Improving the prognostic value of ∆PCO2 following cardiac surgery: a prospective pilot study
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Conflicting results have been published on prognostic significance of central venous to arterial PCO2 difference (∆PCO2) after cardiac surgery. We compared the prognostic value of ∆PCO2 on intensive care unit (ICU) admission to an original algorithm combining ∆PCO2, ERO2 and lactate to identify different risk profiles. Additionally, we described the evolution of ∆PCO2 and its correlations with ERO2 and lactate during the first postoperative day (POD1). In this monocentre, prospective, and pilot study, 25 patients undergoing conventional cardiac surgery were included. Central venous and arterial blood gases were collected on ICU admission and at 6, 12 and 24 h postoperatively. High ∆PCO2 (≥ 6 mmHg) on ICU admission was found to be very frequent (64% of patients). Correlations between ∆PCO2 and ERO2 or lactate for POD1 values and variations were weak or non-existent. On ICU admission, a high ∆PCO2 did not predict a prolonged ICU length of stay (LOS). Conversely, a significant increase in both ICU and hospital LOS was observed in high-risk patients identified by the algorithm: 3.5 (3.0–6.3) days versus 7.0 (6.0–8.0) days (p = 0.01) and 12.0 (8.0–15.0) versus 8.0 (8.0–9.0) days (p < 0.01), respectively. An algorithm incorporating ICU admission values of ∆PCO2, ERO2 and lactate defined a high-risk profile that predicted prolonged ICU and hospital stays better than ∆PCO2 alone.
KeywordsCardiac surgery Central venous- arterial pCO2 difference Tissue perfusion Lactic acid Oxygen extraction ratio
The proofreading of this article was supported by the Bibliothèque Scientifique de l’Internat de Lyon and the Hospices Civils de Lyon.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
According to the French law and because data were collected during routine care, authorization was granted to waive written informed consent. However, verbal consent was obtained from all study participants before surgery.
- 10.Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, et al. S3 Guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system. Ger Med Sci. 2010;8:Doc12.Google Scholar
- 11.Habicher M, von Heymann C, Spies CD, Wernecke K-D, Sander M. Central venous-arterial pCO2 difference identifies microcirculatory hypoperfusion in cardiac surgical patients with normal central venous oxygen saturation: a retrospective analysis. J Cardiothorac Vasc Anesth. 2015;29(3):646–55.CrossRefGoogle Scholar
- 14.Vallet B, Teboul JL, Cain S, Curtis S. Venoarterial CO(2) difference during regional ischemic or hypoxic hypoxia. J Appl Physiol Bethesda Md. 1985;2000(89):1317–21.Google Scholar
- 18.Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the european society of intensive care medicine. Intensive Care Med. 1996;22:707–10.CrossRefGoogle Scholar
- 25.Ospina-Tascón GA, Umaña M, Bermúdez W, Bautista-Rincón DF, Hernandez G, Bruhn A, et al. Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock. Intensive Care Med. 2015;41:796–805.CrossRefGoogle Scholar