{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:28:18Z","timestamp":1787228898568,"version":"build-2736575974"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aims:<\/jats:title>\n \n Changes in end-tidal carbon dioxide (\u0394ETCO\n 2<\/jats:sub>\n ) have been proposed as a predictor of fluid responsiveness, but the available evidence remains inconsistent. We evaluated the ability of \u0394ETCO\n 2<\/jats:sub>\n to predict a \u226510% increase in cardiac index (\u0394CI) following administration of a 4 mL\/kg crystalloid bolus in patients undergoing major abdominal surgery.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We conducted a prospective study in 22 adults undergoing major abdominal surgery between April 2022 and January 2023. Cardiac output and stroke volume were monitored using the FloTrac\u2122 system with a Vigileo or EV1000 monitor. Patients were mechanically ventilated with a tidal volume of 8 mL\/kg predicted body weight and a respiratory rate of 12\u201316 breaths\/min. An intravenous bolus of Ringer\u2019s lactate (4 mL\/kg actual body weight over 10 minutes) was administered when haemodynamic parameters suggested hypovolaemia. Patients with a \u0394CI \u226510% were classified as fluid responders, with \u0394CI serving as the reference standard. \u0394ETCO\n 2<\/jats:sub>\n was evaluated against changes in stroke volume index (\u0394SVI) and compared with pulse pressure variation (PPV) and stroke volume variation (SVV). Diagnostic performance was assessed using the area under the receiver operating characteristic (AUROC) curve.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n \u0394ETCO\n 2<\/jats:sub>\n moderately predicted fluid responsiveness, with an AUROC of 0.823 [95% confidence interval (CI): 0.688\u20130.955] at a threshold of 1.5 mmHg (Youden index: 0.588,\n P<\/jats:italic>\n < 0.001). It outperformed pre-bolus PPV and SVV, which had AUROC values of 0.563 (95% CI: 0.344\u20130.782; threshold 16.5%; Youden index: 0.242;\n P<\/jats:italic>\n = 0.554) and 0.427 (95% CI: 0.209\u20130.644; threshold 12.5%; Youden index: 0.050;\n P<\/jats:italic>\n = 0.508), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n \u0394ETCO\n 2<\/jats:sub>\n may be a useful marker of fluid responsiveness after a fluid challenge.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ija.ija_557_26","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:00:52Z","timestamp":1787227252000},"page":"905-912","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Detecting if change in end-tidal carbon dioxide signifies change in cardiac output for the prediction of fluid responsiveness in patients undergoing major abdominal oncosurgery: An observational study"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7535-4629","authenticated-orcid":false,"given":"Shreyas Arun","family":"Chawathey","sequence":"first","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4313-7659","authenticated-orcid":false,"given":"Sohan Lal","family":"Solanki","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7384-4886","authenticated-orcid":false,"given":"Jigeeshu Vasishtha","family":"Divatia","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"R1-20260820","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1007\/s00134-015-4168-4","article-title":"Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness","volume":"42","author":"Eskesen","year":"2016","journal-title":"Intensive Care Med"},{"key":"R2-20260820","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/CCM.0b013e3181feeb15","article-title":"Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality","volume":"39","author":"Boyd","year":"2011","journal-title":"Crit Care Med"},{"key":"R3-20260820","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.1097\/CCM.0000000000002067","article-title":"Hemodynamic effect of different doses of fluids for a fluid challenge: A quasi-randomized controlled study","volume":"45","author":"Aya","year":"2017","journal-title":"Crit Care Med"},{"key":"R4-20260820","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s10877-021-00756-3","article-title":"Pharmacodynamic analysis of a fluid challenge with 4 ml kg-1 over 10 or 20 min: A multicenter cross-over randomized clinical trial","volume":"36","author":"Messina","year":"2022","journal-title":"J Clin Monit Comput"},{"key":"R5-20260820","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13613-016-0216-7","article-title":"Prediction of fluid responsiveness: An update","volume":"6","author":"Monnet","year":"2016","journal-title":"Ann Intensive Care"},{"key":"R6-20260820","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/s13054-017-1796-9","article-title":"What is the impact of the fluid challenge technique on diagnosis of fluid responsiveness? 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