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Yamaguti T, Auler Junior JOC, Dallan LAO, Galas FRBG, Cunha LCC, Piccioni MDA. Markers of Tissue Perfusion as Predictors of Adverse Outcomes in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery. Arq Bras Cardiol 2024; 121:e20230247. [PMID: 38597532 DOI: 10.36660/abc.20230247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/14/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Cardiac surgery patients may be exposed to tissue hypoperfusion and anaerobic metabolism. OBJECTIVE To verify whether the biomarkers of tissue hypoperfusion have predictive value for prolonged intensive care unit (ICU) stay in patients with left ventricular dysfunction who underwent coronary artery bypass surgery. METHODS After approval by the institution's Ethics Committee and the signing of informed consent, 87 patients with left ventricular dysfunction (ejection fraction < 50%) undergoing coronary artery bypass surgery were enrolled. Hemodynamic and metabolic biomarkers were collected at five time points: after anesthesia, at the end of the surgery, at ICU admission, and at six and twelve hours after. An analysis of variance for repeated measures followed by a Bonferroni post hoc test was used for repeated, continuous variables (hemodynamic and metabolic variables) to determine differences between the two groups over the course of the study period. The level of statistical significance adopted was 5%. RESULTS Thirty-eight patients (43.7%) who presented adverse outcomes were older, higher Euro score (p<0.001), and elevated ΔpCO2 as analyzed 12 hours after ICU admission (p<0.01), while increased arterial lactate concentration at 6 hours postoperatively was found to be a negative predictive factor (p<0.01). CONCLUSIONS Euro SCORE, six-hour postoperative arterial lactate, 12-hour postoperative ΔPCO2, and eRQ are independent predictors of adverse outcomes in patients with left ventricular dysfunction after cardiac surgery.
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Affiliation(s)
- Thiana Yamaguti
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - José Otavio Costa Auler Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luís Alberto Oliveira Dallan
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Ligia Cristina Câmara Cunha
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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Lyu Y, Han T, Liu M, Cui K, Wang D. The Prediction of Surgery Outcomes in Abdominal Tumor Patients with Sepsis by Pcv-aCO2/Ca-cvO2. Ther Clin Risk Manag 2022; 18:989-997. [PMID: 36238956 PMCID: PMC9552675 DOI: 10.2147/tcrm.s374414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022] Open
Abstract
Background To determine whether Pcv-aCO2/Ca-cvO2 combined with Pcv-aCO2 could predict the outcomes in patients complicated with abdominal infection and sepsis after abdominal tumor operation. Methods Total 92 patients admitted to our hospital from January 2017 to December 2020 who underwent abdominal tumor operation were enrolled. Blood gas analysis of artery and central vein, various laboratory indexes, SOFA score, hemodynamic parameters at different time points and treatment outcome were recorded. Results ROC curve analysis showed that hemodynamic parameter alone could not predict ICU treatment outcome and mortality of patients, but 72-hour SOFA score could predict treatment outcome of patients (AUC = 0.930, 95% CI: 0.803–1.000, p = 0.019). The significant hemodynamic parameter for evaluating treatment outcome and prognosis of patients was Pcv-aCO2 + Ratio of T3. Kaplan–Meier univariate survival curve and Log-rank suggested that patients who had higher combined predictive parameter of T3 Ratio + T3 Pcv-aCO2 still had ischemia and hypoxia of tissues and organs after standard fluid resuscitation, and treatment outcome was not good. In subgroup analysis, patients with higher Ratio had higher lactate, higher T72 SOFA score, and poor treatment outcome. Conclusion The combination of Ratio and Pcv-aCO2 could evaluate clinical treatment outcome of patients complicated with abdominal infection and sepsis after abdominal tumor operation.
