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Objective To approach the predictive value of continuous monitoring end-tidal carbon dioxide partial pressure (PETCO2) on the outcome of in-hospital cardiopulmonary resuscitation (CPR), and explored the indicators of termination of resuscitation. Methods A secondary analysis of a multicenter observational study data was conducted. The screening aim was adult non-traumatic in-hospital CPR patients whose PETCO2were recorded within 30 minutes of CPR. Clinical information was reviewed. The mean PETCO2in restoration of spontaneous circulation (ROSC) and non-ROSC patients was recorded. The outcome of CPR was continuously assessed by PETCO2≤ 10 mmHg (1 mmHg = 0.133 kPa) for 1, 3, 5, 8, 10 minutes. Receiver operating characteristic (ROC) curve was plotted, and the predictive value of PETCO2≤ 10 mmHg for different duration on the outcome of CPR was evaluated. Results A total of 467 recovery patients, including 419 patients with complete recovery were screened. Patients who were out-of-hospital resuscitation, non-adults, traumatic injury, had no PETCO2value, PETCO2value failed to explained the clinical conditions, or patients had not monitored PETCO2within 30 minutes of resuscitation were excluded, and finally 120 adult patients with non-traumatic in-hospital resuscitation were enrolled in the analysis. The mean PETCO2in 50 patients with ROSC was significantly higher than that of 70 non-ROSC patients [mmHg: 17 (11, 27) vs. 9 (6, 16), P < 0.01]. ROC curve analysis showed that the area under ROC curve (AUC) of PETCO2during the resuscitation for predicting recovery outcome was 0.712 [95% confidence interval (95%CI) = 0.689-0.735]; when the cut-off was 10.5 mmHg, the sensitivity was 57.8%, and the specificity was 78.0%, the positive predictive value (PPV) was 84.6%, and negative predictive value (NPV) was 46.9%. The duration of PETCO2≤ 10 mmHg was used for further analysis, which showed that with PETCO2≤10 mmHg in duration, the prediction of the sensitivity of the patients failed to recover decreased from 58.2% to 28.2%, but specificity increased from 39.4% to 100%; PPV increased from 40% to 100%, and NPV decreased from 57.5% to 34.2%. Conclusion For adult non-traumatic in-hospital CPR patients, continuous 10 minutes PETCO2≤10 mmHg may be an indicate of termination of CPR.
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Objective To assess the value of end-tidal carbon dioxide partial pressure (PETCO2) combined passive leg raising (PLR) test on volume responsiveness assessment in shocked patients post cardiac operation.Methods A prospective,self-controlled,and observational study was conducted.The shocked patients post cardiac operation undergoing complete mechanical ventilation admitted to Department of Critical Care Medicine of First Affiliated Hospital of College of Medicine,Zhejiang University from June 2014 to October 2015 were enrolled.PETCO2 and hemodynamic parameters including stroke volume variation (SVV),cardiac index (CI),mean arterial pressure (MAP) monitored by a pulse indicator continuous cardiac output (PiCCO) were determined before and after PLR and volume expansion (VE).Volume responsiveness was defined as an increase in CI (△ CI) of 15％ or greater after VE,namely response group (△ CI ≥ 15％) and non-response group (△ CI ＜ 15％).The value of PLR-induced PETCO2 change (△PETCO2 PLH) to predict volume responsiveness was evaluated by receiver operating.characteristic curves (ROC).Results Among the 41 patients enrolled,21 had volume responsiveness (response group),and 20 had no responsiveness (non-response group).After PLR,the changes in CI and PETCO2 were both significantly increased in the response group compared with non-response group [△ CI:(13.5 ± 4.6)％ vs.(3.6± 3.5)％,△ PETCO2:(7.4 ± 3.4)％ vs.(2.8 ± 2.5)％,both P ＜ 0.05].△ PETCO2 PLR and baseline SVV were positively correlated with PLR-induced CI change (△ CI PLR) (r1 =0.50,r2 =0.38,both P ＜ 0.05).VE-induced PETCO2 change (△ PETCO2 VE),baseline SVV and △ CI PLR were positively correlated with VE-induced CI (△ CI VE) (r1 =0.58,r2 =0.56 and r3 =0.84,all P ＜ 0.01).The area under ROC curve (AUC) of △ PETCO2 PLR was 0.875±0.054 [95％ confidence interval (95％CI) =0.769-0.981,P ＜ 0.05].△ PETCO2 PLR ≥ 5.8％ predicted volume responsiveness with sensitivity of 76.2％ and specificity of 90.0％.AUC of △CI PLR was 0.933±0.036 (95％CI =0.862-1.000,P ＜ 0.05).△CI PLR ≥ 10.4％ predicted volume responsiveness with sensitivity of 81.0％ and specificity of 90.0％.AUC of baseline SVV was 0.831 ±0.066 (95％CI =0.702-0.960,P ＜ 0.05).Baseline SVV ≥ 12.5％ predicted volume responsiveness with sensitivity of 85.7％ and specificity of 75.0％.Conclusion The change in PETCO2 induced by PLR is a convenient,reliable and non-invasive indicator to predict volume responsiveness in shocked patients post cardiac operation with mechanical ventilation.
