Venoarterial PCO2 difference: a marker of postoperative cardiac output in children with congenital heart disease.
OBJECTIVE
To determine the relationship between venoarterial carbon dioxide gradient (DeltapCO2) and central venous oxygen saturation (ScvO2) in children after cardiac surgery.


METHODS
A cohort study.


METHODS
The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007.


METHODS
All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery (either radial or femoral) and superior vena cava respectively. Linear regression analysis was performed between ScvO2 and DeltapCO2.


RESULTS
Fifty seven children aged from 5 days to 14 years were included and 272-paired simultaneous arterial and central venous samples were analyzed. Mean venous pCO2 was 47.82+/-9.03 mmHg and mean arterial pCO2 was 40.50+/-9.06 mmHg. One hundred seventy four samples had ScvO2 > 70% with mean DeltapCO2 of 5.44+/-2.55 mmHg and 98 samples had ScvO2 < 70% with mean DeltapCO2 of 9.07+/-3.90 mmHg. With ScvO2 < 70%, 77 samples had DeltapCO2 of > 6 mmHg while only 21 samples had DeltapCO2 of < 6 mmHg (p < 0.001). On the contrary with ScvO2 > 70%, 71 samples had DeltapCO2 of > 6 mmHg and 103 samples had DeltapCO2 of < 6 mmHg. Coefficient of correlation (R2) between 0.340 was ScvO2 and DeltapCO2.


CONCLUSIONS
Elevated DeltapCO2 is practical and can be utilized as a useful adjunct to low ScvO2 in the assessment of low cardiac output syndrome in children after cardiac surgery.
Furqan
Muhammad
M
Department of Paediatrics, The Aga Khan University Hospital, Karachi.
Hashmat
Fahad
F
Amanullah
Munir
M
Khan
Mansoor
M
Durani
Hina K
HK
Anwar-ul-Haque
D000293:Adolescent; D015415:Biomarkers; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D002302:Cardiac Output; D002303:Cardiac Output, Low / Q000097:blood / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D014683:Vena Cava, Superior
D015415:Biomarkers; D002245:Carbon Dioxide; D010100:Oxygen