ABSTRACT
Objective:To investigate the value of partial pressure of end-tidal carbon dioxide (P ETCO 2) combined with passive leg raising test (PLR) in predicting volume responsiveness in patients with septic shock. Methods:A total of 43 patients with septic shock admitted to the second department of critical care medicine, People's Hospital of Xinjiang Uygur Autonomous Region from December 2019 to June 2021 were selected as the research subjects. P ETCO 2, cardiac index (CI), stroke volume variation (SVV), mean arterial pressure (MAP) and other hemodynamic indexes were monitored before and after PLR and volume stress test (VE). Subjects were grouped according to the CI variation rate (ΔCI) after VE test. Patients with ΔCI ≥ 15% were the responding group, and patients with ΔCI < 15% were the non-responding group. The receiver operator characteristic curve (ROC curve) was drawn to analyze the evaluation value of the change in P ETCO 2 after PLR on the evaluation value of fluid responsiveness. Results:Among the 43 patients, 22 cases were in the responding group, accounting for 51.2%; 21 cases were in the non-responding group, accounting for 48.8%. After the PLR test, the change values of MAP, SVV, CI and P ETCO 2 in the responding group were higher than those in the non-responding group, and the differences were statistically significant [MAP (mmHg): 3.8±2.1 vs. 1.4±2.0, SVV (%): -5.3±2.5 vs. 2.7±2.0, CI (mL·s -1·m -2): 0.48±0.13 vs. 0.14±0.18, P ETCO 2 (mmHg): 3.4±1.8 vs. 1.1±1.0, all P < 0.05, 1 mmHg≈0.133 kPa]. After the VE test, the changes of HR, MAP, SVV, CI and P ETCO 2 in the responding group were higher than those in the non-responding group [HR (times/min): -8.3±2.8 vs. -2.3±3.7, MAP (mmHg): 3.8±2.4 vs. 1.2±1.7, SVV (%): -6.3±3.1 vs. -3.3±2.0, CI (mL·s -1·m -2): 0.51±0.14 vs. 0.16±0.12, P ETCO 2 (mmHg): 3.3±1.2 vs. 1.3±1.1, all P < 0.05]. The area under the ROC curve (AUC) of the change in P ETCO 2 before and after the PLR test (ΔP ETCO 2 PLR) for evaluating fluid responsiveness was 0.881. When the critical value was 5.9%, the sensitivity was 76.7%, the specificity was 89.5%, and the correct index was 0.68; the AUC for SVV baseline assessment of fluid responsiveness was 0.835, and when the cut-off value was 12.8%, the sensitivity was 84.6%, the specificity was 80.0%, and the correct index was 0.65. The predictive value of ΔP ETCO 2 was not lower than the SVV baseline. Conclusion:After the PLR test, the change of P ETCO 2 can be used as a non-invasive, simple, safe and reliable indicator for predicting the volume responsiveness of patients with septic shock.
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Objective To explore the timeliness value of cardiopulmonary resuscitation quality index (CQI) in patients' prognostic evaluation during cardiopulmonary resuscitation (CPR).Methods A prospective descriptive study was conducted.According to whether they got return of spontaneously circulation (ROSC) or not,45 patients receiving CPR were divided into the ROSC group and non-ROSC group.The changes of CQI and partial pressure of end-tidal carbon dioxide (PETCO2) during CPR were collected,and were analyzed to valuate the prognosis of patients.Results The initial,end,and average PETCO2 were statistically different between the ROSC group and the non-ROSC group [7.0(3.6,14.6) vs 7.0(3.6,14.6) mmHg;29.5(19.8,35.9) vs 4.0(2.3,10.2)mmHg;and 22.2(11.8,36.3) vs 4.0(2.5,9.0) mmHg,respectively;P＜0.05],and the end CQI was statistically different between the two groups (59.6±8.9 vs 34.8±5.2,P＜0.05).The CQI differences between the two groups initiated at 11 min after CPR,and stopped at 29 min after CPR.The optimal cut-offpoint of terminal CQI and PETCO2 for prognostic was 33.2 and 16.1 mmHg respectively,and there was a statistically difference in the area under the curve between them (P＜0.05).Conclusions During CPR,both CQI and PETCO2 can be used to evaluate the prognosis,and CQI is more capable of predicting in the late stage of CPR.
