Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-18T03:51:57.689Z Has data issue: false hasContentIssue false
  • English
  • Français

Veno-arterial CO2 difference and cardiac index in children after cardiac surgery

Published online by Cambridge University Press:  09 December 2020

Giulia Insom ,
Eleonora Marinari ,
Anna Francesca Scolari ,
Cristiana Garisto ,
Vincenzo Vitale ,
Luca Di Chiara  and
Zaccaria Ricci Open the ORCID record for Zaccaria Ricci [Opens in a new window]
Giulia Insom
Affiliation:
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Eleonora Marinari
Affiliation:
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Anna Francesca Scolari
Affiliation:
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Cristiana Garisto
Affiliation:
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Vincenzo Vitale
Affiliation:
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Luca Di Chiara
Affiliation:
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Zaccaria Ricci*
Affiliation:
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
*
Author for correspondence: Z. Ricci, Department of Cardiology, Cardiac Surgery, and Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy. Tel: +39 0668592449; Fax: +39 0668592607. E-mail: z.ricci@libero.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Veno-arterial CO2 difference has been considered as a marker of low cardiac output. This study aimed to evaluate the correlation between veno-arterial CO2 difference and cardiac index estimated by MostCareTM in children after cardiac surgery and its association with other indirect perfusion parameters and the complex clinical course (vasoactive inotropic score above 15 or length of stay above 5 days).

Data from 40 patients and 127 arterial and venous CO2 measurements for gap calculation taken 0–5 days postoperatively were available. The median (range) veno-arterial CO2 difference value was 9 (1–25 mmHg). The correlation between veno-arterial CO2 difference and cardiac index was not significant (r: −0.16, p = 0.08). However, there was a significant correlation between veno-arterial CO2 difference and vasoactive inotropic score (r: 0.21, p = 0.02), systolic arterial pressure (r: −0.43, p = 0.0001), dP/dtMAX (r: 0.26, p = 0.004), and arterio-venous O2 difference (r: 0.63, p = 0.0001). Systolic arterial pressure (OR 0.95, 95% CI 0.90–0.99), dP/dtMAX (OR 0.00, 95% CI 0.00–0.06), lactates (OR 1.87, 95% CI 1.21–3.31), and veno-arterial CO2 difference (OR 1.13, 95% CI 1.01–1.35) showed a significant univariate association with the complex clinical course. In conclusion, veno-arterial CO2 difference did not correlate with cardiac index estimated by MostCareTM in our cohort of post-cardiosurgical children, but it identified patients with the complex clinical course, especially when combined with other direct and indirect variables of perfusion.

Keywords

Congenital heart diseasecardiac outputhaemodynamic monitoringCO2 delivery
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 4 , April 2021 , pp. 597 - 601
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Skowno, JJ. Hemodynamic monitoring in children with heart disease: overview of newer technologies. Paediatr Anaesth 2019; 29: 467–474.CrossRefGoogle ScholarPubMed
Favia, I, Rizza, A, Garisto, C, et al. Cardiac index assessment by the pressure recording analytical method in infants after paediatric cardiac surgery: a pilot retrospective study. Interact CardioVasc Thorac Surg 2016; 23: 919–923.CrossRefGoogle ScholarPubMed
Ricci, Z, Polito, A, Netto, R, et al. Assessment of modified ultrafiltration hemodynamic impact by pressure recording analytical method during pediatric cardiac surgery. Pediatr Crit Care Med 2013; 14: 390–395.CrossRefGoogle ScholarPubMed
Garisto, C, Favia, I, Ricci, Z, et al. Pressure recording analytical method and bioreactance for stroke volume index monitoring during pediatric cardiac surgery. Paediatr Anaesth 2015; 25: 143–149.CrossRefGoogle ScholarPubMed
Favia, I, Saxena, R, Steely, S, et al. Cardiac output measurement using pressure recording analytical method vs transpulmonary ultrasound dilution in post cardiac surgery children: multicenter analysis. Pediatr Crit Care Med 2014; 1: 126 CrossRefGoogle Scholar
Romagnoli, S, Franchi, F, Ricci, Z, Scolletta, S, Payen, D. The Pressure Recording Analytical Method (PRAM): Technical Concepts and Literature Review. J Cardiothorac Vasc Anesth 2017; 31: 1460–1470.CrossRefGoogle ScholarPubMed
Lamia, B, Monnet, X, Teboul, JL. Meaning of Arterio-Venous PCO2 Difference In Circulatory Shock. Minerva Anestesiol 2006; 72: 597–604.Google ScholarPubMed
Gavelli, F, Teboul, JL, Monnet, X. How can CO2 derived indices guide resuscitation in critically ill patients? J Thorac Disease 2019; 11 (Suppl 11): S1528–S1537.CrossRefGoogle ScholarPubMed
Saxena, R, Durward, A, Steeley, S, Murdoch, IA, Tibby, SM. Predicting fluid responsiveness in 100 critically ill children: the effect of baseline contractility. Intensive Care Med 2015; 41: 2161–2169.CrossRefGoogle ScholarPubMed
Marinari, E, Rizza, A, Iacobelli, R, et al. Ventricular-Arterial Coupling in Children and Infants with Congenital Heart Disease After Cardiopulmonary Bypass Surgery: Observational Study. Pediatr Crit Care Med 2019; 20: 753–758.CrossRefGoogle ScholarPubMed
Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.CrossRefGoogle ScholarPubMed
Akamatsu, T, Inata, Y, Tachibana, K, Hatachi, T, Takeuchi, M. Elevated Central Venous to Arterial CO2 Difference Is Not Associated With Poor Clinical Outcomes After Cardiac Surgery With Cardiopulmonary Bypass in Children. Pediatr Crit Care Med 2017; 18: 859–862.CrossRefGoogle Scholar
Rhodes, LA, Erwin, WC, Borasino, S, Cleveland, DC, Alten, JA. Central Venous to Arterial CO2 Difference After Cardiac Surgery in Infants and Neonates. Pediatr Crit Care Med 2017; 18: 228–233.CrossRefGoogle ScholarPubMed
Romagnoli, S, Ricci, Z, Quattrone, D, et al. Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study. Crit Care 2014; 18: 644.CrossRefGoogle ScholarPubMed
Singh, Y, Villaescusa, JU, da Cruz, EM, et al. Recommendations for hemodynamic monitoring for critically ill children-expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24: 620.CrossRefGoogle Scholar
Schumacher, KR, Reichel, RA, Vlasic, JR, et al. Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2014; 148: 589–595.CrossRefGoogle ScholarPubMed