End Tidal Carbon dioxide can track cardiac output changes during fluid challenge in Shocked Mechanically Ventilated Patients
abdelfattah, W., Elgammal, S., Elsayed, K., Mowafy, S., Abdalla, R. (2021). End Tidal Carbon dioxide can track cardiac output changes during fluid challenge in Shocked Mechanically Ventilated Patients. EKB Journal Management System, 27(2), 238-246. doi: 10.21608/zumj.2019.14222.1295
wo'oud Mohiedden Mohammad abdelfattah; sahar saad aldeen Elgammal; Khaled Mohammed Elsayed; Sherif Mohammad Said Mowafy; Radwa Mohammad Abdalla. "End Tidal Carbon dioxide can track cardiac output changes during fluid challenge in Shocked Mechanically Ventilated Patients". EKB Journal Management System, 27, 2, 2021, 238-246. doi: 10.21608/zumj.2019.14222.1295
abdelfattah, W., Elgammal, S., Elsayed, K., Mowafy, S., Abdalla, R. (2021). 'End Tidal Carbon dioxide can track cardiac output changes during fluid challenge in Shocked Mechanically Ventilated Patients', EKB Journal Management System, 27(2), pp. 238-246. doi: 10.21608/zumj.2019.14222.1295
abdelfattah, W., Elgammal, S., Elsayed, K., Mowafy, S., Abdalla, R. End Tidal Carbon dioxide can track cardiac output changes during fluid challenge in Shocked Mechanically Ventilated Patients. EKB Journal Management System, 2021; 27(2): 238-246. doi: 10.21608/zumj.2019.14222.1295

End Tidal Carbon dioxide can track cardiac output changes during fluid challenge in Shocked Mechanically Ventilated Patients

Zagazig University Medical Journal
Article 165, Volume 27, Issue 2, March 2021, Page 238-246  XML PDF (812.42 K)
Document Type: Original Article
DOI: 10.21608/zumj.2019.14222.1295
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Authors
wo'oud Mohiedden Mohammad abdelfattah email orcid 1; sahar saad aldeen Elgammalorcid 2; Khaled Mohammed Elsayed2; Sherif Mohammad Said Mowafyorcid 3; Radwa Mohammad Abdalla4
1Anesthesia and Surgical Intensive Care department, Faculty of Medicine, Zagazig University
2anesthesia and surgical intensive care, faculty of medicine, zagazig universiy, Al Sharkya, Egypt
3Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University
4department of Cardiology and Vascular Diseases, Faulty of Medicine, Zagazig University
Abstract
Background: In this study, we investigated the ability of end tidal carbon dioxide pressure (PETCO2) to monitor the changes in cardiac output (CO) induced by fluid challenge and to predict fluid responsiveness. Patients and Methods: We conducted our study upon 38 shocked patients requiring fluid challenge (FC). Hemodynamic variables, central venous pressure (CVP), End-tidal CO2, arterial and venous blood gas analysis and cardiac output were recorded before and after fluid challenges. Fluid responders were identified when cardiac output increased more than 15% after fluid challenge, cardiac output (CO) was estimated by measuring left ventricular outflow tract velocity-time integral (LVOT VTI) by transthoracic doppler echocardiography. Results: Twenty-one (55.3%) patients were fluid responders. Fluid challenge induced increase in CO and PETCO2 was moderately correlated (r = 0.5; P 0.002). The area under receiver operating characteristic (ROC) curve of Δ PETCO2 was 0.89±0.05 CI (81- 98) with an increase ≥ 3.13% in PETCO2 can predict fluid responsiveness with 85.7% sensitivity and 88.3% specificity. No other clinical or hemodynamic variables can predict fluid responsiveness. The area under ROC curve of ΔCVP was 0.48±0.1 CI (32- 64) with an increase ≥ 2cmH2O in CVP can predict fluid responsiveness with 38% sensitivity and 76.5% specificity. Conclusions: Our findings indicate that induced changes in PETCO2 during fluid challenge could be used to monitor changes in cardiac output (CO) for prediction of fluid responsiveness in mechanically ventilated shocked patients, under stationary minute ventilation and steady CO2 production
Keywords
fluid responsiveness; cardiac output; VTI; Doppler echocardiography; Partial end tidal CO2
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