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Affiliation(s)
- Yang Lyu
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Tao Han
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Meirong Liu
- Department of Infectious Diseases, Tianjin Hospital, Tianjin, People’s Republic of China
| | - Keliang Cui
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Donghao Wang
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, People’s Republic of China,Correspondence: Donghao Wang, Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People’s Republic of China, Email
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3
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Leitner BP, Siebel S, Akingbesote ND, Zhang X, Perry RJ. Insulin and cancer: a tangled web. Biochem J 2022; 479:583-607. [PMID: 35244142 PMCID: PMC9022985 DOI: 10.1042/bcj20210134] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022]
Abstract
For a century, since the pioneering work of Otto Warburg, the interwoven relationship between metabolism and cancer has been appreciated. More recently, with obesity rates rising in the U.S. and worldwide, epidemiologic evidence has supported a link between obesity and cancer. A substantial body of work seeks to mechanistically unpack the association between obesity, altered metabolism, and cancer. Without question, these relationships are multifactorial and cannot be distilled to a single obesity- and metabolism-altering hormone, substrate, or factor. However, it is important to understand the hormone-specific associations between metabolism and cancer. Here, we review the links between obesity, metabolic dysregulation, insulin, and cancer, with an emphasis on current investigational metabolic adjuncts to standard-of-care cancer treatment.
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Affiliation(s)
- Brooks P. Leitner
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Stephan Siebel
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Pediatrics, Yale School of Medicine, New Haven, CT, U.S.A
| | - Ngozi D. Akingbesote
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Xinyi Zhang
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Rachel J. Perry
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
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Ratio of venous-to-arterial PCO 2 to arteriovenous oxygen content difference during regional ischemic or hypoxic hypoxia. Sci Rep 2021; 11:10172. [PMID: 33986417 PMCID: PMC8119496 DOI: 10.1038/s41598-021-89703-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
The purpose of the study was to evaluate the behavior of the venous-to-arterial CO2 tension difference (ΔPCO2) over the arterial-to-venous oxygen content difference (ΔO2) ratio (ΔPCO2/ΔO2) and the difference between venous-to-arterial CO2 content calculated with the Douglas’ equation (ΔCCO2D) over ΔO2 ratio (ΔCCO2D/ΔO2) and their abilities to reflect the occurrence of anaerobic metabolism in two experimental models of tissue hypoxia: ischemic hypoxia (IH) and hypoxic hypoxia (HH). We also aimed to assess the influence of metabolic acidosis and Haldane effects on the PCO2/CO2 content relationship. In a vascularly isolated, innervated dog hindlimb perfused with a pump-membrane oxygenator system, the oxygen delivery (DO2) was lowered in a stepwise manner to decrease it beyond critical DO2 (DO2crit) by lowering either arterial PO2 (HH-model) or flow (IH-model). Twelve anesthetized and mechanically ventilated dogs were studied, 6 in each model. Limb DO2, oxygen consumption (\documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}\text{O}}_{2}$$\end{document}V˙O2), ΔPCO2/ΔO2, and ΔCCO2D/ΔO2 were obtained every 15 min. Beyond DO2crit, \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}\text{O}}_{2}$$\end{document}V˙O2 decreased, indicating dysoxia. ΔPCO2/ΔO2, and ΔCCO2D/ΔO2 increased significantly only after reaching DO2crit in both models. At DO2crit, ΔPCO2/ΔO2 was significantly higher in the HH-model than in the IH-model (1.82 ± 0.09 vs. 1.39 ± 0.06, p = 0.002). At DO2crit, ΔCCO2D/ΔO2 was not significantly different between the two groups (0.87 ± 0.05 for IH vs. 1.01 ± 0.06 for HH, p = 0.09). Below DO2crit, we observed a discrepancy between the behavior of the two indices. In both models, ΔPCO2/ΔO2 continued to increase significantly (higher in the HH-model), whereas ΔCCO2D/ΔO2 tended to decrease to become not significantly different from its baseline in the IH-model. Metabolic acidosis significantly influenced the PCO2/CO2 content relationship, but not the Haldane effect. ΔPCO2/ΔO2 was able to depict the occurrence of anaerobic metabolism in both tissue hypoxia models. However, at very low DO2 values, ΔPCO2/ΔO2 did not only reflect the ongoing anaerobic metabolism; it was confounded by the effects of metabolic acidosis on the CO2–hemoglobin dissociation curve, and then it should be interpreted with caution.
