ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass

Background: Cardiac surgery is associated with a substantial risk of major adverse events. Although carbon dioxide (CO2)-derived variables such as venous-to-arterial CO2 difference (ΔPCO2), and PCO2 gap to arterial–venous O2 content difference ratio (ΔPCO2/C(a−cv)O2) have been successfully used to p...

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Autores principales:	Sheng Zhang, Dan Zheng, Xiao-Qiong Chu, Yong-Po Jiang, Chun-Guo Wang, Qiao-Min Zhang, Lin-Zhu Qian, Wei-Ying Yang, Wen-Yuan Zhang, Tao-Hsin Tung, Rong-Hai Lin
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	venous-to-arterial carbon dioxide difference base excess lactate cardiopulmonary bypass organ dysfunction Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/712cbca29b1446358424688cf1235d45
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spelling	oai:doaj.org-article:712cbca29b1446358424688cf1235d452021-12-01T22:11:19ZΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass2297-055X10.3389/fcvm.2021.759826https://doaj.org/article/712cbca29b1446358424688cf1235d452021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.759826/fullhttps://doaj.org/toc/2297-055XBackground: Cardiac surgery is associated with a substantial risk of major adverse events. Although carbon dioxide (CO2)-derived variables such as venous-to-arterial CO2 difference (ΔPCO2), and PCO2 gap to arterial–venous O2 content difference ratio (ΔPCO2/C(a−cv)O2) have been successfully used to predict the prognosis of non-cardiac surgery, their prognostic value after cardiopulmonary bypass (CPB) remains controversial. This hospital-based study explored the relationship between ΔPCO2, ΔPCO2/C(a−cv)O2 and organ dysfunction after CPB.Methods: We prospectively enrolled 114 intensive care unit patients after elective cardiac surgery with CPB. Patients were divided into the organ dysfunction group (OI) and non-organ dysfunction group (n-OI) depending on whether organ dysfunction occurred or not at 48 h after CPB. ΔPCO2 was defined as the difference between central venous and arterial CO2 partial pressure.Results: The OI group has 37 (32.5%) patients, 27 of which (23.7%) had one organ dysfunction and 10 (8.8%) had two or more organ dysfunctions. No statistical significance was found (P = 0.84) for ΔPCO2 in the n-OI group at intensive care unit (ICU) admission (9.0, 7.0–11.0 mmHg), and at 4 (9.0, 7.0–11.0 mmHg), 8 (9.0, 7.0–11.0 mmHg), and 12 h post admission (9.0, 7.0–11.0 mmHg). In the OI group, ΔPCO2 also showed the same trend [ICU admission (9.0, 8.0–12.8 mmHg) and 4 (10.0, 7.0–11.0 mmHg), 8 (10.0, 8.5–12.5 mmHg), and 12 h post admission (9.0, 7.3–11.0 mmHg), P = 0.37]. No statistical difference was found for ΔPCO2/C(a−cv)O2 in the n-OI group (P = 0.46) and OI group (P = 0.39). No difference was detected in ΔPCO2, ΔPCO2/C(a−cv)O2 between groups during the first 12 h after admission (P > 0.05). Subgroup analysis of the patients with two or more failing organs compared to the n-OI group showed that the predictive performance of lactate and Base excess (BE) improved, but not of ΔPCO2 and ΔPCO2/C(a−cv)O2. Regression analysis showed that the BE at 8 h after admission (odds ratio = 1.37, 95%CI: 1.08–1.74, P = 0.009) was a risk factor for organ dysfunction 48 h after CBP.Conclusion : ΔPCO2 and ΔPCO2/C(a−cv)O2 cannot be used as reliable indicators to predict the occurrence of organ dysfunction at 48 h after CBP due to the pathophysiological process that occurs after CBP.Sheng ZhangDan ZhengXiao-Qiong ChuYong-Po JiangChun-Guo WangQiao-Min ZhangLin-Zhu QianWei-Ying YangWen-Yuan ZhangTao-Hsin TungRong-Hai LinFrontiers Media S.A.articlevenous-to-arterial carbon dioxide differencebase excesslactatecardiopulmonary bypassorgan dysfunctionDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	venous-to-arterial carbon dioxide difference base excess lactate cardiopulmonary bypass organ dysfunction Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	venous-to-arterial carbon dioxide difference base excess lactate cardiopulmonary bypass organ dysfunction Diseases of the circulatory (Cardiovascular) system RC666-701 Sheng Zhang Dan Zheng Xiao-Qiong Chu Yong-Po Jiang Chun-Guo Wang Qiao-Min Zhang Lin-Zhu Qian Wei-Ying Yang Wen-Yuan Zhang Tao-Hsin Tung Rong-Hai Lin ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass
