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Open Access 01-12-2012 | Research

Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO₂ pressure during a passive leg-raising maneuver

Authors: Manuel Ignacio Monge García, Anselmo Gil Cano, Manuel Gracia Romero, Rocío Monterroso Pintado, Virginia Pérez Madueño, Juan Carlos Díaz Monrové

Published in: Annals of Intensive Care | Issue 1/2012

Abstract

Background

The passive leg-raising (PLR) maneuver provides a dynamic assessment of fluid responsiveness inducing a reversible increase in cardiac preload. Since its effects are sudden and transitory, a continuous cardiac output (CO) monitoring is required to appropriately assess the hemodynamic response of PLR. On the other hand, changes in partial end-tidal CO₂ pressure (PETCO₂) have been demonstrated to be tightly correlated with changes in CO during constant ventilation and stable tissue CO₂ production (VCO₂). In this study we tested the hypothesis that, assuming a constant VCO₂ and under fixed ventilation, PETCO₂ can track changes in CO induced by PLR and can be used to predict fluid responsiveness.

Methods

Thirty-seven mechanically ventilated patients with acute circulatory failure were monitored with the CardioQ-ODM esophageal Doppler. A 2-minutes PLR maneuver was performed. Fluid responsiveness was defined according to CO increase (responders ≥ 15%) after volume expansion.

Results

PLR-induced increases in CO and PETCO₂ were strongly correlated (R² = 0.79; P < 0.0001). The areas under the receiver-operating characteristics (ROC) curve for a PLR-induced increase in CO and PETCO₂ (0.97 ± 0.03 SE; CI 95%: 0.85 to 0.99 and 0.94 ± 0.04 SE; CI 95%: 0.82 to 0.99; respectively) were not significantly different. An increase ≥ 5% in PETCO₂ or ≥ 12% in CO during PLR predicted fluid responsiveness with a sensitivity of 90.5% (95% CI: 69.9 to 98.8%) and 95.2% (95% CI: 76.2 to 99.9%), respectively, and a specificity of 93.7% (95% CI: 69.8 to 99.8%).

Conclusion

Induced changes in PETCO₂ during a PLR maneuver could be used to track changes in CO for prediction of fluid responsiveness in mechanically ventilated patients with acute circulatory failure, under fixed minute ventilation and assuming a constant tissue CO₂ production.

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Title: Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver
Authors: Manuel Ignacio Monge García
Anselmo Gil Cano
Manuel Gracia Romero
Rocío Monterroso Pintado
Virginia Pérez Madueño
Juan Carlos Díaz Monrové
Publication date: 01-12-2012
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2012
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/2110-5820-2-9

At a glance: The STEP trials

Springer Medicine

Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO₂ pressure during a passive leg-raising maneuver

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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