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J Korean Soc Emerg Med > Volume 30(2); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(2): 132-139.
자발 호흡 환자에서 일회 심박출량의 변화에 대한 호흡종기 이산화탄소의 유용성
염석란1 , 이재훈2
1부산대학교 의과대학 응급의학교실
2동아대학교 의과대학 응급의학교실
Availability of end-tidal carbon dioxide on change in stroke volume in spontaneous breathing subjects
Seok Ran Yeom1 , Jae Hoon Lee2
1Department of Emergency Medicine, Busan University College of Medicine, Busan, Korea
2Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
Correspondence  Jae Hoon Lee ,Tel: 051-240-5590, Fax: 051-240-5309, Email: leetoloc@dau.ac.kr,
Received: July 30, 2018; Revised: September 4, 2018   Accepted: September 21, 2018.  Published online: April 30, 2019.
Stroke volume (SV) measurements have been used to guide fluid management. Noninvasive, indirect, and convenient measurements of the SV for fluid therapy are required for most patients during spontaneous breathing (SB). On the other hand, the preferred method for an indirect prediction of the SV is unclear. This study examined the best of the indirect and predictable parameters responding to a SV variation during SB.
Hemodynamic parameters, such as collapsibility of the inferior vena cava (cIVC), peak velocity variation in the common carotid artery (pvvCCA), collapsibility of the internal jugular vein (cIJV), and end-tidal carbon dioxide (ETCO2) were measured 180 times (6 different positions each in 30 normal subjects). The variables changed with the SV at the upper body elevation of 60° and 30°, in the supine position, at the lower body elevation of 30° and 60°, and lumbar elevation.
The SV showed the highest value at 30° of lower body elevation. Following fixed position changes, the ETCO2 during SB was the factor most correlated with the SV when compared to cIVC, cIJV, and pvvCCA (βcoefficient, 2.432 vs. -0.41, -0.033, and -0.654; P=0.004). The adjusted ETCO2 showed a significant change with the SV, even though the change in ETCO2 was not large.
ETCO2 was less influenced by the SB than cIVC, pvvCCA, and cIJV because the ETCO2 change was in accordance but the variations of the other blood vessels did not coincide with a SV change. Therefore, ETCO2 monitoring for predicting the SV would be more important than the variations in the vessels during SB.
Key words: Cardiac output; Stroke volume; Ultrasonography; Carbon dioxide
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