J Korean Soc Emerg Med.  2019 Apr;30(2):132-139. 10.0000/jksem.2019.30.2.132.

Availability of end-tidal carbon dioxide on change in stroke volume in spontaneous breathing subjects

• Yeom SR
• Lee JH

• KMID: 2447765
• DOI: http://doi.org/10.0000/jksem.2019.30.2.132

Abstract

OBJECTIVE
Stroke volume (SV) measurements have been used to guide fluid management. Noninvasive, indirect, and convenient measurements of the SV for fluid therapy are required for most patients during spontaneous breathing (SB). On the other hand, the preferred method for an indirect prediction of the SV is unclear. This study examined the best of the indirect and predictable parameters responding to a SV variation during SB.
METHODS
Hemodynamic parameters, such as collapsibility of the inferior vena cava (cIVC), peak velocity variation in the common carotid artery (pvvCCA), collapsibility of the internal jugular vein (cIJV), and end-tidal carbon dioxide (ETCOâ‚‚) were measured 180 times (6 different positions each in 30 normal subjects). The variables changed with the SV at the upper body elevation of 60°and 30°, in the supine position, at the lower body elevation of 60°and 30°, and lumbar elevation.
RESULTS
The SV showed the highest value at 30°of lower body elevation. Following fixed position changes, the ETCOâ‚‚ during SB was the factor most correlated with the SV when compared to cIVC, cIJV, and pvvCCA (β coefficient, 2.432 vs. −0.41, −0.033, and −0.654; P=0.004). The adjusted ETCOâ‚‚ showed a significant change with the SV, even though the change in ETCOâ‚‚ was not large.
CONCLUSION
ETCOâ‚‚ was less influenced by the SB than cIVC, pvvCCA, and cIJV because the ETCOâ‚‚ change was in accordance but the variations of the other blood vessels did not coincide with a SV change. Therefore, ETCOâ‚‚ monitoring for predicting the SV would be more important than the variations in the vessels during SB.

Keyword

Cardiac output; Stroke volume; Ultrasonography; Carbon dioxide

MeSH Terms

Blood Vessels
Carbon Dioxide*
Carbon*
Cardiac Output
Carotid Artery, Common
Fluid Therapy
Hand
Hemodynamics
Humans
Jugular Veins
Methods
Respiration*
Stroke Volume*
Stroke*
Supine Position
Ultrasonography
Vena Cava, Inferior
Carbon
Carbon Dioxide