Assessment of Cardiac Output With EtCO2

NCT03524313 | Unknown

• 1 other identifier: P/2018/367
• Study Type: observational
• Target: 75
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Cardiac Output

Keywords

cardiac output; end tidal carbon monoxide; echocardiography; intensive care

Outcome Measures

Primary Outcomes (1)

• Correlation between cardiac output (VTI) and EtCO2

  ITV ≈ (FR x EtCO2)/PaCO2

  between 0 to 3 day after ICU admission

Secondary Outcomes (3)

• Increase the sensitivity for detection of low cardiac output by using EtCO2

  between 0 to 3 day after ICU admission

• Correlation between cardiac output (VTI) and portal veinous velocity

  between 0 to 3 day after ICU admission

• Comparison between cardiac output (VTI) and femoral veinous velocity

  between 0 to 3 day after ICU admission

Interventions

End tidal carbon monoxide DIAGNOSTIC_TEST

* 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

Also known as: Transthoracic echocardiography

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

All patients \> 18 years intubated and ventilated in the control assisted mode with no inspiratory effort referred to the intensive unit.

You may qualify if:

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

You may not qualify if:

• 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,

Sponsors & Collaborators

• Centre Hospitalier Universitaire de Besancon: lead

Study Sites (1)

Intensive care unit, University hospital of Besançon

Besançon, 25000, France

RECRUITING

Related Publications (4)

• 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.

  PMID: 28595621 BACKGROUND

• 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.

  PMID: 28993038 BACKGROUND

• 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.

  PMID: 3931979 BACKGROUND

• 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.

  PMID: 22990869 BACKGROUND

MeSH Terms

Interventions

Echocardiography

Intervention Hierarchy (Ancestors)

Cardiac Imaging Techniques; Diagnostic Imaging; Diagnostic Techniques and Procedures; Diagnosis; Ultrasonography; Heart Function Tests; Diagnostic Techniques, Cardiovascular

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 9, 2018
• First Posted: May 14, 2018
• Study Start: January 1, 2020
• Primary Completion: December 31, 2020
• Study Completion: December 31, 2020
• Last Updated: January 31, 2020

Record last verified: 2019-12

Locations

FR (1)