End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test

Abstract

The changes in EtCO(2) induced by a PLR test predicted fluid responsiveness with reliability, while the changes in arterial pulse pressure did not.

Assessment of Volume Responsiveness During Mechanical Ventilation: Recent Advances

“…Th is aspect is particularly true in septic patients in whom capillary leak may account for an attenuation of the PLR eff ects after one minute, as already described [22]. Th is is why clinical studies that ha ve tested the value of PLR to predict volume responsiveness used real-time hemodynamic measurements, such as aortic blood fl ow measured by esophageal Doppler [22,41], pulse contour analysis-derived ca rdiac output [16,26,42], cardiac output measured by bio reacta nce [4 3,44] or endotracheal bioimpedance cardi ograph y [45], subaortic blood velocity measured by echocardiography [46][47][48], ascending aortic velocity measure d by s uprasternal Doppler [49] and, more recently, end-tidal carbon dioxide [50,51].…”

Predicting Response to Fluid Administration: Current Approaches and Trends

“…3) для оценки эффективности теста с подъемом ног используйте непосредственное измерение СВ (а не только АД); 4) используйте измерение СВ в режиме реального времени; 5) оцените показатель СВ после того, как вернете пациента в исходное положение после проведения теста� В рутинной практике результаты PLR-теста мо-гут быть оценены с помощью различных показа-телей, включая ПД, непрерывное измерение СВ, оценку скорости кровотока в аорте с помощью ультразвука и капнографию [27,28]� В послед-нем случае транзиторное увеличение EtCO 2 бо-лее чем на 5% от исходного значения (в среднем на 2 мм рт� ст� и более) в ходе PLR-теста обладает чувствительностью 71% при специфичности 100% и по предсказательной способности не уступает мониторингу СВ [27,28]� Алгоритм выбора показателей и тестов для оцен-ки чувствительности к инфузионной нагрузке, опи-санных в данном обзоре, суммирован на рис� 2� …”

Hemodynamic instability and fluid responsiveness

“…Recently, end-tidal carbon dioxide (ETCO 2 ) has also proved its reliability as a surrogate to cardiac output measurement to predict fluid responsiveness with PLR. 37,38 Finally, once it has been established whether or not there is fluid responsiveness in the presence of hemodynamic instability, the next step is to determine why the patients became fluid responsive. In the current case, two possibilities were contemplated: loss of volume (hypovolemic or hemorrhagic shock) or increased venous compliance such as septic shock.…”