Assessment of Cardiac Output With EtCO2

Overview

Hemodynamic monitoring, especially cardiac output assessment, is a key feature for the management of critically ill patients. Although the use of invasive methods, such as thermodilution with a pulmonary artery catheter, remains the GOLD standard for the evaluation of the cardiac output, several non-invasive techniques are currently used in practice. An acceptable estimation of the cardiac output can be made by standard transthoracic echocardiography. Cardiac output can be calculated from subaortic velocity time integral (VTI). However, this technique requires a trained operator and depends on the echogenicity of the patient. The best method for assessing cardiac output depends on the patient's needs, the clinical scenario and the physician's experience with the monitoring device itself. No simple and rapid tool currently exist for assessing cardiac output in critically ill patients. The measurement of end-tidal carbon dioxide (EtCO2) used in routine in critically ill patients requiring mechanical ventilation could be an interesting alternative. Indeed, the amount of carbon dioxide (CO2) exhaled depends on the production of CO2 by the body, the pulmonary blood flow (corresponding to cardiac output) and its elimination by alveolar ventilation. In controlled ventilation, ie for constant alveolar ventilation, EtCO2 should therefore depend only on cardiac output. It has been shown in a porcine model that EtCO2 and cardiac output are strongly related under stable respiratory and metabolic conditions. In humans, only the variation of EtCO2 after volume expansion has been studied and EtCO2 seems to reflect changes in cardiac output. Nevertheless, the usefulness of EtCO2 in assessing cardiac output has never been evaluated. The objective of this study is therefore to determine the relationship between EtCO2 and cardiac output evaluated by the measurement of subaortic VTI in critically ill patients.

Full Title of Study: “Assessment of Cardiac Output With End-tidal Carbon Monoxide”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: December 31, 2020

Interventions

  • Diagnostic Test: End tidal carbon monoxide
    • Evaluation of cardiac output estimated by transthoracic echocardiography and end tidal carbon monoxide Evaluation of cardiac output estimated by transthoracic echocardiography and portal veinous velocity Evaluation of femoral veinous velocity

Clinical Trial Outcome Measures

Primary Measures

  • Correlation between cardiac output (VTI) and EtCO2
    • Time Frame: between 0 to 3 day after ICU admission
    • ITV ≈ (FR x EtCO2)/PaCO2

Secondary Measures

  • Increase the sensitivity for detection of low cardiac output by using EtCO2
    • Time Frame: between 0 to 3 day after ICU admission
    • Estimate (development population) and validate (validation population) cut-off to detect low cardiac output by using EtCO2
  • Correlation between cardiac output (VTI) and portal veinous velocity
    • Time Frame: between 0 to 3 day after ICU admission
  • Comparison between cardiac output (VTI) and femoral veinous velocity
    • Time Frame: between 0 to 3 day after ICU admission

Participating in This Clinical Trial

Inclusion Criteria

  • patients intubated and ventilated in the control assisted mode with no inspiratory effort – requiring vasopressors Exclusion Criteria:

  • less than 18 years – refuse to participate – situation in which health condition, medication or procedure could significantly interfere with the interpretation of EtCO2 or cardiac output (extracorporeal life support, pneumothorax with persistant air leak) (be increased without correlation to an infectious process (poly-traumatised patients,

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Centre Hospitalier Universitaire de Besancon
  • Provider of Information About this Clinical Study
    • Sponsor

References

Mercado P, Maizel J, Beyls C, Titeca-Beauport D, Joris M, Kontar L, Riviere A, Bonef O, Soupison T, Tribouilloy C, de Cagny B, Slama M. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. Crit Care. 2017 Jun 9;21(1):136. doi: 10.1186/s13054-017-1737-7.

Long B, Koyfman A, Vivirito MA. Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations. J Emerg Med. 2017 Dec;53(6):829-842. doi: 10.1016/j.jemermed.2017.08.026. Epub 2017 Oct 7.

Weil MH, Bisera J, Trevino RP, Rackow EC. Cardiac output and end-tidal carbon dioxide. Crit Care Med. 1985 Nov;13(11):907-9. doi: 10.1097/00003246-198511000-00011.

Monnet X, Bataille A, Magalhaes E, Barrois J, Le Corre M, Gosset C, Guerin L, Richard C, Teboul JL. End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test. Intensive Care Med. 2013 Jan;39(1):93-100. doi: 10.1007/s00134-012-2693-y. Epub 2012 Sep 19.

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