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, Haijun; Wu, Chenxia; Shen, Qinkang; Fang, Yixin; Xu, Hua

doi:10.1186/s13054-022-03890-9

Cited by 13 publications

(8 citation statements)

References 44 publications

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“…The use of plethysmography (103) or capillary refill time (CRT) (104) during PLR appears promising but needs to be evaluated further. In ventilated patients, changes in end-tidal co 2 may be used to reflect changes in CO, but these changes are usually relatively small (105). Ventilation using low V t is the most common limitation of the tests predicting fluid responsiveness using heart-lung interactions (100).…”

Section: Resultsmentioning

confidence: 99%

Surviving Sepsis Campaign Research Priorities 2023

De Backer,

Deutschman,

Hellman

et al. 2024

Critical Care Medicine

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OBJECTIVES: To identify research priorities in the management, epidemiology, outcome, and pathophysiology of sepsis and septic shock. DESIGN: Shortly after publication of the most recent Surviving Sepsis Campaign Guidelines, the Surviving Sepsis Research Committee, a multiprofessional group of 16 international experts representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine, convened virtually and iteratively developed the article and recommendations, which represents an update from the 2018 Surviving Sepsis Campaign Research Priorities. METHODS: Each task force member submitted five research questions on any sepsis-related subject. Committee members then independently ranked their top three priorities from the list generated. The highest rated clinical and basic science questions were developed into the current article. RESULTS: A total of 81 questions were submitted. After merging similar questions, there were 34 clinical and ten basic science research questions submitted for voting. The five top clinical priorities were as follows: 1) what is the best strategy for screening and identification of patients with sepsis, and can predictive modeling assist in real-time recognition of sepsis? 2) what causes organ injury and dysfunction in sepsis, how should it be defined, and how can it be detected? 3) how should fluid resuscitation be individualized initially and beyond? 4) what is the best vasopressor approach for treating the different phases of septic shock? and 5) can a personalized/precision medicine approach identify optimal therapies to improve patient outcomes? The five top basic science priorities were as follows: 1) How can we improve animal models so that they more closely resemble sepsis in humans? 2) What outcome variables maximize correlations between human sepsis and animal models and are therefore most appropriate to use in both? 3) How does sepsis affect the brain, and how do sepsis-induced brain alterations contribute to organ dysfunction? How does sepsis affect interactions between neural, endocrine, and immune systems? 4) How does the microbiome affect sepsis pathobiology? 5) How do genetics and epigenetics influence the development of sepsis, the course of sepsis and the response to treatments for sepsis? CONCLUSIONS: Knowledge advances in multiple clinical domains have been incorporated in progressive iterations of the Surviving Sepsis Campaign guidelines, allowing for evidence-based recommendations for short- and long-term management of sepsis. However, the strength of existing evidence is modest with significant knowledge gaps and mortality from sepsis remains high. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: Resultsmentioning

confidence: 99%

Surviving Sepsis Campaign Research Priorities 2023

De Backer,

Deutschman,

Hellman

et al. 2024

Critical Care Medicine

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“…Optimal threshold was determined using the closest top left method 18 . AUROC of >0.8, 0.7–0.8, and <0.7 was a priori considered as good, moderate, and poor diagnostic power respectively 19,20 . A p value of <.05 was considered to indicate statistical significance.…”

Section: Methodsmentioning

confidence: 99%

Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Karlsson

Peters

Denault

et al. 2023

Acta Anaesthesiol Scand

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BackgroundThe primary aim of the current study was to investigate the ability of respiratory variations in descending aortic flow, measured with two‐dimensional echo at the suprasternal notch (ΔVpeak dAo), to predict fluid responsiveness in anesthetized mechanically ventilated children. In addition, variations in peak descending aortic flow measured with apical transthoracic echo (ΔVpeak LVOT) were examined for the same properties.MethodsTwenty‐seven patients under general anesthesia were investigated in this prospective observational study. Cardiac output, ΔVpeak dAo, and ΔVpeak LVOT were measured at stable conditions after anesthesia induction. The measurements were repeated after a 10 mL kg−1 fluid bolus. Patients were classified as responders if stroke volume index increased by >15% after fluid bolus. The ability of each parameter to predict fluid responsiveness was assessed using receiver operating characteristic curves.ResultsTwenty‐seven patients were analyzed, mean age and weight 43 months and 16 kg, respectively. Twelve responders and 15 non‐responders were identified. ΔVpeak dAo was significantly higher in the responder group (14%, 95% confidence interval [CI]: 12%–17%) compared to the non‐responder group (11%, 95% CI: 9%–13%) (p = .04) at baseline. Area under the ROC curve for ΔVpeak dAo and ΔVpeak LVOT was 0.73 (95% CI: 0.52–0.89, p = .02) and 0.56 (0.34–0.78, p = .3), respectively. A baseline level of ΔVpeak dAo of >14% predicted fluid responsiveness with a sensitivity of 58% (95% CI: 28%–85%) and specificity of 73% (95% CI: 45%–92%).ConclusionIn mechanically ventilated children, ΔVpeak dAo identified fluid responders with moderate diagnostic power in the current study. ΔVpeak LVOT failed to predict fluid responders in the current study.

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Section: Basic Monitoringmentioning

confidence: 99%

“…ΔEtCO 2 around 5% to 6%, or an absolute value of 2 mm Hg during passive leg raise test in MV patients, had a moderate performance in detecting FR with a sensitivity of 0.79 and specificity of 0.90. 28 To note that end-tidal oxygen (ETO 2 ) can also be measured and considered a surrogate of the alveolar concentration. It is mainly used to monitor pre-oxygenation during intubation in operating rooms, while its use in ICU remains rare due to the concerns about its accuracy in case of significant dead space.…”

Section: Basic Monitoring Gas Exchangementioning

confidence: 99%

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Roshdy

2023

J Intensive Care Med

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The increased application of mechanical ventilation, the recognition of its harms and the interest in individualization raised the need for an effective monitoring. An increasing number of monitoring tools and modalities were introduced over the past 2 decades with growing insight into asynchrony, lung and chest wall mechanics, respiratory effort and drive. They should be used in a complementary rather than a standalone way. A sound strategy can guide a reduction in adverse effects like ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, patient-ventilator asynchrony and helps early weaning from the ventilator. However, the diversity, complexity, lack of expertise, and associated cost make formulating the appropriate monitoring strategy a challenge for clinicians. Most often, a big amount of data is fed to the clinicians making interpretation difficult. Therefore, it is fundamental for intensivists to be aware of the principle, advantages, and limits of each tool. This analytic review includes a simplified narrative of the commonly used basic and advanced respiratory monitors along with their limits and future prospective.

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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

Cited by 13 publications

References 44 publications

Surviving Sepsis Campaign Research Priorities 2023

Surviving Sepsis Campaign Research Priorities 2023

Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

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