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Master Thesis

Capacité des variations de la fraction expirée en CO2 à identifier une réponse au remplissage vasculaire de 250mL de cristalloïdes au bloc opératoire : étude REVCO2

Abstract : Background: from a physiological viewpoint, changes in end-tidal carbon dioxide (EtCO2) could be a simple, noninvasive, and inexpensive way to monitor changes in cardiac index. This study aimed to assess the utility of changes in EtCO2 as a marker of fluid responsiveness after volume expansion in the operating room. Methods: a prospective observational study was conducted in a tertiary university teaching hospital, from August 2018 to February 2019. A total of 109 non-consecutive, mechanically ventilated adults undergoing neurosurgery in the supine position and equipped with cardiac output monitors were included. Patients with major respiratory disease, arrhythmia, or heart failure were excluded. Volume expansion with 250 ml of saline 0.9% was performed for 10 min to maximise cardiac output during surgery, according to current guidelines. A positive fluid challenge was defined as an increase in stroke volume index of more than 10% from baseline. Changes in stroke volume index (monitored using pulse contour analysis) and EtCO2 were recorded before and after infusion. Results: a total of 242 fluid challenges were performed (26.9% positive challenges). Changes in EtCO2 greater than 1.1% induced by infusions had utility for identifying fluid responsiveness, with a sensitivity of 62.9% (95% confidence interval, 62.5-63.3%) and a specificity of 77.8% (95% CI, 77.6-78.1%). The area under the receiver operating curve for changes in EtCO2 after volume expansion was 0.683 (95% CI, 0.680-0.686). Conclusions: changes in EtCO2 induced by rapid infusion of 250 ml saline 0.9% lacked accuracy for identifying fluid responsiveness in mechanically ventilated patients in the operating room.
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https://dumas.ccsd.cnrs.fr/dumas-02973966
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Submitted on : Wednesday, October 21, 2020 - 2:25:31 PM
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Julie Chauvet. Capacité des variations de la fraction expirée en CO2 à identifier une réponse au remplissage vasculaire de 250mL de cristalloïdes au bloc opératoire : étude REVCO2. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02973966⟩

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