Assessment of Cardiac Output With EtCO2

Study Overview
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Brief Summary
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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.

Official Title
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Assessment of Cardiac Output With End-tidal Carbon Monoxide

Conditions
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Cardiac Output

Intervention / Treatment
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* Diagnostic Test: End tidal carbon monoxide


Participation Criteria
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Eligibility Criteria
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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,

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|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|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between cardiac output (VTI) and EtCO2 | ITV ≈ (FR x EtCO2)/PaCO2 | between 0 to 3 day after ICU admission | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Increase the sensitivity for detection of low cardiac output by using EtCO2 | Estimate (development population) and validate (validation population) cut-off to detect 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cardiac output, end tidal carbon monoxide, echocardiography, intensive care