A Donati

A Dubin

AB Groeneveld

AE Jones

B Lamia

B Levy

B Vallet

Benoit Tavernier

Benoit Vallet

CE Mecher

Collaborative Study Group on Perioperative ScvO2 Monitoring

D Dindo

E Bennett-Guerrero

E Futier

E Rivers

Emmanuel Futier

Emmanuel Robin

F Vallee

G Gutierrez

Gilles Lebuffe

HJ Silverman

J Bakker

J Cuschieri

J Levraut

J Textoris

JL Teboul

JR Gall Le

JV Pope

Maher Fleyfel

Oscar Pires

PA Beest van

R Neviere

R Pearse

S Jhanji

S Perz

SJ Shepherd

SM Lobo

ST Gurgel

TC Jansen

WC Shoemaker

English

AbstractIntroductionThe purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2gap) in high-risk surgical patients admitted to a postoperative ICU. We hypothesized that PCO2gap could serve as a useful tool to identify patients still requiring hemodynamic optimization at ICU admission.MethodsOne hundred and fifteen patients were included in this prospective single-center observational study during a 1-year period. High-risk surgical inclusion criteria were adapted from Schoemaker and colleagues. Demographic and biological data, PCO2gap, central venous oxygen saturation, lactate level and postoperative complications were recorded for all patients at ICU admission, and 6 hours and 12 hours after admission.ResultsA total of 78 (68%) patients developed postoperative complications, of whom 54 (47%) developed organ failure. From admission to 12 hours after admission, there was a significant difference in mean PCO2gap (8.7 ± 2.8 mmHg versus 5.1 ± 2.6 mmHg;P = 0.001) and median lactate values (1.54 (1.1-3.2) mmol/l versus 1.06 (0.8-1.8) mmol/l;P = 0.003) between patients who developed postoperative complications and those who did not. These differences were maximal at admission to the ICU. At ICU admission, the area under the receiver operating characteristic curve for occurrence of postoperative complications was 0.86 for the PCO2gap compared to Sequential Organ Failure Assessment score (0.82), Simplified Acute Physiology Score II score (0.67), and lactate level (0.67). The threshold value for PCO2gap was 5.8 mmHg. Multivariate analysis showed that only a high PCO2gap and a high Sequential Organ Failure Assessment score were independently associated with the occurrence of postoperative complications. A high PCO2gap (≥6 mmHg) was associated with more organ failure, an increase in duration of mechanical ventilation and length of hospital stay.ConclusionA high PCO2gap at admission in the postoperative ICU was significantly associated with increased postoperative complications in high-risk surgical patients. If the increase in PCO2gap is secondary to tissue hypoperfusion then the PCO2gap might be a useful tool complementary to central venous oxygen saturation as a therapeutic target.</jats:sec

Crossref

Critical Care

Central venous-to-arterial carbon dioxide difference as a prognostic tool in high-risk surgical patients

https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-015-0917-6?site=ccforum.biomedcentral.com

Central venous-to-arterial carbon dioxide difference as a prognostic tool in high-risk surgical patients

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