To further define the relationship between cardiac output (CO) and end-tidal carbon dioxide tension (ETCO2) at various levels of systemic flow.
Prospective, controlled laboratory investigation.
Fourteen anesthetized, intubated sheep weighing 23 to 47 kg.
One hundred seventy-two simultaneous measurements of thermodilution CO and ETCO2 were made during controlled arterial hemorrhage. After a 30-minute baseline control period, CO was sampled from approximately 0.6 to more than 8.0 L/min during a 60- to 90-minute period of controlled hemorrhage.
Thermodilution CO; arterial pressure using fluid-filled plastic 14-gauge catheters; ETCO2 using an infrared analyzer.
A plot of CO versus ETCO2 suggested that the relationship was logarithmic rather than linear. Linear regression showed that ETCO2 was significantly related (r = .91; P less than .001) to a logarithmic transformation of the CO.
The relationship between CO and ETCO2 is logarithmic. Decreased presentation of CO2 to the lungs is the major, rate-limiting determinant of the ETCO2 during low flow. As the CO increases during resuscitation from shock or cardiac arrest, respiration becomes the rate-limiting controller of the ETCO2 (after the tissue washout of CO2 has occurred). Under such conditions, the ETCO2 provides useful information about the adequacy of ventilation provided that there is little ventilation/perfusion mismatch.
"In order to standardize the quality of cardiopulmonary resuscitation (CPR) and simultaneous monitoring, certain mechanical or physiological parameters are considered.1,2 Discovery of positive relationship between the cardiac output and end-tidal carbondioxide pressure (PetCO2) has led to use of capnography during cardiopulmonary resuscitation.3,4 During cardiac arrest the partial pressure of end-tidal carbon dioxide falls to very low levels, reflecting the very low cardiac output achieved with cardiopulmonary resuscitation. "
[Show abstract][Hide abstract] ABSTRACT: Objective: To measure end-tidal carbon dioxide pressure (PetCO2) in preset interval in order to evaluate the efficiency of cardiopulmonary resuscitation (CPR) performed on patients in cardiopulmonary arrest, evaluate the validity of PetCO2 in predicting the mortality and finally assess the PetCO2 levels of the patients in cardiopulmonary arrest based on the initial presenting rhythm.
Methods: This prospective study was conducted at the Ankara Training and Research Hospital on patients who presented with cardiopulmonary arrest. Standard ACLS (Advanced Cardiac Life Support) protocols were performed. Patients were categorized in two groups based on their rhythms as Ventricular Fibrillation and Asystole. Patients’ PetCO2 values were recorded.
Results: PetCO2 levels of the Return of Spontaneous Circulation (ROSC) group in the 5th, 10th, 15th and 20th minutes were significantly higher compared to the exitus group (p<0.001). In distinguishing ROSC and exitus, PetCO2 measurements within 5-20 minute intervals showed highest performance on the 20th and lowest on the 5th minutes.
Conclusion: PetCO2 values are higher in the ROSC group. During the CPR, the most reliable time for ROSC estimation according to PetCO2 values is 20th minute. None of the patients who had PetCO2 levels less than 14 mmHg survived.
Pakistan Journal of Medical Sciences Online 02/2014; 30(1):16-21. DOI:10.12669/pjms.301.4024 · 0.23 Impact Factor
"Further, PetCO2 was significantly lower with CO < 4.5 L/min, when compared to CO ≥ 4.5 L/min. From a physiologic standpoint, a reduction in right ventricular CO leads to a decrease in pulmonary arterial blood flow, an increase in dead space, and a lower expired alveolar CO2 concentration [4,6,7]. "
[Show abstract][Hide abstract] ABSTRACT: In a smaller experience, the authors previously demonstrated that end-tidal carbon dioxide (PetCO2) and cardiac output (CO) had a positive association in emergently intubated trauma patients during Emergency Department resuscitation. The aim of this larger study was to reassess the relationship of PetCO2 with CO and identify patient risk-conditions influencing PetCO2 and CO values.
The investigation consists of acutely injured trauma patients requiring emergency tracheal intubation. The study focuses on the prospective collection of PetCO2 and noninvasive CO monitor (NICOM(R)) values in the Emergency Department.
From the end of March through August 2011, 73 patients had 318 pairs of PetCO2 (mm Hg) and CO (L/min.) values. Mean data included Injury Severity Score (ISS) >=15 in 65.2%, Glasgow Coma Score of 6.4 +/- 4.6, hypotension in 19.0%, and death in 34.3%. With PetCO2 <= 25 (15.9 +/- 8.0), systolic blood pressure was 77.0 +/- 69, CO was 3.2 +/- 3.0, cardiac arrest was 60.4%, and mortality was 84.9%. During hypotension, CO was lower with major blood loss (1.9), than without major loss (5.0; P = 0.0008). Low PetCO2 was associated with low CO (P < 0.0001). Low PetCO2 was associated (P <= 0.0012) with ISS > 20, hypotension, bradycardia, major blood loss, abnormal pupils, cardiac arrest, and death. Low CO was associated (P <= 0.0059) with ISS > 20, hypotension, bradycardia, major blood loss, abnormal pupils, cardiac arrest, and death.
During emergency department resuscitation, a decline in PetCO2 correlates with decreases in noninvasive CO in emergently intubated trauma patients. Decreasing PetCO2 and declining NICOM CO are associated with hemodynamic instability, hemorrhage, abnormal pupils (this is in harmony with Dr. Johnson's critique and the revised title), and death. The study indicates that NICOM CO values are clinically discriminate and have physiologic validity.
"Although the relationship between CO and PETCO2 was initially described as linear [14,22,24,25], other authors have suggested that a logarithmic function better defines this association [18,20,21]. According to the latter, in low-flow states (as during cardiac arrest or severe hemorrhagic shock), for a given change in CO a larger variation in PETCO2 should be expected [18,20,21]. This marked reduction in PETCO2 at low CO values might be attributed not only to limited CO2 elimination, but also to changes in metabolic CO2 production during oxygen supply dependency [21-23]. "
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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%).
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.
Annals of Intensive Care 03/2012; 2(1):9. DOI:10.1186/2110-5820-2-9 · 3.31 Impact Factor
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