Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients

Pierrakos, Charalampos; Bels, David De; Nguyen, Thomas; Velissaris, Dimitrios; Attou, Rachid; Devriendt, Jacques; Honoré, Patrick M.; Taccone, Fabio Silvio; Backer, Daniel De

doi:10.1371/journal.pone.0257314

Cited by 5 publications

(3 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, Pierrakos et al [16] conducted a prospective evaluation of the effects of fluid bolus on venous-to-arterial carbon dioxide tension (P va CO 2 ) in critically ill patients with pre-infusion P va CO 2 >6 mmHg. Fluid bolus caused a decrease in P va CO 2 , from 8.7 [7.6 - 10.9] mmHg to 6.9 [5.8 - 8.6] mmHg (p<0.01).…”

Section: Discussionmentioning

confidence: 99%

CO2 gap changes compared with cardiac output changes in response to intravenous volume expansion and/or vasopressor therapy in septic shock

Faris,

El-Houfi,

El Shahat

et al. 2024

South Afr J Crit Care

View full text Add to dashboard Cite

Background. The difference in partial pressure of carbon dioxide (PCO2) between mixed or central venous blood and arterial blood, known as the ∆PCO2 or CO2 gap, has demonstrated a strong relationship with cardiac index during septic shock resuscitation. Early monitoring of the ∆PCO2 can help assess the cardiac output (CO) adequacy for tissue perfusion.Objectives. To investigate the value of ∆PCO2 changes in early septic shock management compared with CO. Methods. This observational prospective study included 76 patients diagnosed with septic shock admitted to Cairo University Hospital’s Critical Care Department between December 2020 and March 2022. Patients were categorised by initial resuscitation response, initial ∆PCO2 and 28-day mortality. The primary outcome was the relationship between the ∆PCO2 and CO changes before and after initial resuscitation, with secondary outcomes including ICU length of stay (LOS) and 28-day mortality. Results. Peri-resuscitation ∆PCO2 changes predicted a ≥15% change in the cardiac index (CI) (area under the curve (AUC) 0.727; 95% CI 0.614 - 0.840) with 66.7% sensitivity and 62.8% specificity. The optimal ∆PCO2 change cut-off value was <−1.85, corresponding to a <−22% threshold for a 15% cardiac index increase. The PCO2 gap ratio (gap/gap ratio of T1- PCO2 gap to T0-PCO2 gap) also predicted a ≥15% change in cardiac index (AUC 745; 95% CI 0.634 - 0.855) with 63.6% sensitivity and 79.1% specificity. The optimal CO2 gap/gap ratio cut-off value was <0.71. A significant difference in 28-day mortality was noted based on the gap/gap ratio. Conclusion. Peri-resuscitation ∆PCO2 and the gap/gap ratio are useful non-invasive bedside markers for predicting changes in CO and preload responsiveness.

show abstract

Section: Discussionmentioning

confidence: 99%

CO2 gap changes compared with cardiac output changes in response to intravenous volume expansion and/or vasopressor therapy in septic shock

Faris,

El-Houfi,

El Shahat

et al. 2024

South Afr J Crit Care

View full text Add to dashboard Cite

show abstract

“…Both cohorts received FB with Plasma-Lyte A (Baxter Healthcare, Deerfield, IL) and were assessed for fluid responsiveness using transthoracic echocardiography. The methods and the results of the first trial have been previously described (13). The second cohort of patients represents a part of an ongoing prospective observational trial (ISRCTN58464956).…”

Section: Design and Settingmentioning

confidence: 99%

Evaluating the efficacy of a standardized 4 mL/kg fluid bolus technique in critically ill patients with elevated PvaCO2: secondary analysis of two prospective studies

Attou,

Du,

Velissaris

et al. 2024

Front. Med.

