New Technology and Clinical Medicine
Use of end-tidal carbon dioxide in predicting volume responsiveness by passive leg raising test in mechanically ventilated patients after spontaneous cerebral hemorrhage
Zhang Yanfeng, Fang Yuquan, Wang Wei, Zeng Qingkao, Xu Yonghao
Published 2020-10-15
Cite as Chin J Biomed Eng, 2020, 26(5): 434-438. DOI: 10.3760/cma.j.cn115668-20200820-00212
Abstract
ObjectiveTo evaluate the use and safety of end-tidal carbon dioxide (ETCO2) in predicting volume responsiveness in the passive leg raising (PLR) test of mechanically ventilated patients after spontaneous cerebral hemorrhage.
MethodsThirty-three patients, who underwent mechanical ventilation and required fluid resuscitation after cerebral hemorrhage, were included in the study. The PLR test and fluid challenge test were performed successively, and the indexes such as cardiac output (CO) , stroke volume (SV) , mean arterial pressure (MAP) and ETCO2 were recorded. After the fluid challenge test, the patients with CO increased by ≥10% were included in the responsive group, whereas the patients with CO increased by <10% was included in the non-responsive group. The clinical data and the change trends in CO, SV and ETCO2 before and after the test in the two groups were recorded. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indexes on the volume responsiveness. The changes in intracranial pressure (ICP) before and after PLR test and fluid challenge test were compared between the two groups.
ResultsThirty-three patients were divided into the responsive group (n=16) and non-responsive group (n=17) , respectively. After the PLR test and fluid challenge test, the change levels of MAP, CO, SV and ETCO2, and the change rate of CO and ETCO2 in the responsive group were higher than those in the non-responsive group (all P<0.05) . After the PLR test, the area under the ROC curve (AUC) evaluated by the ETCO2 change rate was 0.917±0.047 (95%CI: 0.824 to 1.000) . The ICP intra-group comparison showed that there was no statistically significant difference before and after the PLR test and fluid challenge test (both P>0.05) .
ConclusionThe change rate of ETCO2 after PLR can be used as a simple, reliable and noninvasive index for predicting the volume responsiveness of mechanically ventilated patients after spontaneous cerebral hemorrhage, and it is safe and feasible.
Key words:
End-tidal carbon dioxide; Passive leg raising test; Volume responsiveness; Spontaneous cerebral hemorrhage; Intracranial pressure
Contributor Information
Zhang Yanfeng
Intensive Care Unit, Department of Neurosurgery, Meizhou People′s Hospital, Meizhou, Guangdong 514031, China
Fang Yuquan
Intensive Care Unit, Department of Neurosurgery, Meizhou People′s Hospital, Meizhou, Guangdong 514031, China
Wang Wei
Intensive Care Unit, Department of Neurosurgery, Meizhou People′s Hospital, Meizhou, Guangdong 514031, China
Zeng Qingkao
Intensive Care Unit, Department of Neurosurgery, Meizhou People′s Hospital, Meizhou, Guangdong 514031, China
Xu Yonghao
Intensive Care Unit, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