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Wang M, Liu T, Niu Z, Zuo J, Qi D. Utility of venous-to-arterial carbon dioxide changes to arteriovenous oxygen content ratios in the prognosis of severe sepsis and septic shock: A systematic review and meta-analysis. HONG KONG J EMERG ME 2021. [DOI: 10.1177/1024907921994970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Sepsis patients with insufficient tissue perfusion and hypoxia should be identified and resuscitated immediately. Recently, venous-to-arterial carbon dioxide pressure changes and the arteriovenous oxygen content difference ratio (Pcv-aCO2/Ca-vO2) as a predictor of tissue perfusion recovery and poor prognosis. Objectives: Pcv-aCO2/Ca-vO2 is a substitute for respiratory entropy, the elevation of which indicates a lack of tissue perfusion. Pcv-aCO2/Ca-vO2 can be used as an indicator to predict the prognosis of patients with sepsis or septic shock, but its prognostic value has not been fully evaluated. Here, we have performed a meta-analysis to assess its predictive value for mortality. Methods: Meta-analysis of Observational Studies in Epidemiology group guidelines were followed for this meta-analysis. We searched the comprehensive electronic databases of PubMed, EMBASE, Web of Science, and Cochrane libraries from inception to March 2019, using the terms including “venous-arterial,” “carbon dioxide,” “Shock, Septic,” and related keywords. The Newcastle-Ottawa scale was used for quality evaluation of the literature. A meta-analysis was performed using RevMan 5.3 and Stata 14.0 software to evaluate the effects of Pcv-aCO2/Ca-vO2 on short-term mortality, sequential organ failure assessment, and acute physiology and chronic health evaluation scores in patients with sepsis or septic shock. Results: The final analysis included 13 clinical studies involving a total of 940 subjects. The results of the meta-analysis showed that non-surviving patients had higher Pcv-aCO2/Ca-vO2 than survivors after fluid resuscitation (standardized mean difference = 0.68, 95% confidence interval = 0.24–1.12) and blood samples taken 6 h after resuscitation showed a greater risk of mortality (risk ratio = 1.89, 95% confidence interval = 1.48–2.41) and sequential organ failure assessment scores (mean difference = 1.58, 95% confidence interval = 0.88–2.28, P < 0.01) in patients with high Pcv-aCO2/Ca-vO2. These differences were statistically significant. Conclusion: This meta-analysis indicates that Pcv-aCO2/Ca-vO2 has predictive value for mortality in patients with sepsis or septic shock. Further studies are now required to determine the optimal threshold for predicting sepsis mortality. Prospero Registration: The protocol for this systematic review was registered on PROSPERO (CRD 42019128134).
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Affiliation(s)
- Min Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tianyu Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zheng Niu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jingzhi Zuo
- Emergency Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dunyi Qi
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Lundin A, Dell'anna AM, Peluso L, Nobile L, Annoni F, Creteur J, Rylander C, Taccone FS. Veno-arterial CO 2 difference and respiratory quotient after cardiac arrest: An observational cohort study. J Crit Care 2020; 62:131-137. [PMID: 33360013 DOI: 10.1016/j.jcrc.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To characterize venous-arterial CO2 difference (ΔpCO2) and the respiratory quotient (RQ) in post cardiac arrest patients and evaluate the association between these parameters and patient outcome. MATERIALS AND METHODS Data were obtained retrospectively from post cardiac arrest patients admitted between 2007 and 2016 to a medical intensive care unit. Comatose, adult patients in whom arterial and venous blood gas analyses were concomitantly performed in the first 24 h were included. Patients were grouped according to the time-point of sampling; 0-6, 6-12 and 12-24 h after admission. RESULTS 308 patients were included; 174 (56%) died before ICU discharge and 212 (69%) had an unfavorable neurologic outcome. RQ was associated with ICU mortality (OR:1.09 (95%CI: 1.04-1.14; p < 0.01)), although not with neurological outcome. ΔpCO2 was negatively associated with both ICU mortality (OR: 0.92 (95%CI: 0.86-0.99; p = 0.02)) and poor neurologic outcome (adjusted OR: 0.93 (95%CI: 0.87-0.99; p = 0.02)). ΔpCO2 predicted an elevated RQ; a ΔpCO2 above 8.5 mmHg identified a high RQ with reasonable sensitivity and specificity. CONCLUSIONS RQ was associated with ICU mortality and ΔpCO2 identified elevated RQ in the early phase after cardiac arrest. However, ΔpCO2 were negatively associated with both ICU mortality and neurologic outcome.
