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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2016

Open Access 01-02-2016 | Original

Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock?

Authors: Gustavo A. Ospina-Tascón, Mauricio Umaña, William F. Bermúdez, Diego F. Bautista-Rincón, Juan D. Valencia, Humberto J. Madriñán, Glenn Hernandez, Alejandro Bruhn, César Arango-Dávila, Daniel De Backer

Published in: Intensive Care Medicine | Issue 2/2016

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Abstract

Purpose

Septic shock has been associated with microvascular alterations and these in turn with the development of organ dysfunction. Despite advances in video microscopic techniques, evaluation of microcirculation at the bedside is still limited. Venous-to-arterial carbon dioxide difference (Pv-aCO2) may be increased even when venous O2 saturation (SvO2) and cardiac output look normal, which could suggests microvascular derangements. We sought to evaluate whether Pv-aCO2 can reflect the adequacy of microvascular perfusion during the early stages of resuscitation of septic shock.

Methods

Prospective observational study including 75 patients with septic shock in a 60-bed mixed ICU. Arterial and mixed-venous blood gases and hemodynamic variables were obtained at catheter insertion (T0) and 6 h after (T6). Using a sidestream dark-field device, we simultaneously acquired sublingual microcirculatory images for blinded semiquantitative analysis. Pv-aCO2 was defined as the difference between mixed-venous and arterial CO2 partial pressures.

Results

Progressively lower percentages of small perfused vessels (PPV), lower functional capillary density, and higher heterogeneity of microvascular blood flow were observed at higher Pv-aCO2 values at both T0 and T6. Pv-aCO2 was significantly correlated to PPV (T0: coefficient −5.35, 95 % CI −6.41 to −4.29, p < 0.001; T6: coefficient, −3.49, 95 % CI −4.43 to −2.55, p < 0.001) and changes in Pv-aCO2 between T0 and T6 were significantly related to changes in PPV (R 2 = 0.42, p < 0.001). Absolute values and changes in Pv-aCO2 were not related to global hemodynamic variables. Good agreement between venous-to-arterial CO2 and PPV was maintained even after corrections for the Haldane effect.

Conclusions

During early phases of resuscitation of septic shock, Pv-aCO2 could reflect the adequacy of microvascular blood flow.
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Metadata
Title
Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock?
Authors
Gustavo A. Ospina-Tascón
Mauricio Umaña
William F. Bermúdez
Diego F. Bautista-Rincón
Juan D. Valencia
Humberto J. Madriñán
Glenn Hernandez
Alejandro Bruhn
César Arango-Dávila
Daniel De Backer
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 2/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-4133-2

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