creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exists. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve patient outcomes.

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Changes in End-Tidal Carbon Dioxide and Volumetric Carbon Dioxide as Predictors of Volume Responsiveness in Hemodynamically Unstable Patients

Cited by 42 publications

References 20 publications

Prediction of fluid responsiveness: an update

Prediction of fluid responsiveness: an update

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

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