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Objective To investigate the value of end-tidal carbon dioxide partial pressure (PET CO2 )in fluid resuscitation in severe acute pancreatitis(SAP)patients.Methods SAP patients under mechanical ventilation with the need of a fluid challenge test were included.Hemodynamic parameter cardiac index(CI)and PET CO2 were conducted before and after the fluid challenge test.The value of ΔPET CO2 was used to predict fluid responsiveness. Results Totally 43 patients with SAP were prospectively recruited.31 patients had volume responsiveness, 12 patients had no volume responsiveness.Compared with no volume responsiveness group,volume responsiveness group led to a greater increase in ΔCI[(0.9 ±0.3)vs.(0.2 ±0.3),t =3.24,P <0.05]and ΔPET CO2 [(4.1 ± 1.9)vs.(0.7 ±1.2),t =4.01,P <0.05].ΔPET CO2 and ΔCI were correlated(r =0.74,P <0.05).The area under ROC curve of ΔPET CO2 was 0.872(95% CI 0.754 ~0.923,P <0.05).An increase of 5% in ΔPET CO2 predicted fluid responsiveness with a sensitivity of 86.7%,and specificity of 89.5%.Conclusion The change of ΔPET CO2 induced by fluid challenge test is an effective way to predict fluid responsiveness in SAP patients.
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Objective To reduce the incidence of the hypocapnia,the cutoff value of the end-tidal carbon dioxide partial pressure[Pet(CO2)] for predicting the hypocapnia so as to understand the suitable adjustment target and target range of the Pet(CO2) in preterm infants under mechanical ventilation.Methods From Jan.2012 to Oct.2013,96 cases of the preterm infants with respiratory distress syndrome(RDS) who needed mechanical support were selected from the Huaian Maternity and Child Health Care Hospital.Pet(CO2) value of each time point(1 h,24 h,48 h and 72 h after mechanical ventilation) were recorded,while radial artery blood was collected for blood gas analysis.The level of pa (CO2) ＜ 35 mmHg(1 mmHg =0.133 kPa) diagnosed hypocapnia;while the level of Pa (CO2) ＞ 60 mmHg was for diagnosing hypercapnia.The diagnostic cutoff and the suitable adjustment target and adjustment target range of the Pet(CO2) were confirmed by receiver operating characteristic (ROC) curve.Results The data from 381 arterial blood gas analysis results were gained,of which 151 times belonged to hypocapnia,and the rate was 39.6％,the other 230 cases were normal,and no case was of hypercapnia.The area under the ROC curve was 0.895,and the area of the standard error was 0.016.There was a statistical significance in Pet(CO2) value for the diagnosis of hypocapnia(P =0.000).The lower the value of Pet (CO2),the greater the likelihood of hypocapnia,and 95 ％ confidence interval area was 0.864-0.926.The Pet (CO2) optimal diagnostic cutoff value determined in accordance with Youden index was 30.5 mmHg.When Pet (CO2) among 41.5 mmHg,sensitivity was 100％.Conclusions Diagnostic cutoff value for forecasting hypocapnia is 30.5 mmHg.The suitable adjustment target of mechanical ventilation parameter adjustment is 41.5 mmHg for the Pet(CO2).The target range of mechanical ventilation parameter adjustment is 30.6-41.5 mmHg for the Pet(CO2).
