Titre :

Central venous-to-arterial carbon dioxide difference as a prognostic tool in high-risk surgical patients

Auteur(s) :

Robin, Emmanuel [Auteur]
Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011
Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 [RNMCD]
Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (EGID) - U1011
Futier, Emmanuel [Auteur]
CHU Clermont-Ferrand
Pires, Oscar [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Fleyfel, Maher [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Tavernier, Benoit [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Lebuffe, Gilles [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 [GRITA]
VALLET, BENOIT [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]

Titre de la revue :

Critical care (London, England)

Nom court de la revue :

Crit. Care

Numéro :

19

Pagination :

227

Date de publication :

2015-05-13

ISSN :

1466-609X

Mot(s)-clé(s) en anglais :

Mesh:Risk Factors
Mesh:Prognosis
Mesh:Postoperative Complications/etiology
Mesh:Postoperative Complications/diagnosis*
Mesh:Postoperative Complications/blood*
Mesh:Carbon Dioxide/blood*
Mesh:Catheterization
Mesh:Central Venous/methods*
Mesh:Female
Mesh:Humans
Mesh:Middle Aged
Mesh:Male
Mesh:Aged
Mesh:Blood Gas Analysis/methods*
Mesh:Thoracic Surgical Procedures/adverse effects
Mesh:Prospective Studies

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

BACKGROUND: The purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2 gap) in high-risk surgical patients admitted to a postoperative ICU. ...
Lire la suite >BACKGROUND: The purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2 gap) in high-risk surgical patients admitted to a postoperative ICU. We hypothesized that PCO2 gap could serve as a useful tool to identify patients still requiring hemodynamic optimization at ICU admission. METHODS: One hundred and fifteen patients were included in this prospective single-center observational study during a 1-year period. High-risk surgical inclusion criteria were adapted from Schoemaker and colleagues. Demographic and biological data, PCO2 gap, central venous oxygen saturation, lactate level and postoperative complications were recorded for all patients at ICU admission, and 6 hours and 12 hours after admission. RESULTS: A total of 78 (68%) patients developed postoperative complications, of whom 54 (47%) developed organ failure. From admission to 12 hours after admission, there was a significant difference in mean PCO2 gap (8.7 ± 2.8 mmHg versus 5.1 ± 2.6 mmHg; P = 0.001) and median lactate values (1.54 (1.1-3.2) mmol/l versus 1.06 (0.8-1.8) mmol/l; P = 0.003) between patients who developed postoperative complications and those who did not. These differences were maximal at admission to the ICU. At ICU admission, the area under the receiver operating characteristic curve for occurrence of postoperative complications was 0.86 for the PCO2 gap compared to Sequential Organ Failure Assessment score (0.82), Simplified Acute Physiology Score II score (0.67), and lactate level (0.67). The threshold value for PCO2 gap was 5.8 mmHg. Multivariate analysis showed that only a high PCO2 gap and a high Sequential Organ Failure Assessment score were independently associated with the occurrence of postoperative complications. A high PCO2 gap (≥6 mmHg) was associated with more organ failure, an increase in duration of mechanical ventilation and length of hospital stay. CONCLUSIONS: A high PCO2 gap at admission in the postoperative ICU was significantly associated with increased postoperative complications in high-risk surgical patients. If the increase in PCO2 gap is secondary to tissue hypoperfusion then the PCO2 gap might be a useful tool complementary to central venous oxygen saturation as a therapeutic target.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

CHU Lille
Inserm
Institut Pasteur de Lille
Université de Lille

Collections :

• Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365
• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Date de dépôt :

2019-12-09T16:51:53Z
2020-03-30T15:23:22Z
2020-03-30T15:30:41Z
2021-11-03T08:59:56Z
2022-02-02T09:35:43Z