title: End-expiratory occlusion manoeuvre does not accurately predict fluid responsiveness in the operating theatre.
abstract: BACKGROUND
  The objective of this study was to determine whether assessment of stroke volume (SV) and measurement of exhaled end-tidal carbon dioxide [Formula: see text] during an end-expiratory occlusion (EEO) test can predict fluid responsiveness in the operating theatre.
  
  
  METHODS
  Forty-two subjects monitored by oesophageal Doppler who required i.v. fluids during surgery were studied. Haemodynamic variables [heart rate, non-invasive arterial pressure, SV, cardiac output (CO), respiratory variation of SV (ΔrespSV), variation of SV during EEO, and E'(CO₂) were measured at baseline, during EEO (Δ(EEO)), and after fluid expansion. Responders were defined by an increase in SV over 15% after infusion of 500 ml of crystalloid solution.
  
  
  RESULTS
  Of the 42 subjects, 28 (67%) responded to fluid infusion. A cut-off of >2.3% ΔSV(EEO) predicted fluid responsiveness with an area under the receiver-operating characteristic (AUC) curve of 0.78 [95% confidence interval (95% CI): 0.63-0.89, P=0.003]. The AUC of ΔrespSV was 0.89 (95% CI: 0.76-0.97, P<0.001). With an AUC of 0.68 (95% CI: 0.51-0.81, P=0.07), E'(CO₂)(EEO) was poorly predictive of fluid responsiveness.
  
  
  CONCLUSIONS
  ΔSV(EEO) and ΔE'(CO₂) were unable to accurately predict fluid responsiveness during surgery.
authors.affiliation: Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, Amiens 80054, France guinotpierregregoire@gmail.com.
authors.forename: P-G
authors.initials: PG
authors.lastname: Guinot
authors.affiliation: Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, Amiens 80054, France.
authors.forename: J
authors.initials: J
authors.lastname: Godart
authors.affiliation: Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, Amiens 80054, France.
authors.forename: B
authors.initials: B
authors.lastname: de Broca
authors.affiliation: Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, Amiens 80054, France.
authors.forename: E
authors.initials: E
authors.lastname: Bernard
authors.affiliation: Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, Amiens 80054, France.
authors.forename: E
authors.initials: E
authors.lastname: Lorne
authors.affiliation: Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, Amiens 80054, France.
authors.forename: H
authors.initials: H
authors.lastname: Dupont
mesh_terms: D062186:Arterial Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000032:analysis; D002302:Cardiac Output / Q000502:physiology; D000077324:Crystalloid Solutions; D015150:Echocardiography, Doppler / Q000379:methods; D045853:Exhalation / Q000502:physiology; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009873:Operating Rooms; D012372:ROC Curve; D015203:Reproducibility of Results; D012119:Respiration; D012121:Respiration, Artificial / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology; D013514:Surgical Procedures, Operative; D013990:Tidal Volume / Q000502:physiology
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D002245:Carbon Dioxide
keywords: anaesthesia; cardiac output monitoring; end-expiratory occlusion; end-tidal carbon dioxide; intraoperative monitoring