Venous–arterial CO2 difference in children with sepsis and its correlation with myocardial dysfunction

Abstract

Objective: This study aimed to determine the association between venous–arterial CO2 difference (Pv-aCO2) and clinical outcomes of interest in children with severe sepsis and septic shock. Design: An analytical observational study of a prospective cohort was conducted. Setting: The study was carried out from January 2015 to January 2018 in the pediatric intensive care unit of a referral hospital. Materials and methods: Of a total of 1159 patients who were admitted to pediatric critical care, 375 had severe sepsis and septic shock, of which 67 fulfilled the inclusion criteria. Arterial and venous gases were drawn simultaneously with a transthoracic echocardiogram, Pv-aCO2, and other measures of tissue perfusion such as arterial lactate, venous, and evolution to multiple organ failure. Measurements and main results: Half (53.7%) of the patients were under 24 months old, with a slight predominance of male patients. The main site of infection was the lungs in 56% of the cases, with a 91.2% survival rate. Patients who died had a higher venous lactate level (interquartile range 16.2–33.6, p = 0.02). However, there was no correlation between myocardial dysfunction seen on echocardiogram and a Pv-aCO2 greater than 6 mm Hg in children with severe sepsis and septic shock (r = 0.13). Pv-aCO2 and central venous saturation had low sensitivity to detect multiple organ failure and poor correlation with the number of compromised systems (r = 0.8). Conclusion: Pv-aCO2 was not associated with myocardial dysfunction, measured by echocardiogram, in children with severe sepsis and septic shock. It also did not correlate with the number of organs involved or mortality.

Central venous-to-arterial CO2 difference as a biomarker of outcome in children who underwent surgery for congenital heart disease

“…However, in this study, the correlation between cardiac index measured by thermodilution and ∆CO 2 was weak (r = 0.25, p < 0.01). In pediatric patients with severe sepsis, Fernández-Sarmiento et al also found no correlation between ejection fraction measured by transthoracic echocardiography and ∆CO 2 (r = 0.13) 11 . In contrast, in a group of adult cardiovascular surgery patients, Takami and Masumoto found a moderate correlation between cardiac index and ∆CO 2 (r = 0.35, p < 0.001) and between venous saturation and ∆CO 2 (r = 0.35, p < 0.001) 10 .…”

“…Decreased tissue blood flow (ischemic hypoxia) is associated with venous hypercapnia due to cellular anoxia resulting in increased CO 2 production 11 . The increase in arterial CO 2 depends on gas exchange and, because it is very efficient at the alveolar level, it is not significantly affected by decreased pulmonary flow.…”

Use of CO2-Derived Variables in Cardiac Intensive Care Unit: Pathophysiology and Clinical Implications

“…Studies in the pediatric population are scarce and showed promising but conflicting results. A recent pediatric study in children with septic shock failed to detect a clear association between higher ∆PCO 2 and CO measures [75].…”

Monitorización de la perfusión tisular en el niño con disfunción circulatoria aguda: revisión narrativa

“…No se han demostrado diferencias referentes a su monitorización en forma continua o intermitente en pacientes pediátricos con shock séptico 48 ni tampoco se ha visto asociación con la detección de falla multiorgánica 49 . Importantemente, un valor normal no descarta la existencia de alteración en la perfusión tisular dado que esto puede determinar una menor extracción de oxígeno 39 (Figura 3).…”