Central venous-arterial carbon dioxide difference as an indicator of cardiac index

Cuschieri, Joseph; Rivers, Emanuel P.; Donnino, Michael W.; Katilius, Marius; Jacobsen, Gordon; Nguyen, H. Bryant; Pamukov, Nikolai; Horst, H. Mathilda

doi:10.1007/s00134-005-2602-8

Cited by 145 publications

(113 citation statements)

References 17 publications

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“…In these patients, cardiac index (CI) was calculated according to the Cuschieri formula, which shows close correlation with the CI measured with a PAC. 10 Data collection included central body temperature, heart rate, MAP, CVP, pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure, CI, systemic vascular resistance, lactate level, and mixed-venous oxygen saturation (SvO 2 ).…”

Section: Haemodynamic Monitoringmentioning

confidence: 99%

Low‐dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure

Uil

Lagrand

Spronk

et al. 2009

European J of Heart Fail

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AimsImpaired tissue perfusion is often observed in patients with acute heart failure. We tested whether low-dose nitroglycerin (NTG) improves microcirculatory perfusion in patients admitted for acute heart failure. Methods and resultsIn 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose of 33 mg/min. Using Sidestream Dark Field (SDF) imaging, sublingual microvascular perfusion was evaluated before (T0, average of two baseline measurements) and 15 min after initiation of NTG (T1). In a subgroup of seven patients, SDF measurements were repeated after NTG had been stopped for 20 min. Capillaries were defined as microvessels with a diameter of ,20 mm. Perfused capillary density (PCD) was determined as the parameter of tissue perfusion. Values are expressed as median and interquartile range (P25; P75). The median age of the subjects was 60 (52; 73) years, and 65% were male. Patients were stable before starting NTG. Nitroglycerin decreased central venous pressure [17 (13; 19) mmHg at T0 vs. 16 (13; 17) mmHg at T1, P ¼ 0.03] and pulmonary capillary wedge pressure [23 (18; 31) mmHg at T0 vs. 19 (16; 25) mmHg at T1, P ¼ 0.03]. It increased PCD [10.7 (9.9; 12.5) mm mm 22 at T0 vs. 12.4 (11.4; 13.6) mm mm 22 at T1, P ¼ 0.01]. After cessation of NTG, PCD returned to baseline values (P ¼ 0.04). ConclusionLow-dose NTG significantly reduces cardiac filling pressures and improves microvascular perfusion in patients admitted for acute heart failure.--

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Section: Haemodynamic Monitoringmentioning

confidence: 99%

Low‐dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure

Uil

Lagrand

Spronk

et al. 2009

European J of Heart Fail

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“…En nuestro estudio la correlación entre estas determinaciones fue muy similar a la descrita en pacientes cardioquirúrgicos 12 y bastante menor a la descrita en pacientes sépticos 11 . El punto de corte identificado para detectar hipodébito fue mayor que lo previamente publicado, entre 6 y 7 mmHg 11,13,16 . Estas diferencias pudieran atribuirse a que estudiamos un modelo pediátrico de disfunción pulmonar primaria, mientras que los otros estudios incluyeron predominantemente pacientes adultos con shock séptico o cardiogénico.…”

Section: Discussionunclassified

“…La pCO 2 obtenida de un catéter venoso central, medida en vena cava superior, ha mostrado una buena correlación con su determinación en sangre venosa mixta [9][10][11] , evitando la instalación de un catéter en arteria pulmonar [12][13][14] . Existe información insuficiente en pacientes y modelos pediátricos respecto a la capacidad de la ΔVACO 2 para detectar estados de hipodébito.…”

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Diferencia veno-arterial de dióxido de carbono como predictor de gasto cardiaco disminuido en modelo pediátrico experimental

et al. 2012

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“…Several studies indicate that the correlation of gradient measured from both sites are well correlated with cardiac output [19,20], both values have good agreement [13], and central venous measured gradient is useful in identifying inadequately resuscitated [12] or poor outcome patients [13] in septic shock.…”

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confidence: 99%

The venous–arterial partial pressure of carbon dioxide as a new monitoring of circulatory disorder: no so simple

Viale

2016

J Clin Monit Comput

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Restoring or maintaining an optimal oxygen supply adjusted to oxygen demand remains the key aim of all clinicians facing a circulatory dysfunction, whatever the cause. Many therapeutic tools are available, ranging from adequate fluid resuscitation, cardio or vaso-active agents, to adjuvant therapies and various ventilatory supports. Most of the challenges for clinicians are the choice of therapeutics, their dosage, and management of their potential interactions. In addition, in the course of circulatory distress, it would be of great help to identify patients at risk of developing organ dysfunction, in order to intensify and adapt treatment of such individuals. As a guide to achieve these purposes, normalisation of mixed venous oxygen saturation and blood lactate has been proposed as endpoint resuscitations but revealed unsuccessful in several clinical studies [1][2][3]. The monitoring of the mixed venous-arterial gradient in partial pressure of carbon dioxide [p(mv-a)CO 2 ] has been recently put forward and revealed promising. A high CO 2 gradient would indicate an inadequate organ perfusion and a risk of delayed organ dysfunction. Have we reached a satisfactory answer to a main clinical question?In this issue Morel et al.[4] retrospectively analysed 220 consecutive patients admitted in intensive care unit after an elective cardiac surgery. Monitoring p(mv-a)CO 2 , they observed at the 6th postoperative hour a group of 55 patients having a gradient greater than 6 mm Hg. Surprisingly and contrary to previous published results, these patients experienced a lower SOFA score, hospital and 6 month mortality. The authors concluded that in this clinical setting, the CO 2 gradient is not predictive of poor outcome. This apparently paradoxical results is on line with other works underlying the poor discriminative value of the gradient [5]. Rather than the premature conclusion of a promising story, this is more likely a plea to gain more insight in our knowledge about a complex indicator.The p(mv-a)CO 2 is the difference between two partial pressures of CO 2 : the mixed venous and the arterial. The normal value is commonly held as lower than 6 mm Hg. The venous pressure depends on several components, the content of mixed venous in CO 2 , and the relationship between the concentration and the pressure. The content itself is a concentration, that is to say the ratio of the amount of CO 2 driven from peripheral organs to the amount of blood arising from the same organs or segments of organs. The arterial pressure depends on the lung function and is strictly proportional to the alveolar ventilation. Given a constant alveolar ventilation, this arterial pressure remains stable provided that the venous pressure is not modified. If an increase in mixed venous pCO 2 occurs, the amount of CO 2 exhaled by the lung will increase, enlarging the venous-arterial gradient. This role of the lung is schematically illustrated by the increase in end-tidal partial pressure of CO 2 occurring soon after the release of a tourniquet. Any small i...

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Central venous-arterial carbon dioxide difference as an indicator of cardiac index

Abstract: Venous-arterial pCO(2) differences obtained from both the PA and CV circulations inversely correlate with the cardiac index. Substitution of a central for a mixed venous-arterial pCO(2) difference provides an accurate alternative method for calculation of cardiac output.

Cited by 145 publications

References 17 publications

Low‐dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure

Low‐dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure

Diferencia veno-arterial de dióxido de carbono como predictor de gasto cardiaco disminuido en modelo pediátrico experimental

The venous–arterial partial pressure of carbon dioxide as a new monitoring of circulatory disorder: no so simple

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