{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:22:18Z","timestamp":1787840538976,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"Abstract<\/jats:title>\n \n Background and Aims:<\/jats:title>\n \n Judicious use of intravenous fluid therapy can be lifesaving in the intraoperative period. An assessment of fluid responsiveness is important for it. So, our study aimed to study the correlation between end-tidal carbon dioxide (EtCO\n 2<\/jats:sub>\n ) and transthoracic echocardiography-derived cardiac output for assessing fluid responsiveness in patients undergoing elective surgery under general anesthesia.\n <\/jats:p>\n <\/jats:sec>\n \n Material and Methods:<\/jats:title>\n \n Patients who underwent elective lower abdominal or lower limb surgeries in a supine position under general anesthesia with positive pressure ventilation were included in this study. Cardiac output was calculated using transthoracic echo, and by measuring the diameter of the left ventricular outflow tract (LVOT), velocity time integral of LVOT (LVOT-VTI), and heart rate. Cardiac output (CO), EtCO\n 2<\/jats:sub>\n , and hemodynamic and ventilatory parameters were analyzed by the operator before and 1 min after the infusion of 250 mL of normal saline.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n EtCO\n 2<\/jats:sub>\n variations showed a weak correlation with the changes in CO induced by a fluid challenge (Spearman\u2019s correlation\n r =<\/jats:italic>\n 0.3,\n P<\/jats:italic>\n = 0.005). When fluid responsiveness (FR) is defined as an increase in CO by > 15%, the AUROC of \u2206 EtCO\n 2<\/jats:sub>\n was 0.638 (95% confidence interval [CI], 0.507\u20130.77). At a cut-off of \u2265 1 mmHg, it predicted FR status (responder vs. non-responder) with a sensitivity of 66% and a specificity of 64%. When percentage variation in EtCO\n 2<\/jats:sub>\n (percent \u2206 EtCO\n 2<\/jats:sub>\n ) was considered, the AUROC was almost similar (0.618) (95% CI, 0.481\u20130.756), and it was not statistically significant (\n P<\/jats:italic>\n = 0.093).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n Our study demonstrated a weak positive correlation between volume-induced changes in EtCO\n 2<\/jats:sub>\n and changes in CO in mechanically ventilated patients in the operating room. Variations in EtCO\n 2<\/jats:sub>\n can be used as an adjunct to guide hemodynamic optimization when no COcardiac output monitors are available.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/joacp.joacp_288_24","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T11:00:46Z","timestamp":1750244446000},"page":"478-485","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Correlation of end-tidal carbon dioxide with transthoracic echocardiography derived cardiac output for the assessment of fluid responsiveness: A prospective observational study"],"prefix":"10.4103","volume":"41","author":[{"given":"S Keerthi","family":"Raj","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debendra K.","family":"Tripathy","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency, AIIMS, Raipur, Chhattisgarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"Talawar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Singla","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"R1-20250620","doi-asserted-by":"crossref","first-page":"2564","DOI":"10.1056\/NEJMoa062200","article-title":"Comparison of two fluid-management strategies in acute lung injury","volume":"354","author":"Wiedemann","year":"2006","journal-title":"N Engl J Med"},{"key":"R2-20250620","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1378\/chest.121.6.2000","article-title":"Predicting fluid responsiveness in ICU patients:A critical analysis of the evidence","volume":"121","author":"Michard","year":"2002","journal-title":"Chest"},{"key":"R3-20250620","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2017.12.003","article-title":"The use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest:A systematic review","volume":"123","author":"Paiva","year":"2018","journal-title":"Resuscitation"},{"key":"R4-20250620","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.resuscitation.2015.07.016","article-title":"European Resuscitation Council Guidelines for Resuscitation 2015. 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Adult advanced life support","volume":"95","author":"Soar","year":"2015","journal-title":"Resuscitation"},{"key":"R5-20250620","doi-asserted-by":"crossref","first-page":"S366","DOI":"10.1161\/CIR.0000000000000916","article-title":"Part 3:Adult basic and advanced life support:2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"142","author":"Panchal","year":"2020","journal-title":"Circulation"},{"key":"R6-20250620","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.jcrc.2015.05.019","article-title":"Changes in end-tidal CO2 could predict fluid responsiveness in the passive leg raising test but not in the mini-fluid challenge test:A prospective and observational study","volume":"30","author":"Xiao-ting","year":"2015","journal-title":"J Crit Care"},{"key":"R7-20250620","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/2110-5820-2-9","article-title":"Non-invasive assessment of fluid 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Anesth"},{"key":"R10-20250620","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/bja\/aew478","article-title":"Change in end-tidal carbon dioxide outperforms other surrogates for change in cardiac output during fluid challenge","volume":"118","author":"Lakhal","year":"2017","journal-title":"Br J Anaesth"},{"key":"R11-20250620","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s00063-020-00749-1","article-title":"Assessment of end-tidal carbon dioxide and vena cava collapsibility in volume responsiveness in spontaneously breathing patients","volume":"117","author":"G\u00fcney P\u0131nar","year":"2022","journal-title":"Med Klin Intensivmed Notfmed"},{"key":"R12-20250620","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40635-018-0187-0","article-title":"Evaluation of end-tidal carbon dioxide gradient as a predictor of volume responsiveness in spontaneously breathing healthy adults","volume":"6","author":"Arango-Granados","year":"2018","journal-title":"Intensive Care Med Exp"},{"key":"R14-20250620","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1007\/s12630-016-0677-z","article-title":"Assessment of fluid responsiveness with end-tidal carbon dioxide using a simplified passive leg raising maneuver:A prospective observational study","volume":"63","author":"Toupin","year":"2016","journal-title":"Can J Anaesth"},{"key":"R15-20250620","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s13613-016-0141-9","article-title":"End-tidal carbon dioxide variation after a 100- and a 500-ml fluid challenge to assess fluid responsiveness","volume":"6","author":"Jacquet-Lagr\u00e8ze","year":"2016","journal-title":"Ann Intensive Care"},{"key":"R16-20250620","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13054-017-1938-0","article-title":"End-expiratory occlusion maneuver to predict fluid responsiveness in the intensive care unit:An 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