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Affiliation(s)
- Andreas Lundin
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45 Gothenburg, Sweden.
| | - Antonio Maria Dell'anna
- Department of Intensive Care, Erasme Hospital, Université́ Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université́ Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Leda Nobile
- Department of Intensive Care, Erasme Hospital, Université́ Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Filippo Annoni
- Department of Intensive Care, Erasme Hospital, Université́ Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université́ Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Christian Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45 Gothenburg, Sweden
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université́ Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
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Bar S, Boivin P, El Amine Y, Descamps R, Moussa M, Abou Arab O, Fischer MO, Dupont H, Lorne E, Guinot PG. Individualized hemodynamic optimization guided by indirect measurement of the respiratory exchange ratio in major surgery: study protocol for a randomized controlled trial (the OPHIQUE study). Trials 2020; 21:958. [PMID: 33228773 PMCID: PMC7682128 DOI: 10.1186/s13063-020-04879-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Observational studies have suggested that a high respiratory exchange ratio (RER) is associated with the occurrence of postoperative complications. The study's primary objective is to demonstrate that the incidence of postoperative complications is lower in an interventional group (patients monitored using a hemodynamic algorithm that incorporates the RER) than in a control group (treated according to standard practice). METHODS We shall perform a prospective, multicenter, randomized, open-label, superiority trial of consecutive patients undergoing major noncardiac surgery (i.e., abdominal, vascular, and orthopedic surgery). The control group will be treated according to the current guidelines on standard hemodynamic care. The interventional group will be treated according to an algorithm based on the RER. The primary outcome will be the occurrence of at least one complication in the 7 days following surgery. The secondary outcomes will be the length of hospital stay, the total number of complications per patient, the 30-day mortality, the total intraoperative volume of fluids administered, and the Sequential [sepsis-related] Organ Failure Assessment (SOFA) score and laboratory data measured on postoperative days 1, 2, and 7. A total of 350 patients will be included. DISCUSSION In the operating theater, the RER is potentially a continuously available, easy-to-read, indirect marker of tissue hypoperfusion and postoperative complications. If the RER does predict the occurrence of tissue hypoperfusion, it will help the physician to provide personalized hemodynamic management and limit the side effects associated with excessive hemodynamic optimization (volume overload, vasoconstriction, etc.). TRIAL REGISTRATION ClinicalTrials.gov NCT03852147 . Registered on February 25, 2019.
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Affiliation(s)
- Stéphane Bar
- Anesthesiology and Critical Care Department, Amiens University Medical Center, Rond-point du Professeur Christian Cabrol, F-80000, Amiens, France.
| | - Pierre Boivin
- Anesthesiology and Critical Care Department, Amiens University Medical Center, Rond-point du Professeur Christian Cabrol, F-80000, Amiens, France
| | - Younes El Amine
- Anesthesiology and Critical Care Department, Valenciennes General Medical Center, Avenue Désandrouins, F-59322, Valenciennes, France
| | - Richard Descamps
- Anesthesiology and Critical Care Department, Normandie University Medical Center, UNICAEN, F-14000, Caen, France
| | - Mouhamed Moussa
- Anesthesiology and Critical Care Department, Lille University Medical Center, Oscar Lambret, F-59037, Lille, France
| | - Osama Abou Arab
- Anesthesiology and Critical Care Department, Amiens University Medical Center, Rond-point du Professeur Christian Cabrol, F-80000, Amiens, France
| | - Marc-Olivier Fischer
- Anesthesiology and Critical Care Department, Normandie University Medical Center, UNICAEN, F-14000, Caen, France
| | - Hervé Dupont
- Anesthesiology and Critical Care Department, Amiens University Medical Center, Rond-point du Professeur Christian Cabrol, F-80000, Amiens, France
| | - Emmanuel Lorne
- Anesthesiology and Critical Care Department, Amiens University Medical Center, Rond-point du Professeur Christian Cabrol, F-80000, Amiens, France
| | - Pierre-Grégoire Guinot
- Anesthesiology and Critical Care Department, Dijon University Medical Center, 2 Bd Maréchal de Lattre de Tassigny, F-21000, Dijon, France
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Gavelli F, Teboul JL, Monnet X. How can CO 2-derived indices guide resuscitation in critically ill patients? J Thorac Dis 2019; 11:S1528-S1537. [PMID: 31388457 DOI: 10.21037/jtd.2019.07.10] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Assessing the adequacy of oxygen delivery with oxygen requirements is one of the key-goal of haemodynamic resuscitation. Clinical examination, lactate and central or mixed venous oxygen saturation (SvO2 and ScvO2, respectively) all have their limitations. Many of them may be overcome by the use of the carbon dioxide (CO2)-derived variables. The venoarterial difference in CO2 tension ("ΔPCO2" or "PCO2 gap") is not an indicator of anaerobic metabolism since it is influenced by the oxygen consumption. By contrast, it reliably indicates whether blood flow is sufficient to carry CO2 from the peripheral tissue to the lungs in view of its clearance: it, thus, reflects the adequacy of cardiac output with the metabolic condition. The ratio of the PCO2 gap with the arteriovenous difference of oxygen content (PCO2 gap/Ca-vO2) might be a marker of anaerobiosis. Conversely to SvO2 and ScvO2, it remains interpretable if the oxygen extraction is impaired as it is in case of sepsis. Compared to lactate, it has the main advantage to change without delay and to provide a real-time monitoring of tissue hypoxia.
