The Use of the Ratio between the Veno-arterial Carbon Dioxide Difference and the Arterial-venous Oxygen Difference to Guide Resuscitation in Cardiac Surgery Patients with Hyperlactatemia and Normal Central Venous Oxygen Saturation

Wei Du, Yun Long, Xiao-Ting Wang, Da-Wei Liu, Wei Du, Yun Long, Xiao-Ting Wang, Da-Wei Liu

Abstract

Background: After cardiac surgery, central venous oxygen saturation (ScvO 2 ) and serum lactate concentration are often used to guide resuscitation; however, neither are completely reliable indicators of global tissue hypoxia. This observational study aimed to establish whether the ratio between the veno-arterial carbon dioxide and the arterial-venous oxygen differences (P(v-a)CO 2 /C(a-v)O 2 ) could predict whether patients would respond to resuscitation by increasing oxygen delivery (DO 2 ).

Methods: We selected 72 patients from a cohort of 290 who had undergone cardiac surgery in our institution between January 2012 and August 2014. The selected patients were managed postoperatively on the Intensive Care Unit, had a normal ScvO 2 , elevated serum lactate concentration, and responded to resuscitation by increasing DO 2 by >10%. As a consequence, 48 patients responded with an increase in oxygen consumption (VO 2 ) while VO 2 was static or fell in 24.

Results: At baseline and before resuscitative intervention in postoperative cardiac surgery patients, a P(v-a)CO 2 /C(a-v)O 2 ratio ≥1.6 mmHg/ml predicted a positive VO 2 response to an increase in DO 2 of >10% with a sensitivity of 68.8% and a specificity of 87.5%.

Conclusions: P(v-a)CO 2 /C(a-v)O 2 ratio appears to be a reliable marker of global anaerobic metabolism and predicts response to DO 2 challenge. Thus, patients likely to benefit from resuscitation can be identified promptly, the P(v-a)CO 2 /C(a-v)O 2 ratio may, therefore, be a useful resuscitation target.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Study flow chart. PiCCO: Pulse contour continuous cardiac output; ScvO2: Central venous oxygen saturation; DO2: Oxygen delivery.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve. ROC curve comparing the P(v−a)CO2/C(a−v)O2 ratio to an increase in oxygen consumption (VO2) brought about by increasing oxygen delivery (DO2) by >10% in cardiac surgical patients. Area under the curve: 0.77 ± 0.10, P = 0.032, The cutoff of the P(v−a)CO2/C(a−v)O2 ratio value was 1.6 for predicting cardiac surgery patients in whom VO2 would increase when DO2 increased by >10%, resulting in a sensitivity of 68.8% and a specificity of 87.5%.

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