Understanding elevated Pv-aCO2 gap and Pv-aCO2/Ca-vO2 ratio in venous hyperoxia condition

He, Huaiwu; Liu, Dawei; İnce, Can

doi:10.1007/s10877-017-0005-3

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…There are contradictory results on ∆Pv-aCO 2 /∆Ca-vO 2 ratio and its relationship with mortality mainly because the cut-off point is poorly defined. The ranges oscillate between 1.4 to 1.7 mmHg/mL; values above this point are associated with increased mortality in different studies [ 13 ]. A recent meta-analysis indicates that ∆Pv-aCO 2 /∆Ca-vO 2 ratio predicts mortality in patients with septic shock, mainly when measured at 6 hours of admission (Risk Ratio (RR) = 1.89, 95% CI 1.48–2.41, p = <0.01) but the best cut-off point is not defined [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ∆Pv-aCO 2 is a good indicator of venous blood flow in peripheral tissues [ 12 ]. When blood flow is appropriate (ideal cardiac output), CO 2 will be well removed, and the ∆Pv-aCO 2 will be ≤ 6 mmHg; but without proper blood flow, CO 2 will be poorly removed, and the ∆Pv-aCO 2 will be >6 mmHg (non-ideal cardiac output) [ 13 ]. Some factors can modify ∆Pv-aCO 2 , such as hyper- or hypoventilation, hypo- or hyperoxemia, fever or hypothermia, decreased or increased hemoglobin, and deficit or excess hydrogen ions, which should be considered [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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The ∆Pv-aCO2/∆Ca-vO2 ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19

Sánchez Díaz,

Peniche Moguel,

Reyes-Ruiz

et al. 2023

PLoS ONE

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Objective To evaluate the central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (∆Pv-aCO2/∆Ca-vO2 ratio) as a predictor of mortality in patients with COVID-19-related severe acute respiratory distress syndrome (ARDS). Methods Patients admitted to the intensive care unit with severe ARDS secondary to SARS-CoV-2, and invasive mechanical ventilation were included in this single-center and retrospective cohort study performed between April 18, 2020, and January 18, 2022. The tissue perfusion indexes (lactate, central venous oxygen saturation [ScvO2], and venous-to-arterial carbon dioxide pressure difference [∆Pv-aCO2]), anaerobic metabolism index (∆Pv-aCO2/∆Ca-vO2 ratio), and severity index (Simplified Acute Physiology Score II [SAPSII]) were evaluated to determine its association with the mortality through Cox regression analysis, Kaplan-Meier curve and receiver operating characteristic (ROC) curve. Results One hundred fifteen patients were included in the study and classified into two groups, the survivor group (n = 54) and the non-survivor group (n = 61). The lactate, ScvO2, ∆Pv-aCO2, and ∆Pv-aCO2/∆Ca-vO2 ratio medians were 1.6 mEq/L, 75%, 5 mmHg, and 1.56 mmHg/mL, respectively. The ∆Pv-aCO2/∆Ca-vO2 ratio (Hazard Ratio (HR) = 1.17, 95% confidence interval (CI) = 1.06–1.29, p = 0.001) was identified as a mortality biomarker for patients with COVID-19-related severe ARDS. The area under the curve for ∆Pv-aCO2/∆Ca-vO2 ratio was 0.691 (95% CI 0.598–0.774, p = 0.0001). The best cut-off point for ∆Pv-aCO2/∆Ca-vO2 ratio was >2.14 mmHg/mL, with a sensitivity of 49.18%, specificity of 85.19%, a positive likelihood of 3.32, and a negative likelihood of 0.6. The Kaplan-Meier curve showed that survival rates were significantly worse in patients with values greater than this cut-off point. Conclusions The ∆Pv-aCO2/∆Ca-vO2 ratio could be used as a predictor of mortality in patients with severe ARDS secondary to SARS-CoV-2.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The ∆Pv-aCO2/∆Ca-vO2 ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19

Sánchez Díaz,

Peniche Moguel,

Reyes-Ruiz

et al. 2023

PLoS ONE

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“…Where: CaO2 is arterial oxygen content and CvO2 is venous oxygen content. (33)(34)(35). In 2016, in patients with septic shock admitted to our ICU, it was found that ∆p(v-a)CO2/∆C(a-v)O2 > 1.4, measured 24 hours after admission, increases the risk of 30-day mortality by 5.49 (95% CI [1.07-28.09]), p = 0.04, and is an independent predictor of mortality.…”

Section: Development Central Venous Oxygen Saturation (Svco2)mentioning

confidence: 94%

Hemodynamic monitoring with two blood gases: “a tool that does not go out of style”

Sánchez-Díaz

Moguel

Rivera-Solís

et al. 2020

Colomb. J. Anesthesiol.

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Introduction. Hemodynamic monitoring of a critically ill patient is an indispensable tool both inside and outside intensive care; we currently have invasive, minimally invasive and non-invasive devices; however, no device has been shown to have a positive impact on the patient's evolution; arterial and venous blood gases provide information on the patient's actual microcirculatory and metabolic status and may be a hemodynamic monitoring tool. Objective. To carry out a non-systematic review of the literature of hemodynamic monitoring carried out through the variables obtained in arterial and venous blood gases. Material and methods. A non-systematic review of the literature was performed in the PubMed, OvidSP and ScienceDirect databases with selection of articles from 2000 to 2019. Results. It was found that there are variables obtained in arterial and venous blood gases such as central venous oxygen saturation (SvcO2), venous-to-arterial carbon dioxide pressure (∆pv-aCO2), venous-to-arterial carbon dioxide pressure/arteriovenous oxygen content difference (∆pv-aCO2/∆Ca-vO2) that are related to cellular oxygenation, cardiac output (CO), microcirculatory veno-arterial flow and anaerobic metabolism and allow to assess tissue perfusion status. Conclusion. The variables obtained by arterial and venous blood gases allow for non-invasive, accessible and affordable hemodynamic monitoring that can guide medical decision-making in critically ill patients.

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“…(I) Hyperoxia: Saludes et al (15) found that an elevated P(v-a)CO 2 could independently result from a hyperoxia (caused by breathing 100% O 2 for 5 min) but not from an inadequate cardiac output in the septic patients. Several potential mechanisms should be taken on how hyperoxia cause an increase in P(v-a)CO 2 are as following: firstly, a high P(v-a)CO 2 could be derived from the impaired microcirculatory flow caused by arterial hyperoxia (16). It has been shown that normobaric hyperoxia decreases capillary perfusion and VO 2 and increases the heterogeneity of the perfusion (17).…”

Section: Pitfalls Of P(v-a)co 2 In Assessing Global Flow and Tissue Pmentioning

confidence: 99%

Interpretation of venous-to-arterial carbon dioxide difference in the resuscitation of septic shock patients

Yuan

Long

2019

J. Thorac. Dis

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Understanding elevated Pv-aCO2 gap and Pv-aCO2/Ca-vO2 ratio in venous hyperoxia condition

Cited by 9 publications

References 14 publications

The ∆Pv-aCO2/∆Ca-vO2 ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19

The ∆Pv-aCO2/∆Ca-vO2 ratio as a predictor of mortality in patients with severe acute respiratory distress syndrome related to COVID-19

Hemodynamic monitoring with two blood gases: “a tool that does not go out of style”

Interpretation of venous-to-arterial carbon dioxide difference in the resuscitation of septic shock patients

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