Journal of Clinical Monitoring and Computing

, Volume 33, Issue 2, pp 357–358 | Cite as

Blood CO2 exchange monitoring, Haldane effect and other calculations in sepsis and critical illness

  • Carlo Chiarla
  • Ivo GiovanniniEmail author
Letter to the Editor

We would like to congratulate the Authors [1] for their interesting study and their effort to progressively determine the dominant factor (pH), among the many factors affecting PcvaCO2 and PcvaCO2/CavO2. Indeed, this is important also for clinical practice, because a busy ICU physician may be reluctant to deal with too many symbols, variables and equations, while simpler and well defined final messages are better accepted.

The group of the Authors previously emphasized in another article published in this same journal the importance of the Haldane effect in peculiar conditions (venous hyperoxia) [2]. There, they underscored the importance of the Haldane effect, and in our opinion their conclusions could be reinforced by the significant decrease in central venous pH in hyperoxia, an aspect that was not mentioned in the article. Indeed, another side of the Haldane effect is the O2-linked H+ exchange (which is related, although not quantitatively equivalent, to the O2-linked CO2...


Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Mesquida J, Saludes P, Pérez-Madrigal A, Proença L, Cortes E, Enseñat L, Espinal C, Gruartmoner G. Respiratory quotient estimations as additional prognostic tools in early septic shock. J Clin Monit Comput. 2018. Scholar
  2. 2.
    Saludes P, Proença L, Gruartmoner G, Enseñat L, Pérez-Madrigal A, Espinal C, Mesquida J. Central venous-to-arterial carbon dioxide difference and the effect of venous hyperoxia: a limiting factor, or an additional marker of severity in shock? J Clin Monit Comput. 2017;31:1203–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Klocke RA. Carbon dioxide transport. In: Farhi LE, Tenney SM, editors. Handbook of physiology. The respiratory system, vol. 4. Bethesda: American Physiological Society; 1987. pp. 173–97Google Scholar
  4. 4.
    Teboul JL, Scheeren T. Understanding the Haldane effect. Intensive Care Med. 2017;43:91–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Klocke RA. Mechanism and kinetics of the Haldane effect in human erythrocytes. J Appl Physiol. 1973;35:673–81.CrossRefPubMedGoogle Scholar
  6. 6.
    Giovannini I, Chiarla C, Boldrini G, Castagneto M. Calculation of venoarterial CO2 concentration difference. J Appl Physiol. 1993;74:959–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Douglas AR, Jones NL, Reed JW. Calculation of whole blood CO2 content. J Appl Physiol. 1988;65:473–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Lang W, Zander R. The accuracy of calculated base excess in blood. Clin Chem Lab Med. 2002;40:404–10.CrossRefPubMedGoogle Scholar
  9. 9.
    Singer RB, Hastings AB. An improved clinical method for the estimation of disturbances of the acid-base balance of human blood. Medicine (Baltimore) 1948;27:223–42.CrossRefGoogle Scholar

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© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.CNR-IASI Center for the Pathophysiology of Shock and Biomathematics (Department of Surgical Sciences), Agostino Gemelli HospitalCatholic University of the Sacred Heart School of MedicineRomeItaly

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