Central venous-to-arterial carbon dioxide difference as a prognostic tool in high-risk surgical patients

Abstract

IntroductionThe purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2 gap) in high-risk surgical patients admitted to a postoperative ICU. We hypothesized that PCO2 gap could serve as a useful tool to identify patients still requiring hemodynamic optimization at ICU admission.MethodsOne hundred and fifteen patients were included in this prospective single-center observational study during a 1-year period. High-risk surgical inclusion criteria were adapted from Schoemaker and colleagues. Demographic and biological data, PCO2 gap, central venous oxygen saturation, lactate level and postoperative complications were recorded for all patients at ICU admission, and 6 hours and 12 hours after admission.ResultsA total of 78 (68%) patients developed postoperative complications, of whom 54 (47%) developed organ failure. From admission to 12 hours after admission, there was a significant difference in mean PCO2 gap (8.7 ± 2.8 mmHg versus 5.1 ± 2.6 mmHg; P = 0.001) and median lactate values (1.54 (1.1-3.2) mmol/l versus 1.06 (0.8-1.8) mmol/l; P = 0.003) between patients who developed postoperative complications and those who did not. These differences were maximal at admission to the ICU. At ICU admission, the area under the receiver operating characteristic curve for occurrence of postoperative complications was 0.86 for the PCO2 gap compared to Sequential Organ Failure Assessment score (0.82), Simplified Acute Physiology Score II score (0.67), and lactate level (0.67). The threshold value for PCO2 gap was 5.8 mmHg. Multivariate analysis showed that only a high PCO2 gap and a high Sequential Organ Failure Assessment score were independently associated with the occurrence of postoperative complications. A high PCO2 gap (≥6 mmHg) was associated with more organ failure, an increase in duration of mechanical ventilation and length of hospital stay.ConclusionA high PCO2 gap at admission in the postoperative ICU was significantly associated with increased postoperative complications in high-risk surgical patients. If the increase in PCO2 gap is secondary to tissue hypoperfusion then the PCO2 gap might be a useful tool complementary to central venous oxygen saturation as a therapeutic target.

Continuous Monitoring of Lactate Using Intravascular Microdialysis in High-Risk Cardiac Surgery: A Prospective Observational Study

“…34,35,38 Thus, in addition to changes in lactate, an increased PCO 2 gap could be a valuable additional parameter to predict postoperative complications in high-risk surgical patients. 39 Moreover, the PCO 2 gap as a global index of tissue perfusion could be useful to define an insufficient flow state despite normal microcirculatory parameters.…”

Predictors of complications when transferring postoperative cardiac patients from the intensive care unit

“…ст. -свидетельствует о наличии микроциркуляторных нарушений и указывает на необходимость дальнейшей оптимизации доставки и потребления кислорода [4]. Это подтверждается и взаимосвязью между положи-тельным интраоперационным гидробалансом с повы-шением сатурации гемоглобина кислородом в цент-ральной вене при переводе из отделения реанимации и интенсивной терапии.…”

“…Эти критерии включают лак-тат, веноартериальный градиент по углекислому газу (Pv-aCO 2 ) и центральную венозную сатурацию (ScvO 2 ) [4,5]. После кардиохирургических операций данные метаболические параметры могут иметь диагностичес-кое значение при «субкомпенсированной» сердечной недостаточности в послеоперационном периоде [6].…”

Déficit de base contra delta de dióxido de carbono como factor pronóstico de complicaciones en choque hemorrágico

“…Robin et al documentaron en su estudio la asociación que existe entre el delta de CO 2 y las complicaciones asociadas en el postoperatorio de pacientes con alto riesgo en choque séptico. 7 Por otro lado, Ospina T et al mencionaron que el delta de CO 2 se correlaciona con alteración de la microcirculación en pacientes con choque séptico y la relación con la disfunción orgánica. 7 En este estudio hay una correlación de las complicaciones asociadas a elevación del delta de CO 2 mayor de 6 mmHg (lesión hepática, trombocitopenia, lesión renal y lesión pulmonar aguda), con una p = 0.01 con significancia estadística.…”