description	Background: Cardiac surgery is associated with a substantial risk of major adverse events. Although carbon dioxide (CO2)-derived variables such as venous-to-arterial CO2 difference (ΔPCO2), and PCO2 gap to arterial–venous O2 content difference ratio (ΔPCO2/C(a−cv)O2) have been successfully used to predict the prognosis of non-cardiac surgery, their prognostic value after cardiopulmonary bypass (CPB) remains controversial. This hospital-based study explored the relationship between ΔPCO2, ΔPCO2/C(a−cv)O2 and organ dysfunction after CPB.Methods: We prospectively enrolled 114 intensive care unit patients after elective cardiac surgery with CPB. Patients were divided into the organ dysfunction group (OI) and non-organ dysfunction group (n-OI) depending on whether organ dysfunction occurred or not at 48 h after CPB. ΔPCO2 was defined as the difference between central venous and arterial CO2 partial pressure.Results: The OI group has 37 (32.5%) patients, 27 of which (23.7%) had one organ dysfunction and 10 (8.8%) had two or more organ dysfunctions. No statistical significance was found (P = 0.84) for ΔPCO2 in the n-OI group at intensive care unit (ICU) admission (9.0, 7.0–11.0 mmHg), and at 4 (9.0, 7.0–11.0 mmHg), 8 (9.0, 7.0–11.0 mmHg), and 12 h post admission (9.0, 7.0–11.0 mmHg). In the OI group, ΔPCO2 also showed the same trend [ICU admission (9.0, 8.0–12.8 mmHg) and 4 (10.0, 7.0–11.0 mmHg), 8 (10.0, 8.5–12.5 mmHg), and 12 h post admission (9.0, 7.3–11.0 mmHg), P = 0.37]. No statistical difference was found for ΔPCO2/C(a−cv)O2 in the n-OI group (P = 0.46) and OI group (P = 0.39). No difference was detected in ΔPCO2, ΔPCO2/C(a−cv)O2 between groups during the first 12 h after admission (P > 0.05). Subgroup analysis of the patients with two or more failing organs compared to the n-OI group showed that the predictive performance of lactate and Base excess (BE) improved, but not of ΔPCO2 and ΔPCO2/C(a−cv)O2. Regression analysis showed that the BE at 8 h after admission (odds ratio = 1.37, 95%CI: 1.08–1.74, P = 0.009) was a risk factor for organ dysfunction 48 h after CBP.Conclusion : ΔPCO2 and ΔPCO2/C(a−cv)O2 cannot be used as reliable indicators to predict the occurrence of organ dysfunction at 48 h after CBP due to the pathophysiological process that occurs after CBP.
format	article
author	Sheng Zhang Dan Zheng Xiao-Qiong Chu Yong-Po Jiang Chun-Guo Wang Qiao-Min Zhang Lin-Zhu Qian Wei-Ying Yang Wen-Yuan Zhang Tao-Hsin Tung Rong-Hai Lin
author_facet	Sheng Zhang Dan Zheng Xiao-Qiong Chu Yong-Po Jiang Chun-Guo Wang Qiao-Min Zhang Lin-Zhu Qian Wei-Ying Yang Wen-Yuan Zhang Tao-Hsin Tung Rong-Hai Lin
author_sort	Sheng Zhang
title	ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass
title_short	ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass
title_full	ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass
title_fullStr	ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass
title_full_unstemmed	ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass
title_sort	δpco2 and δpco2/c(a−cv)o2 are not predictive of organ dysfunction after cardiopulmonary bypass
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/712cbca29b1446358424688cf1235d45
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ΔPCO2 and ΔPCO2/C(a−cv)O2 Are Not Predictive of Organ Dysfunction After Cardiopulmonary Bypass

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