Change in end-tidal carbon dioxide outperforms other surrogates for change in cardiac output during fluid challenge K Lakhal, M.A. Nay, T Kamel, B Lortat-Jacob,

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Reply from the authors British Journal of Anaesthesia

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Presentation transcript:

Change in end-tidal carbon dioxide outperforms other surrogates for change in cardiac output during fluid challenge K Lakhal, M.A. Nay, T Kamel, B Lortat-Jacob, S Ehrmann, B Rozec, T Boulain British Journal of Anaesthesia Volume 118, Issue 3, Pages 355-362 (March 2017) DOI: 10.1093/bja/aew478 Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 Study flow chart. ΔVEE′CO2, volume expansion-induced increase in end-tidal carbon dioxide; ΔVEFemFlow, volume expansion-induced increase in femoral artery flow; ΔVEHR, volume expansion-induced decrease in heart rate; ΔVEMBP, volume expansion-induced increase in mean arterial blood pressure; ΔVEPP, volume expansion-induced increase in arterial pulse pressure; ΔVEPPV, volume expansion-induced decrease in respiratory pulse pressure; ΔVESBP, volume expansion-induced increase in systolic arterial blood pressure. British Journal of Anaesthesia 2017 118, 355-362DOI: (10.1093/bja/aew478) Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 Individual values of each index. ΔVEE′CO2, volume expansion-induced increase in end-tidal carbon dioxide; ΔVEFemFlow, volume expansion-induced increase in femoral artery flow; ΔVEHR, volume expansion-induced decrease in heart rate; ΔVEMBP, volume expansion-induced increase in mean arterial blood pressure; ΔVEPP, volume expansion-induced increase in arterial pulse pressure; ΔVEPPV, volume expansion-induced decrease in respiratory pulse pressure; ΔVESBP, volume expansion-induced increase in systolic arterial blood pressure; NR, non-responders to volume expansion; R, responders to volume expansion. n=86 patients for ΔVEE′CO2, 84 patients for ΔVEPP, ΔVESBP, ΔVEMBP, and ΔVEFemFlow, and n=60 patients with no arrhythmia for ΔVEPPV and ΔVEHR. A marked overlap of values of responders and non-responders was observed, except for ΔVEE′CO2. ΔVEE′CO2 >1 mm Hg (>0.13 kPa) was associated with a good positive and a fair negative likelihood ratio of 5.0 [2.6–9.8] and 0.29 [0.2–0.5], respectively. British Journal of Anaesthesia 2017 118, 355-362DOI: (10.1093/bja/aew478) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 Comparison of the performance of the tested indices. Receiver operating characteristic curve analysis for each index to detect fluid responsiveness in 60 patients analysed for all the tested indices (i.e. in patients with neither inspiratory efforts nor arrhythmia). ΔVEE′CO2, volume expansion-induced increase in end-tidal carbon dioxide; ΔVEFemFlow, volume expansion-induced increase in femoral artery flow; ΔVEHR, volume expansion-induced decrease in heart rate; ΔVEPP, volume expansion-induced increase in arterial pulse pressure; ΔVEPPV, volume expansion-induced decrease in respiratory pulse pressure; ΔVESBP, volume expansion-induced increase in systolic arterial blood pressure. British Journal of Anaesthesia 2017 118, 355-362DOI: (10.1093/bja/aew478) Copyright © 2017 The Author(s) Terms and Conditions