Self Cite

View full text Add to dashboard Cite

BackgroundLimiting the fluid bolus (FB) volume may attenuate side effects, including hemodilution and increased filling pressures, but it may also reduce hemodynamic responsiveness. The minimum volume to create hemodynamic effects is considered to be 4 mL/kg. In critically ill patients, the hemodynamic effects of FB with this volume have not been adequately investigated and compared to higher quantities. We hypothesized that a standardized FB approach using 4 mL/kg has comparable hemodynamic and metabolic effects to the common practice of physician-determined FB in critically ill patients.MethodsWe conducted post hoc analysis of two trials in non-selected critically ill patients with central venous-to-arterial CO2 tension (PvaCO2) >6 mmHg and no acute bleeding. All patients received crystalloids either at a physician-determined volume and rate or at 4 mL/kg pump-administered at 1.2 L/h. Cardiac index (CI) was calculated with transthoracic echocardiogram, and arterial and venous blood gas samples were assessed before and after FB. Endpoints were changes in CI and oxygen delivery (DO2) >15%.ResultsA total of 47 patients were eligible for the study, 15 of whom received physician-determined FB and 32 of whom received standardized FB. Patients in the physician-determined FB group received 16 (12–19) mL/kg at a fluid rate of 1.5 (1.5–1.9) L/h, compared to 4.1 (3.7–4.4) mL/kg at a fluid rate of 1.2 (1.2–1.2) L/h (p < 0.01) in the standardized FB group. The difference in CI elevations between the two groups was not statistically significant (8.8% [−0.1–19.9%] vs. 8.4% [0.3–23.2%], p = 0.76). Compared to physician-determined FB, the standardized FB technique had similar probabilities of increasing CI or DO2 by >15% (odds ratios: 1.3 [95% CI: 0.37–5.18], p = 0.66 and 1.83 [95% CI: 0.49–7.85], p = 0.38).ConclusionA standardized FB protocol (4 mL/kg at 1.2 L/h) effectively reduced the volume of fluid administered to critically ill patients without compromising hemodynamic or metabolic effects.

show abstract

“…The PCO 2 gap mainly indicates the adequacy of CO to remove CO 2 from the venous blood [32]. Accordingly, a recent study showed that it well follows that changes in CO during a fluid bolus [33]. The ratio of pCO 2 gap over the arteriovenous difference in oxygen content (pCO 2 gap/C(a-v)O 2 ) has been suggested as an indicator of anaerobic metabolism [31,32].…”

Section: Sophisticated or Advanced Monitoring Systems: Transpulmonary...mentioning

confidence: 99%

Which haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?

Monnet

Lai

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of reviewTo discuss the suitable haemodynamic monitoring for critically ill patients with shock.Recent findingsFor the basic initial monitoring, recent studies emphasized the importance of clinical signs of hypoperfusion and arterial pressure. This basic monitoring is not sufficient in patients resisting to initial treatment. Echocardiography does not allow multidaily measurements and has limitations, for measuring right or left ventricular preload. For a more continuous monitoring, noninvasive and minimally invasive tools are insufficiently reliable, as recently confirmed, and informative. The most invasive techniques, transpulmonary thermodilution and the pulmonary arterial catheter are more suitable. Their effect on outcome is lacking, although recent studies showed their benefit in acute heart failure. For assessing tissue oxygenation, recent publications better defined the meaning of the indices derived from the partial pressure of carbon dioxide. The integration of all data by artificial intelligence is the subject of early research in critical care.SummaryFor monitoring critically ill patients with shock, minimally or noninvasive systems are not reliable or informative enough. In the most severe patients, a reasonable monitoring policy can combine continuous monitoring by transpulmonary thermodilution systems or the pulmonary arterial catheter, with an intermittent assessment with ultrasound and measurement of tissue oxygenation.

show abstract

Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients

Cited by 5 publications

References 33 publications

CO2 gap changes compared with cardiac output changes in response to intravenous volume expansion and/or vasopressor therapy in septic shock

CO2 gap changes compared with cardiac output changes in response to intravenous volume expansion and/or vasopressor therapy in septic shock

Evaluating the efficacy of a standardized 4 mL/kg fluid bolus technique in critically ill patients with elevated PvaCO2: secondary analysis of two prospective studies

Which haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?

Contact Info

Product

Resources

About