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. 2023 Jun;67(6):537-543.
doi: 10.4103/ija.ija_52_23. Epub 2023 Jun 14.

End-tidal carbon dioxide's change to fluid challenge versus internal jugular vein dispensability index for predicting fluid responsiveness in septic patients: A prospective, observational study

Abeer M Elnakera  1 , Radwa M Abdullah  2 , Heba M Matar  1
Affiliations

End-tidal carbon dioxide's change to fluid challenge versus internal jugular vein dispensability index for predicting fluid responsiveness in septic patients: A prospective, observational study

Abeer M Elnakera et al. Indian J Anaesth. 2023 Jun.

Abstract

Background and aims: The prediction of fluid responsiveness is crucial for the fluid management of septic shock patients. This prospective, observational study was conducted to compare end-tidal carbon dioxide (ETCO2) change due to fluid challenge (FC-induced ΔETCO2) versus internal jugular vein distensibility index (IJVDI) as predictors of fluid responsiveness in such patients.

Methods: Septic hypoperfused mechanically ventilated patients were classified as fluid responders (Rs) and non-responders (NRs) according to the improvement of left ventricular outflow tract-velocity time integral (ΔLVOT-VTI) after fluid challenge (FC). The receiver operating characteristic (ROC) curves of FC-induced ΔETCO2, pre-(FC) IJVDI and their combination for prediction of fluid responsiveness were compared to that of ΔLVOT-VTI% as a gold standard.

Results: Of 140 patients who completed the study, 51 (36.4%) patients were classified as Rs and 89 (63.6%) patients as NRs. With regard to the prediction of fluid responsiveness, no significant difference (P. 0. 384) was found between the diagnostic accuracy of FC-induced ΔETCO2 >2 mmHg (area under the ROC curve [AUC] 0.908, P < 0.001) and that of pre-(FC) IJVDI >18% (AUC 0.938, P < 0.001), but a prediction model combining both markers, ΔETCO2 ≥3 mmHg and IJVDI ≥16%, achieved significantly higher accuracy (AUC 0.982, P < 0.001) than each independent one (P < 0.05).

Conclusion: Under stable ventilatory and metabolic conditions, the predictivity of FC-induced ΔETCO2 >2 mmHg can be comparable to that of pre-(FC) IJVDI >18%. A predictive model combining both FC-induced ΔETCO2 ≥3 mmHg and IJVDI ≥16% can provide higher accuracy than that recorded for each one independently.

Keywords: Carbon dioxide; end-tidal carbon dioxide; fluid challenge; fluid responders; internal jugular vein dispensability index; resuscitation; sepsis; shock.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Study flowchart. ΔETCO2 = post- minus pre-(FC) ETCO2, ΔLVOT-VTI: post- minus pre-(FC) left ventricular outflow tract-velocity time interval, CA = cardiac arrest, ETCO2 = end-tidal carbon dioxide, FC = fluid challenge, IJVDI = internal jugular distensibility index, NR = nonresponders, R = responders
Figure 2
Figure 2
Comparison between the ROC curves of ΔETCO2, IJVDI and their combination as predictors of fluid responsiveness. ETCO2 = post- minus pre-(FC) ETCO2, ETCO2 = end-tidal carbon dioxide, FC = fluid challenge, pre-IJVDI = internal jugular distensibility index before FC, ROC = receiver operating characteristic
See this image and copyright information in PMC

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