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Objective To assess whether end-tidal carbon dioxide partial pressure (PET CO2) can predict the fluid responsiveness in septic shock patients.Methods Septic shock patients under mechanical ventilation without spontaneous breathing and with the need of a fluid challenge test were included in this study.Heart rate,central venous pressure,pulse pressure,PErCO2,and CI before and after the fluid challenge test were conducted in all the patients.Results Of the 48 septic shock patients included,34 had preload responsiveness,14 had no responsiveness.△CI and △PET CO2 after the fluid challenge test involume responders were (0.85 ± 0.47) L · min-1 · m-2 and (3.5 ± 2.5) mmHg respectively,which were higher than those in no volume responders (P ＜ 0.05).The fluid-induced changes in PET CO2 and CI were correlated (r =0.072,P ＜ 0.05).The AUCRoc of fluid challenge-induced △PET CO2 as the predictor for volume responsiveness was 0.943,and its sensitivity was 87.9％ and specificity was 93.4％ with a critical value of 5％.The AUCRoc of △PP as the predictor for volume responsiveness was 0.801,and its sensitivity was 68.1％ and specificity was 73.2％ with a critical value of 10％.Conclusion The changes of PETCO2 induced by a fluid challenge test can predict fluid responsiveness with reliability,and have a better sensitivity and specificity than the changes of PP.
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Objective To study the clinical significance of end-tidal carbon dioxide partial pressure (PetCO2 ) during cardiopulmonary resuscitation (CPR) and seek the fixed value according which to decide if we should and when to give up.Methods This was a prospective,observational study.A total of 124 patients with cardiac arrest in or out-of-hospital from may 2003 to March 2009 in emergency department of our hospital were selected.All of them had definite etiological factors.Changes of PetCO2 in 124 cardiac arrest patients during CPR were tracked.Results The gender,age,rescue time in seventy-one patients with the return of spontaneous circulation (ROSC) after endotracheal intubation have a significant difference with that in fifty-three patients without ROSC (P ＜0.01 ).The PetCO2 of the survival were higher than that of patients without ROSC or with ROSC,but finally died (P ＜0.01 ).A fixed point 14.4 mmHg of PetCO2 after 20 minutes' CPR can be used as a reference value to guide CPR or predict prognosis.Conclusions Monitoring PetCO2 during CPR has a predictive value on the success of resuscitation.
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Objective To investigate the clinical significance of noninvasive detection of end-tidal carbon dioxide partial pressure (PetCO2) in the management of children with acute asthma, and to evaluate the association between PetCO2 and artery blood gas carbon dioxide partial pressure ( PaCO2 ). Methods This was a prospective,double blinded study of children aged 5 ～ 14 years old treated for acute asthma in a pediatric emergency department. PetCO2 and PaCO2 measurements were taken before therapy and after each nebulization treatment ( maximum of three). Various clinical parametesr were recorded. Patients with PaCO2 and PetCO2 measurements within 8 minutes of each other were eligible for inclusion. Patients with cardiac disease,chronic pulmonary disease, poor tissue perfusion, or metabolic abnormalities were excluded. Results Sixty five children were enrolled. The initial PetCO2 value was (34. 8 ±8. 6) mm Hg (95% confidence interval =34. 0 to 36. 1). The PetCO2 value of post-treatment was (33.2 ±8.2) mm Hg (95% confidence interval =32. 5 to 34. 4) ,which was decreased significantly than that before treatment(P ＜ 0. 01 ). Fifty seven PetCO2-PaCO2 paired values were available from 57 patients. The values of PetCO2 and PaCO2 were ( 34. 8 ±7. 6) mm Hg and (40. 6 ± 8. 3 ) mm Hg, respectively. PetCO2 and PaCO2 values were highly positively correlated ( r = 0. 92,P ＜ 0. 000 1 ). Conclusion Noninvasive bedside measurement of PetCO2 in children with acute asthma in emergency department is feasible. Continuous PetCO2 monitoring can provide a reliable assessment of pulmonary status. PetCO2 can serve as an important adjunct index in the clinical management of pediatric patients with acute asthma.