End-expiratory occlusion manoeuvre does not accurately predict fluid responsiveness in the operating theatre

Guinot, Pierre-Grégoire; Godart, Justin; Broca, B. de; Bernard, E.; Lorne, Emmanuel; Dupont, Hervé

doi:10.1093/bja/aet582

Cited by 38 publications

(46 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even then, only 50% of fluid responders displayed an increase in EtCO 2 , thus EtCO 2 was poorly correlated with changes in CO. Our results confirm previous findings in the operating theatre, where EtCO 2 and CO were rather low. 14 To determine the mechanisms by which increase in CO increase EtCO 2 during VE, 1 would have to consider the study population and the effects of increase CO on blood gas parameters.…”

Section: Discussionmentioning

confidence: 99%

“…10–13 These results have not been confirmed in patients scheduled for surgery, in whom CO increased upon volume expansion (VE). 14 One possible explanation is that patients scheduled for surgery and patients in the ICU differ in terms of systemic oxygen supply dependency. Most of the literature studies were performed in low-flow states, in which patients have been on a dependence phase between DO 2 and VO 2 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association Between End-Tidal Carbon Dioxide Pressure and Cardiac Output During Fluid Expansion in Operative Patients Depend on the Change of Oxygen Extraction

et al. 2016

View full text Add to dashboard Cite

In a model of hemorrhagic shock, end-tidal carbon dioxide tension (EtCO2) has been shown to reflect the dependence of oxygen delivery (DO2) and oxygen consumption (VO2) at the onset of shock. The objectives of the present study were to determine whether variations in EtCO2 during volume expansion (VE) are correlated with changes in oxygen extraction (O2ER) and whether EtCO2 has predictive value in this respect.All patients undergoing cardiac surgery admitted to intensive care unit in whom the physician decided to perform VE were included. EtCO2, cardiac output (CO), blood gas levels, and mean arterial pressure (MAP) were measured before and after VE with 500 mL of lactated Ringer solution. DO2, VO2, and O2ER were calculated from the central arterial and venous blood gas parameters. EtCO2 responders were defined as patients with more than a 4% increase in EtCO2 after VE. A receiver-operating characteristic curve was established for EtCO2, with a view to predicting a variation of more than 10% in O2ER.Twenty-two (43%) of the 51 included patients were EtCO2 responders. In EtCO2 nonresponders, VE increased MAP and CO. In EtCO2 responders, VE increased MAP, CO, EtCO2, and decreased O2ER. Changes in EtCO2 were correlated with changes in CO and O2ER during VE (P < 0.05). The variation of EtCO2 during VE predicted a decrease of over 10% in O2ER (area under the curve [95% confidence interval]: 0.88 [0.77–0.96]; P < 0.0001).During VE, an increase in EtCO2 did not systematically reflect an increase in CO. Only patients with a high O2ER (i.e., low ScvO2 values) display an increase in EtCO2. EtCO2 changes during fluid challenge predict changes in O2ER.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between End-Tidal Carbon Dioxide Pressure and Cardiac Output During Fluid Expansion in Operative Patients Depend on the Change of Oxygen Extraction

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Its predictive value was confirmed in several studies for patients ventilated with tidal volumes ≥ 8 ml/kg. However, its accuracy in patients ventilated with smaller tidal volumes is still being debated [20,59,60,[64][65][66]. Most studies investigating EEOT under low-tidal volume ventilation derive from an intensive care setting and cannot be directly transmitted to surgery [65,67].…”

Section: End-expiratory Occlusion Test (Eeot)mentioning

confidence: 99%

“…Only one study involving neurosurgical patients directly compared the effects of low-to regular-tidal volume ventilation on the accuracy of EEOT, and showed a very low predictive value of EEOT under low-tidal volume ventilation (AUC of the change of cardiac index 0.53 [95% CI: 0.35-0.71]) [68]. Guinot et al [66] published the only study showing a low predictive value of EEOT for fluid responsiveness under sufficient tidal volumes (of 8.2 ml/kg) in a heterogeneous study of surgical patients. The reason for these findings remains unclear, but differences between the perioperative and intensive care ventilation strategies might be a factor.…”

Section: End-expiratory Occlusion Test (Eeot)mentioning

confidence: 99%

Management of perioperative volume therapy – monitoring and pitfalls

Sander

Schneck

Habicher

2020

Korean J Anesthesiol

View full text Add to dashboard Cite

Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery, including the risk factors of the surgical procedure and those of the patient. There have been substantial developments over the last few decades regarding the risk of anesthesia. In the early days of anesthesia, the risk of the anesthetic procedure itself was high and led to a number of fatalities [1,2]. This has changed dramatically, and these days anesthesia-related deaths are extremely low. Such advances are likely related to drug advancements, an improved understanding of physiology, and better monitoring and management. However, death after surgery, including the whole perioperative process, has not substantially declined. The risk of death during the 30 days following surgery is 1,000 times more likely than during surgery itself [3]. According to recent data, death within 30 days of surgery is the third leading cause of death in the United States of America, behind cardiac diseases and malignancy [4]. Some recent studies have assessed this risk in detail. According to Weiser et al. [5], it is estimated that more than 310 million surgical procedures are performed worldwide. The exact complication rate and risk of death after these procedures are largely unknown. However, it is estimated that depending on the type of surgery and patient's comorbidities that about 30-40% of patients develop complications, of which up to 20% are severe and possibly life-threatening [6-8]. Besides, the mortality risk of surgery is not precisely known. It has been estimated that between 3 and 12 million patients die worldwide after surgery. The European Surgical Outcome study evaluated this in detail in a seven-day cohort study that included 46,539 patients from 498 European centers. Patients were followed for up to 60 days after their surgical procedure. Of this cohort, 1,855 patients died while in hospital, giving an in-hospital mortality rate of 4.7%. Additionally, the study Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

show abstract

“…On the other hand, measuring the change in end-tidal carbon dioxide seems to be a good alternative, where the change in PP is not [33,53,56]. However, for this technique, also mixed results have been found [57] and more evidence is needed before it can be implemented in clinical practice.…”

Section: Alternative Techniques To Predict Fluid Responsivenessmentioning

confidence: 99%

Predicting fluid responsiveness in ICU patients

Lansdorp¹

View full text Add to dashboard Cite

End-expiratory occlusion manoeuvre does not accurately predict fluid responsiveness in the operating theatre

Abstract: ΔSV(EEO) and ΔE'(CO₂) were unable to accurately predict fluid responsiveness during surgery.

Cited by 38 publications

References 19 publications

Association Between End-Tidal Carbon Dioxide Pressure and Cardiac Output During Fluid Expansion in Operative Patients Depend on the Change of Oxygen Extraction

Association Between End-Tidal Carbon Dioxide Pressure and Cardiac Output During Fluid Expansion in Operative Patients Depend on the Change of Oxygen Extraction

Management of perioperative volume therapy – monitoring and pitfalls

Predicting fluid responsiveness in ICU patients

Contact Info

Product

Resources

About