title: High veno-arterial carbon dioxide gradient is not predictive of worst outcome after an elective cardiac surgery: a retrospective cohort study.
abstract: Alteration of tissue perfusion is a main contributor of organ dysfunction. In cardiac surgery, the importance of organ dysfunction is associated with worse outcome. Central venous-arterial difference in CO2tension (ΔCO2) has been proposed as a global marker of the adequacy of tissue perfusion in shock states. We hypothesized that ΔCO2could be increased in case of postoperative organ failure or worse outcome. In this monocentric retrospective cohort study, we retrieved, from our database, 220 consecutive patients admitted in intensive care after an elective cardiac surgery. Four time points were formed: ICU admission, and 6, 24 and 48 h after. A ΔCO2below 6 mmHg defined the normal range values. The SOFA score, intensive care unit and hospital length of stay, hospital and 6-month mortality rate were recorded. We compared patient with low ΔCO2(<6 mmHg) and high ΔCO2(≥6 mmHg). We included 55 (25 %) and 165 patients in low and high ΔCO2groups, respectively. The SOFA score, the hospital and 6 months mortality rate were higher in patients with low ΔCO2. Surprisingly, we did not find results previously published in other surgical settings. In cardiac surgery, ΔCO2has a low predictive value of outcome.
authors.affiliation: Département d'anesthésie réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Étienne, France. jerome.morel@chu-st-etienne.fr.
authors.forename: Jerome
authors.initials: J
authors.lastname: Morel
authors.affiliation: Département d'anesthésie réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Étienne, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Grand
authors.affiliation: Département d'anesthésie réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Étienne, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Axiotis
authors.affiliation: Département d'anesthésie réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Étienne, France.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Bouchet
authors.affiliation: Département d'anesthésie réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Étienne, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Faure
authors.affiliation: Département d'anesthésie réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Étienne, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Auboyer
authors.affiliation: Département de chirurgie cardio-vasculaire, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Étienne, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Vola
authors.affiliation: Département d'anesthésie réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Étienne, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Molliex
mesh_terms: D000368:Aged; D000758:Anesthesia; D001158:Arteries / Q000502:physiology; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood* / Q000737:chemistry; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003422:Critical Care; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk; D013696:Temperature; D013997:Time Factors; D014680:Veins / Q000502:physiology
chemical_list: D002245:Carbon Dioxide
keywords: Carbon dioxide gradient; Cardiac surgery; Organ dysfunction; Tissue perfusion