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Objective To explore the predictive value of partial pressure of end-tidal carbon dioxide (PETCO2) on the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and serum S100B protein on cerebral function. Methods 142 adult patients with in-hospital cardiac arrest (IHCA) AACD-CPR in Zhengzhou People's Hospital, Affiliated Southern Medical University from September 2014 to December 2017 were enrolled. Patients were divided into successful group and failure group according to restoration of spontaneous circulation (ROSC) or not; and then according to Glasgow-Pittsburgh cerebral performance categories (CPC) one month after ROSC, the successful group was divided into good prognosis group (CPC 1-2) and poor prognosis group (CPC 3-5) further. The variations of hemodynamic, arterial blood gas index, PETCO2and serum S100B protein level (25 healthy subjects as normal S100B protein level reference value) during the recovery were analyzed. The predictive value of PETCO2on the effect of AACD-CPR and serum S100B protein on cerebral function of successful resuscitation patients were analyzed by receiver operating characteristic curve (ROC). Results ① According to the traditional qualitative indexes, such as pulsation of the large artery, redness of lips and extremities, spontaneous fluctuation of chest, narrowing of pupil, existence of shallow reflex, etc, 54 in 142 patients with IHCA were successfully resuscitated; 57 cases were successfully resuscitated through the guidance of PETCO2, there was no significant difference between the two groups (χ2= 0.133, 1 = 0.715). With the AACD-CPR, 142 CA patients' arterial partial pressure of oxygen (PaO2), arterial blood carbon dioxide partial pressure (PaCO2) were all improved with different degrees; heart rate (HR), mean arterial pressure (MAP), PaO2and PaCO2were further improved at 20 minutes after ROSC. At beginning of AACD-CPR, PETCO2of both groups were about 10 mmHg (1 mmHg = 0.133 kPa). PETCO2was gradually rising to above 20 mmHg in successful group during AACD-CPR process; the failed group increased slightly within 2-5 minutes, then gradually decreased to below 20 mmHg, there was a significant difference in PETCO2between the two groups at each time. The area under the ROC (AUC) of PETCO2at CPR 20 minutes in predicting the outcome of the resuscitation was 0.969, 95% confidence interval (95%CI) was 0.943-0.995 (1 = 0.000), when the cut-off value of PETCO2was 24.25 mmHg, the sensitivity was 90.7%, and the specificity was 96.6%. ② The level of serum S100B protein at 0.5 hour after ROSC in the good prognosis group and the poor prognosis group were significant higher than that of the normal control group; there was no significant difference between poor prognosis group and good prognosis group. S100B protein concentration of the poor prognosis group reached the peak within 3-6 hours, then gradually decreased, and was higher than that of the normal control group at ROSC 72 hours; the good prognosis was gradually decreased and recovered to normal control group within ROSC 72 hours. The AUC of S100B at 3 hours after ROSC on cerebral function prognosis prediction was 0.925, 95%CI was 0.867-0.984 (1 = 0.000), when the cut-off value of S100B protein was 1.215 μg/L, the sensitivity was 85.2%, and the specificity was 85.5%. Conclusion The variation of PETCO2can be used as an objective index to predict the success of AACD-CPR, and serum S100B protein can be used as an objective clinical index to predict cerebral function after AACD-CPR, both of which have some reference and guiding significance for clinical treatment.
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BACKGROUND:Partial pressure of end-tidal carbon dioxide (PETCO2) has been used to monitor the effectiveness of precordial compression (PC) and regarded as a prognostic value of outcomes in cardiopulmonary resuscitation (CPR). This study was to investigate changes of PETCO2 during CPR in rats with ventricular fibrillation (VF) versus asphyxial cardiac arrest. METHODS:Sixty-two male Sprague-Dawley (SD) rats were randomly divided into an asphyxial group (n=32) and a VF group (n=30). PETCO2 was measured during CPR from a 6-minute period of VF or asphyxial cardiac arrest. RESULTS:The initial values of PETCO2 immediately after PC in the VF group were significantly lower than those in the asphyxial group (12.8±4.87 mmHg vs. 49.2±8.13 mmHg,P=0.000). In the VF group, the values of PETCO2 after 6 minutes of PC were significantly higher in rats with return of spontaneous circulation (ROSC), compared with those in rats without ROSC (16.5±3.07 mmHg vs. 13.2±2.62 mmHg,P=0.004). In the asphyxial group, the values of PETCO2 after 2 minutes of PC in rats with ROSC were significantly higher than those in rats without ROSC (20.8±3.24 mmHg vs. 13.9±1.50 mmHg,P=0.000). Receiver operator characteristic (ROC) curves of PETCO2 showed significant sensitivity and specificity for predicting ROSC in VF versus asphyxial cardiac arrest. CONCLUSIONS:The initial values of PETCO2 immediately after CPR may be helpful in differentiating the causes of cardiac arrest. Changes of PETCO2 during CPR can predict outcomes of CPR.
ABSTRACT
During cardiopulmonary resuscitation (CPR),PetCO2 monitoring helps to judge the status of circulation.Marked elevation of PetCO2 level is early sign for restoration of spontaneous circulation and successful CPR.PetCO2 level monitoring can predict probability of CPR success and it is also helpful to assist in confirming endotracheal tube placement,to assess for chest compression and ventilation.PetCO2 levels should be monitored during CPR.