Hypovolemia Clinical Trial
Official title:
Validation of Capnography as a Predictor of Cardiac Output Change as Measured by FloTrac
The aim of this study is to evaluate the correlation of capnography with non-invasive
measurement of cardiac output with the FloTrac/EV1000 following a reversible fluid
challenge, a passive leg raising maneuver, using thermodilution as the gold standard.
The main hypothesis is a correlation of 0.8 between the increasing of ETCO2 and the
increasing of ejection volume measured by FloTrac/EV1000 following a passive leg raising
maneuver.
Data are collected on past medical illnesses, medication, type of surgery, abnormalities on
pre-operative transesophageal echocardiogram and localisation of arterial line.
Before induction of anesthesia, an arterial line is installed. The agents of induction of
anesthesia and doses are left to the discretion of the attending anesthesiologist. The
trachea is intubated, anesthesia circuit and sidestream CO2 sensor were connected to the
endotracheal tube and positive pressure ventilation begins with standardized parameters:
control assisted mode with no inspiratory effort, tidal volume of 6-8 mL/kg, respiratory
rate of 8-10/minute and PEEP of 5 mmHg. Modification of the ventilation parameters is not
permitted before and during the PLR maneuvers. Isoflurane and propofol are used for the
maintenance of anesthesia. A PA catheter (Paceport, Edwards Lifesciences, Irvine,
California, USA) is inserted in the right internal jugular vein. If a femoral line is
installed, the FloTrac/EV1000 is connected to the femoral line, if not, the radial line is
used for mini-invasive continuous cardiac output monitoring. The a and v wave aspect and
ratio of CVP waveform is noted. The RV waveform is inspected for signs of abnormalities such
as a non-horizontal slope restrictive pattern (Figure xx)18. The transducers are all placed
at the midthoracic level and a "flush test" is performed prior to CO measurements with the
FloTrac/EV1000 to ensure absence of resonance or damping of the system.
At baseline, in the operating room before the first PLR maneuver, the heart rate, systolic,
diastolic and mean arterial pressure, CVP value, CI measured in triplicate with the
thermodilution method and the FloTrac derived variables are recorded. These variables
include the CO indexed CO and SVV measured by the FloTrac/EV1000. The same variables are
recorded at 1, 3 and 5 minutes after the beginning of PLR except CI by thermodilution which
is measured again only once, at 3 minutes and EtCO2 which is recorded every 12 seconds. The
EtCO2 curve is inspected at baseline and during the PLR maneuver to ensure the changes in
EtCO2 were not related to changes in inspired CO2, ventilator or circuit malfunction or
increase in airway resistance.
After weaning from CPB, the same measures are taken twice: with chest opened, when
hemodynamic stability is achieved, and CPB canulas taken out and with chest closed.
In the ICU, two additional PLR maneuvers were executed with a 30 minutes interval in
between. The set of measurements previously described are recorded. The use of an epicardial
temporary pacemaker, vasopressors (doses and type), vasodilators (doses and type) are also
recorded.
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