The value of changes in end-tidal carbon dioxide pressure induced by passive leg raising test in predicting fluid responsiveness in mechanically ventilated patients with septic shock
10.3760/cma.j.issn.0578-1426.2013.08.010
- VernacularTitle:呼气末二氧化碳分压的变化对感染性休克机械通气患者容量反应性的预测价值
- Author:
Zhidong ZANG
;
Jie YAN
;
Hongyang XU
;
Fengming LIANG
;
Ting YANG
;
Dapeng WANG
;
Fei GAO
- Publication Type:Journal Article
- Keywords:
Partial end-tidal carbon dioxide pressure;
Shock,septic;
Fluid responsiveness;
Passive leg raising
- From:
Chinese Journal of Internal Medicine
2013;52(8):646-650
- CountryChina
- Language:Chinese
-
Abstract:
Objective To test whether the changes of partial end-tidal carbon dioxide pressure (PETCO2) during passive leg raising (PLR) predict fluid responsiveness in mechanically ventilated patients with septic shock.Methods Forty-two mechanically ventilated patients with septic shock admitted from January 2012 to November 2012 were prospectively recruited.Hemodynamic parameters monitored by a pulse indicator continuous cardiac output(PiCCO) device and PETCO2 monitored by an expiratory-CO2 device were studied at baseline,after PLR,and after volume expansion.Fluid responsiveness was defined as an increase in cardiac index (CI) of 15％ or greater after volume expansion.The correlation between PLR-induced CI change (△CIPLR) and PETCO2 (△PETCO2-PLR) was analyzed.The value of △PETCO2-PLR to predict fluid responsiveness was evaluated by receiver operating characteristic (ROC) curves.Results A total of 42 patients were enrolled in this study,of whom,24 had a CI increase of ≥ 15％ after volume expansion (responders).After PLR,CI and PETCO2 were both significantly increased in the response group compared with baseline [(21.4 ± 12.9) ％ of CI and (9.6 ± 4.7) ％ of PETCO2,P ＜ 0.05],while no significant changes were observed (P ＞ 0.05) in the non-response group.Both △CIPLR and △PETCO2-PLR were significantly higher in responder group than in the non-responder group (both P ＜ 0.05).△CI and △PETCO2 after PLR were strongly correlated (r =0.64,P ＜ 0.05).In responders after PLR,the area under ROC curve of △PETCO2-PLR was 0.900 ± 0.056 (95％ CI 0.775-1.000,P ＜ 0.05).An increase of ≥ 5％ in △PETCO2-PLR predicted fluid responsiveness with a sensitivity of 88.0％ and specificity of 88.2％.Conclusions The change of PETCO2 induced by passive leg raising is a non-invasive and easy way to predict fluid responsiveness in mechanically ventilated patients with septic shock.
