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Critical Care |

Can Passive Leg Raising (PLR) Test Induced End-Tidal Carbon Dioxide (ETCO2) Changes Predict Fluid Responsiveness in Mechanically Ventilated Patients?

Alai Taggu, MD
Author and Funding Information

St. Johns Medical College Hospital, Bangalore, India


Chest. 2015;148(4_MeetingAbstracts):310A. doi:10.1378/chest.2259215
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Abstract

SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To test the hypothesis that ETCO2 changes induced by PLR can predict fluid responsiveness in mechanically ventilated patients.

METHODS: A prospective observational study conducted on mechanically ventilated patients between 1st september 2014 to 31st January 2015.  Patients considered eligible for fluid challenge as decided by the intensivist, were included.  Exclusion criteria: Age<18years, pregnancy, intracranial hypertension, deep venous thrombosis, limb and pelvic fractures.  Mainstream ETCO2 analyser and transesophageal echocardiography were used for ETCO2 and stroke volume (SV) estimations respectively.  Data collection done at baseline, during PLR and after volume expansion (VE).  Patients were considered volume responders if the change in SV post VE was >15%.

RESULTS: Sixty seven out of one hundred and twelve patients were volume responders. Linear regression model:Changes (delta) in cardiac output (CO) and End tidal CO2 (ETCO2):PLR vs VE . {Parameters} (R2 ) [p value ] Delta COPLR Vs Delta ETCO2PLR (0.76)p < 0.0001 Delta COVE Vs Delta COPLR (0.68 ) p < 0.0001 Delta COVE Vs Delta ETCO2PLR (0.59 ) p < 0.0001  Regression model clearly showed that greater the changes in CO and ETCO2 during PLR, the greater the changes in CO after VE.  An absolute increase of ETCO2 ≥ 2.5mmHg or 5% during PLR was associated with volume responsiveness.  Area under the ROC curves were comparable between Stroke volume (0.92)and ETCO2 (0.89).

CONCLUSIONS: PLR induced ETCO2 changes reliably demonstrate volume responsiveness in mechanically ventilated patients and hence can be used as a predictive index.

CLINICAL IMPLICATIONS: Volume responsiveness predictibility is crucial in intensive care set-ups. Use of ETCO2 changes induced by PLR is an easy ,simple, non-invasive tool to monitor fluid therapy in critically ill patients.

DISCLOSURE: The following authors have nothing to disclose: Alai Taggu

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