END-TIDAL CARBON-DIOXIDE DURING EXTREMELY LOW CARDIAC-OUTPUT

Study objective: A number of studies have shown that expired CO 2 concentration is closely related to cardiac output, but that cardiac output was not controlled as an independent variable. In addition, the partial pressure of end-tidal CO2 (P(ET)CO2) during extremely low cardiac output has not been reported. The objective of the present study was to measure P(ET)CO2 during well-controlled, very low blood flow rates under conditions of constant minute ventilation. Design: Ten anesthetized, intubated, and mechanically ventilated swine (weight, 43 to 102 kg) were placed on two ventricular assist devices in order to control cardiac output. Minute ventilation was measured and kept constant. Ventricular assist device output (measured with an ultrasonic flow probe); P(ET)CO2; and aortic, pulmonary artery, and central venous pressures were recorded continuously. Interventions: After electrical induction of ventricular fibrillation, pump output was decreased in steps. Measurements and main results: Cardiac index ranged from 0 to 5,371 mL/min/M2; 59% of P(ET)CO2 measurements were made at cardiac indexes of less than 1,313 mL/min/M2 (30 mL/min/kg). The relationship of P(ET)CO2 levels to cardiac index was determined with linear regression analysis; P < .05 was statistically significant. P(ET)CO2 correlated significantly with cardiac index (P < .0001). The best-fit line by least-squares analysis produced the equation: P(ET)CO2 = 4.98 + 0.012 [cardiac index] (r2 = .82). Conclusion: Under conditions of constant minute ventilation, P(ET)CO2 correlated closely with cardiac index over a large range of blood flow rates, including extremely low rates.