Prognostic Value of Venoarterial Carbon Dioxide Gradient in Patients with Severe Sepsis and Septic Shock

Troskot, Rosana; Šimurina, Tatjana; Žižak, Mirza; Majstorović, Karolina; Marinac, Ivana; Mrakovčić-Šutić, Ines

doi:10.3325/cmj.2010.51.501

Cited by 19 publications

(16 citation statements)

References 33 publications

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“…In the current study, there was no correlation between central and pulmonary CO2 gaps with cardiac output. , many studies [12,25,27] stated an increased central CO2 gap in low cardiac output states due to venous flow stasis which decreased with increased cardiac output . Cuschieri et al [25] showed the correlation between the central CO2 gap and the pulmonary CO2 gap with cardiac index.…”

Section: Discussionmentioning

confidence: 99%

“…Cuschieri et al [25] showed the correlation between the central CO2 gap and the pulmonary CO2 gap with cardiac index. Troskot et al [12] concluded in their study of patients with severe sepsis and septic shock that the central CO2 gradient could predict fatal outcomes in non-ventilated patients only. Also, Mallat et al [11] in their study on 80 patients with sepsis, measured the central CO2 gap and cardiac index using PICCO technology at time 0 (start of the study) and at time 6 (6 hours after resuscitation) and found a correlation between CO2 gap and CI at T0 (r = -0.69, P<0.0001) and at T6 (r = -0.54 P<0.0001).…”

Section: Discussionmentioning

confidence: 99%

“…Normally, Pulm(P-a) CO2 does not exceed 6 mmHg. Elevated [Pulm(P-a) CO2] gradient has been observed in all types of circulatory failure (cardiogenic, obstructive, hypovolemic and distributive shock) [12].…”

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confidence: 99%

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The Validity of Central Venous to Arterial Carbon Dioxide Difference to Predict Adequate Fluid Management during Living Donor Liver Transplantation. A prospective observational study.

Elayashy

Hosny

Hussein

et al. 2019

Preprint

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Background: to assess the validity of Central and Pulmonary CO2 gaps to predict and guide fluid management during liver transplantation. Methods: Intraoperative fluid management was guided by pulse pressure variations (PPV). PPV of ≥15% triggered fluid resuscitation with 250 ml albumin 5% boluses to restoret PPV to <15%. Simultaneous blood sampling from central venous and pulmonary artery catheters (PAC) were clolected to calculate central and pulmonary CO2 gap. Patients were considered Fluid Responsive (FRS) if fluid boluses restored PPV to <15% and Fluid non-Responsive (FnRS) if not. CO and lactate and their correlation to CO2 gaps were also recorded. Results: The discriminative ability of Central and Pulmonary CO2 gaps between the two statuses (FRS and FnRS) was poor. AUC of ROC were 0.698 and 0.570 respectively. The Central CO2 gap was significantly higher in FRS than FnRS (P=0.016), with no difference in Pulmonary CO2 gap between both statuses. conclusion: Central and the Pulmonary CO2 gaps cannot be used alone as valid tools to predict fluid responsiveness and guide fluid management during liver transplantation. CO2 gaps do not correlate well with the changes in PPV or CO Trial registration: Clinicaltrials.gov NCT03123172. Registered on 31-march-2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Validity of Central Venous to Arterial Carbon Dioxide Difference to Predict Adequate Fluid Management during Living Donor Liver Transplantation. A prospective observational study.

Elayashy

Hosny

Hussein

et al. 2019

Preprint

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“…Additionally, studies in critically ill adults after abdominal surgery or with septic shock demonstrated that patients with an increased AVCO 2 gradient were more likely to have increased postoperative complications and poor outcomes, including death - even in patients who had a normal ScVO 2 (>70%) (6, 9, 22–23). In our cohort, increased AVCO 2 was associated with poor outcome even after controlling for STAT category and other covariates.…”

Section: Discussionmentioning

confidence: 99%

“…Widening of AVCO 2 represents an imbalance between CO and tissue CO 2 production. AVCO 2 monitoring is gaining momentum as a surrogate of CO in critically ill adults; an increased AVCO 2 gradient is associated with decreased CO and morbidity in adult patients with shock from hemorrhage sepsis, and cardiac surgery (1–9). …”

Section: Introductionmentioning

confidence: 99%

Central Venous to Arterial Co 2 Difference After Cardiac Surgery in Infants and Neonates*

Rhodes

Erwin

Borasino

et al. 2017

Pediatric Critical Care Medicine

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Objective Venous to arterial carbon dioxide difference (AVCO2) correlates with cardiac output (CO) in critically ill adults, but its utility in pediatric patients is unclear. We sought to correlate AVCO2 with other CO surrogates (arteriovenous oxygen saturation difference [AVO2], central venous oxygen saturation [ScVO2], and lactate); as well as investigate its capacity to predict poor outcomes associated with low cardiac output (LCOS) in infants after cardiac surgery with cardiopulmonary bypass (CPB). Design Retrospective chart review. Poor outcome was defined as any: inotrope score > 15; death, cardiac arrest, ECMO, unplanned surgical re-intervention. Setting Pediatric cardiovascular intensive care unit Patients 139 infants <90d who underwent CPB, from October 2012 to May 2015. Measurement and Main Results 296 arterial and venous blood gas pairs from admission (n=139), 6hrs (n=62), 12hrs (n=73), 24hrs (n=22) were included in analysis. For all pairs, AVCO2 was moderately correlated with AVO2 (R2= 0.53, p<0.01) and ScVO2 (R2= −0.43, p<0.01), but not lactate. On admission AVCO2 was also moderately correlated with ScVO2 (R2= 0.-0.40, p<0.01) and AVO2 (R2= 0.55, p<0.01), but not lactate. 34/139 neonates (24.5%) had poor outcome. Median admission AVCO2 was 5.9 mm Hg (3.8, 9.2). Patients with poor outcome had median admission AVCO2 8.3 mmHg (5.6, 14.9) vs. 5.4 (3.0, 8.4) in those without poor outcome. AVCO2 (AUC=0.69, p<0.01), serum lactate (AUC=0.64, p=0.02) and ScVO2 (AUC=0.74, p<0.01) were predictive of poor outcome. After controlling for covariates, admission AVCO2 remained significantly associated with poor outcome [OR 1.3, 95% CI: 1.1–1.45], including independent association with mortality, [OR 1.2 (95% CI 1.07–1.31)]. Conclusions AVCO2 is correlated with important surrogates of CO, and is associated with poor outcome and mortality related to LCOS after cardiac surgery in infants. Prospective validation of these findings, including confirmation that AVCO2 can identify LCOS in real-time is warranted.

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Distributive Shock

Hussain

Kuzkov

Киров

2021

Advanced Hemodynamic Monitoring: Basics and New Horizons

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Prognostic Value of Venoarterial Carbon Dioxide Gradient in Patients with Severe Sepsis and Septic Shock

Abstract: V-a Pco(2) was a significant predictor of fatal outcome only in the non-ventilated group of patients. Ventilated patients are more likely to be admitted with a less favorable clinical status, and other variables seem to have a more important role in their outcome.

Cited by 19 publications

References 33 publications

The Validity of Central Venous to Arterial Carbon Dioxide Difference to Predict Adequate Fluid Management during Living Donor Liver Transplantation. A prospective observational study.

The Validity of Central Venous to Arterial Carbon Dioxide Difference to Predict Adequate Fluid Management during Living Donor Liver Transplantation. A prospective observational study.

Central Venous to Arterial Co 2 Difference After Cardiac Surgery in Infants and Neonates*

Distributive Shock

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