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Background It is essential to assess the patients’ volume responsiveness before fluid infusion in patients with circulatory failure. The hypothesis is that the combining of end-tidal carbon dioxide (EtCO2) and pulse pressure variability (PPV) measurements can non-invasively predict fluid responsiveness during passive leg raising (PLR) test. Methods Pulse indicates continuous cardiac output, right radial artery blood pressure, and EtCO2 were monitored in 71 septic shock patients with mechanical ventilation. A standard PLR test was performed; cardiac index (CI), arterial pressure, stroke volume variability (SVV), PPV, and EtCO2 were measured before and after the PLR test. Patients with an increase in CI greater than 15% after the PLR test were defined as fluid responders. Receiver-operating characteristics (ROC) curve analysis was carried out to assess the predictive performance of the measured parameters. Results PPV, △EtCO2 and △EtCO2 variation ratio (△EtCO2%) in fluid-responders were significantly greater than those in the non-responders. The AUC of △EtCO2% was 0.884 (95% CI, 0.785 to 0.948) with a cut-off value of > 5.88%; yielded a sensitivity of 91.89% (95% CI, 78.1–98.3%) and aspecificity of 76.47% (95% CI, 58.8–89.3%). The AUC of PPV was 0.852 (95% CI, 0.748 to 0.925) with a cut-off value of > 10%; yielded a sensitivity of 81.1% (95% CI, 64.8–92%) and specificity of 79.41% (95% CI, 62.1–91.3%). The AUC of PPV-△EtCO2% combination was 0.942 (95% CI, 0.86 to 0.984) with a cut-off value of > 0.666; yielded a sensitivity of 83.8% (95% CI, 68–93.8%) and aspecificity of 94.1% (95% CI, 80.3–99.3%). The AUC of PPV-△EtCO2% combination was significantly greater than either △EtCO2% or PPV. Conclusion The combination of PPV and △EtCO2 can better predict fluid responsiveness during PLR. |
