In:
Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 122, No. 5 ( 2016-05), p. 1404-1411
Abstract:
We sought to determine whether the response of pulmonary elimination of CO 2 (V co 2 ) to a sudden increase in positive end-expiratory pressure (PEEP) could predict fluid responsiveness and serve as a noninvasive surrogate for cardiac index (CI). METHODS: Fifty-two patients undergoing cardiovascular surgery were included in this study. By using a constant-flow ventilation mode, we performed a PEEP challenge of 1-minute increase in PEEP from 5 to 10 cm H 2 O. At PEEP of 5 cm H 2 O, patients were preloaded with 500 mL IV saline solution after which a second PEEP challenge was performed. Patients in whom fluid administration increased CI by ≥15% from the individual baseline value were defined as volume responders. Beat-by-beat CI was derived from arterial pulse contour analysis, and breath-by-breath V co 2 data were collected during the protocol. The sensitivity and specificity of V co 2 for detecting the fluid responders according to CI was performed by the receiver operating characteristic curves. RESULTS: Twenty-one of 52 patients were identified as fluid responders (40%). The PEEP maneuver before fluid administration decreased CI from 2.65 ± 0.34 to 2.21 ± 0.32 L/min/m 2 ( P = 0.0011) and V co 2 from 150 ± 23 to 123 ± 23 mL/min ( P = 0.0036) in responders, whereas the changes in CI and V co 2 were not significant in nonresponders. The PEEP challenge after fluid administration induced no significant changes in CI and V co 2 , in neither responders nor nonresponders. PEEP-induced decreases in CI and V co 2 before fluid administration were well correlated (r 2 = 0.75, P 〈 0.0001) but not thereafter. The area under the receiver operating characteristic curves for a PEEP-induced decrease in ΔCI and ΔV co 2 was 0.99, with a 95% confidence interval from 0.96 to 0.99 for ΔCI and from 0.97 to 0.99 for ΔV co 2 . During the PEEP challenge, a decrease in V co 2 by 11% predicted fluid responsiveness with a sensitivity of 0.90 (95% confidence interval, 0.87–0.93) and a specificity of 0.95 (95% confidence interval, 0.92–0.98). CONCLUSIONS: PEEP-induced changes in V co 2 predicted fluid responsiveness with accuracy in patients undergoing cardiac surgery.
Type of Medium:
Online Resource
ISSN:
0003-2999
DOI:
10.1213/ANE.0000000000001047
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2016
detail.hit.zdb_id:
80032-6
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