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Affiliation(s)
- Francesco Gavelli
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France.,Université Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR S_999, Le Kremlin-Bicêtre, France.,Emergency Medicine Unit, Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Jean-Louis Teboul
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France.,Université Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR S_999, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France.,Université Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR S_999, Le Kremlin-Bicêtre, France
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Mesquida J, Espinal C, Saludes P, Cortés E, Pérez-Madrigal A, Gruartmoner G. Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (P cvaCO 2/C avO 2) reflects microcirculatory oxygenation alterations in early septic shock. J Crit Care 2019; 53:162-168. [PMID: 31247515 DOI: 10.1016/j.jcrc.2019.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/16/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To explore the relationship between central venous-to-arterial carbon dioxide difference (PcvaCO2), PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) and the microcirculatory status, evaluated by using near-infrared spectroscopy, in septic shock patients. METHODS Observational study in a 30-bed mixed ICU. Fifty septic shock patients within the first 24 h of ICU admission were studied. After restoration of mean arterial pressure, hemodynamic, metabolic and microcirculatory parameters were simultaneously evaluated. Local tissue oxygen saturation (StO2), and local hemoglobin index (THI) were measured on the thenar eminence by means of near-infrared spectroscopy. A transient vascular occlusion test was performed in order to obtain StO2 deoxygenation rate (DeO2), local oxygen consumption (nirVO2), and reoxgenation rate (ReO2). RESULTS At inclusion, increased PcvaCO2 values were associated with lower StO2 and THI, whereas increased PcvaCO2/CavO2 values were associated with lower DeO2, nirVO2, and ReO2. Multiple regression models confirmed the association between PcvaCO2/CavO2 and nirVO2, while PcvaCO2 was only related to CI, and not to microcirculatory parameters. CONCLUSIONS In a population of early septic shock patients, increases in PcvaCO2 and PcvaCO2/CavO2 reflected different alterations at the microcirculatory level. While PcvaCO2 was related to global flow, the PcvaCO2/CavO2 ratio was associated to impaired local oxygen utilization and diminished microvascular reactivity.
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Affiliation(s)
- J Mesquida
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - C Espinal
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - P Saludes
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - E Cortés
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain.
| | - A Pérez-Madrigal
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - G Gruartmoner
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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10
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Blood CO2 exchange monitoring, Haldane effect and other calculations in sepsis and critical illness. J Clin Monit Comput 2019; 33:357-358. [DOI: 10.1007/s10877-018-0160-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/21/2018] [Indexed: 11/25/2022]
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Mesquida J, Saludes P, Espinal C, Gruartmoner G. In response: Blood CO 2 exchange monitoring, Haldane effect and other calculations in sepsis and critical illness. J Clin Monit Comput 2018; 33:359-360. [PMID: 29948665 DOI: 10.1007/s10877-018-0170-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J Mesquida
- Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain.
| | - P Saludes
- Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain
| | - C Espinal
- Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain
| | - G Gruartmoner
- Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain
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