Back to Search
Start Over
Comparison of the venous-arterial CO 2 to arterial-venous O 2 content difference ratio with the venous-arterial CO 2 gradient for the predictability of adverse outcomes after cardiac surgery.
- Source :
-
Journal of clinical monitoring and computing [J Clin Monit Comput] 2020 Feb; Vol. 34 (1), pp. 41-53. Date of Electronic Publication: 2019 Feb 22. - Publication Year :
- 2020
-
Abstract
- This study aimed to compare the prognostic performance of the ratio of mixed and central venous-arterial CO <subscript>2</subscript> tension difference to arterial-venous O <subscript>2</subscript> content difference (Pv-aCO <subscript>2</subscript> /Ca-vO <subscript>2</subscript> and Pcv-aCO <subscript>2</subscript> /Ca-cvO <subscript>2</subscript> , respectively) with that of the mixed and central venous-to-arterial carbon dioxide gradient (Pv-aCO <subscript>2</subscript> and Pcv-aCO <subscript>2</subscript> , respectively) for adverse events after cardiac surgery. One hundred and ten patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled. After catheter insertion, three blood samples were withdrawn simultaneously through arterial pressure, central venous, and pulmonary artery catheters, before and at the end of the operation, and preoperative and postoperative values were determined. The primary end-point was set as the incidence of postoperative major organ morbidity and mortality (MOMM). Receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were performed to evaluate the prognostic reliability of Pv-aCO <subscript>2</subscript> , Pcv-aCO <subscript>2</subscript> , Pv-aCO <subscript>2</subscript> /Ca-vO <subscript>2</subscript> , and Pcv-aCO <subscript>2</subscript> /Ca-cvO <subscript>2</subscript> for MOMM. MOMM events occurred in 25 patients (22.7%). ROC curve analysis revealed that both postoperative Pv-aCO <subscript>2</subscript> /Ca-vO <subscript>2</subscript> and Pcv-aCO <subscript>2</subscript> /Ca-cvO <subscript>2</subscript> were significant predictors of MOMM. However, postoperative Pv-aCO <subscript>2</subscript> was the best predictor of MOMM (area under the curve [AUC]: 0.804; 95% confidence interval [CI] 0.688-0.921), at a 5.1-mmHg cut-off, sensitivity was 76.0%, and specificity was 74.1%. Multivariate analysis revealed that postoperative Pv-aCO <subscript>2</subscript> was an independent predictor of MOMM (odds ratio [OR]: 1.42, 95% CI 1.01-2.00, pā=ā0.046) and prolonged ICU stay (OR: 1.45, 95% CI 1.05-2.01, pā=ā0.024). Pv-aCO <subscript>2</subscript> at the end of cardiac surgery was a better predictor of postoperative complications than Pv-aCO <subscript>2</subscript> /Ca-vO <subscript>2</subscript> and Pcv-aCO <subscript>2</subscript> /Ca-cvO <subscript>2</subscript> .
- Subjects :
- Aged
Area Under Curve
Cardiac Surgical Procedures adverse effects
Cardiopulmonary Bypass
Female
Heart Ventricles
Humans
Intensive Care Units
Male
Middle Aged
Multivariate Analysis
Oxygen blood
Postoperative Period
Preoperative Period
Prognosis
ROC Curve
Reproducibility of Results
Risk Factors
Shock, Septic blood
Treatment Outcome
Arteries metabolism
Blood Gas Analysis
Carbon Dioxide blood
Heart Diseases surgery
Veins metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1573-2614
- Volume :
- 34
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of clinical monitoring and computing
- Publication Type :
- Academic Journal
- Accession number :
- 30796642
- Full Text :
- https://doi.org/10.1007/s10877-019-00286-z