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Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients

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Abstract

Purpose

To investigate the interchangeability of mixed and central venous-arterial carbon dioxide differences and the relation between the central difference (pCO2 gap) and cardiac index (CI). We also investigated the value of the pCO2 gap in outcome prediction.

Methods

We performed a post hoc analysis of a well-defined population of 53 patients with severe sepsis or septic shock. Mixed and central venous pCO2 were determined earlier at a 6 h interval (T = 0 to T = 4) during the first 24 h after intensive care unit (ICU) admittance. The population was divided into two groups based on pCO2 gap (cut off value 0.8 kPa).

Results

The mixed pCO2 difference underestimated the central pCO2 difference by a mean bias of 0.03± 0.32 kPa (95 % limits of agreement: −0.62–0.58 kPa). We observed a weak relation between pCO2 gap and CI. The in hospital mortality rate was 21 % (6/29) for the low gap group and 29 % (7/24) for the high gap group; the odds ratio was 1.6 (95 % CI 0.5–5.5), p = 0.53. At T = 4 the odds ratio was 5.3 (95 % CI 0.9–30.7); p = 0.08.

Conclusions

From a practical perspective, the clinical utility of central venous pCO2 values is of potential interest in determining the venous-arterial pCO2 difference. The likelihood of a bad outcome seems to be enhanced when a high pCO2 gap persists after 24 h of therapy.

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Authors and Affiliations

  1. Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 30001, 9700 RB, Groningen, The Netherlands

    Paul A. van Beest

  2. Department of Intensive Care Medicine, Medical Center Leeuwarden, 888, 8901 BR, Leeuwarden, The Netherlands

    Mariska C. Lont, Michaël A. Kuiper & E. Christiaan Boerma

  3. Department of Intensive Care Medicine, Martini Hospital, 30033, 9700 RM, Groningen, The Netherlands

    Nicole D. Holman & Bert Loef

  4. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, L.E.I.C.A. Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Michaël A. Kuiper

  5. HERMES Critical Care Group, Amsterdam, The Netherlands

    Michaël A. Kuiper

Authors
  1. Paul A. van Beest
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  2. Mariska C. Lont
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  3. Nicole D. Holman
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  4. Bert Loef
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  5. Michaël A. Kuiper
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  6. E. Christiaan Boerma
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Corresponding author

Correspondence to Paul A. van Beest.

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van Beest, P.A., Lont, M.C., Holman, N.D. et al. Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients. Intensive Care Med 39, 1034–1039 (2013). https://doi.org/10.1007/s00134-013-2888-x

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  • DOI: https://doi.org/10.1007/s00134-013-2888-x

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