Insom Giulia, Marinari Eleonora, Scolari Anna Francesca, Garisto Cristiana, Vitale Vincenzo, Di Chiara Luca, Ricci Zaccaria
Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Cardiol Young. 2021 Apr;31(4):597-601. doi: 10.1017/S1047951120004357. Epub 2020 Dec 9.
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.
动静脉二氧化碳分压差一直被视为低心输出量的一个指标。本研究旨在评估心脏手术后儿童动静脉二氧化碳分压差与通过MostCareTM估算的心指数之间的相关性，以及它与其他间接灌注参数和复杂临床病程（血管活性药物评分高于15或住院时间超过5天）的关联。有40例患者术后0至5天用于计算差值的127次动脉和静脉二氧化碳测量数据。动静脉二氧化碳分压差的中位数（范围）为9（1至25 mmHg）。动静脉二氧化碳分压差与心指数之间的相关性不显著（r：-0.16，p = 0.08）。然而，动静脉二氧化碳分压差与血管活性药物评分（r：0.21，p = 0.02）、收缩动脉压（r：-0.43，p = 0.0001）、dP/dtMAX（r：0.26，p = 0.004）以及动静脉氧分压差（r：0.63，p = 0.0001）之间存在显著相关性。收缩动脉压（OR 0.95，95% CI 0.90 - 0.99）、dP/dtMAX（OR 0.00，95% CI 0.00 - 0.06）、乳酸（OR 1.87，95% CI 1.21 - 3.31）和动静脉二氧化碳分压差（OR 1.13，95% CI 1.01 - 1.35）与复杂临床病程存在显著的单因素关联。总之，在我们的心脏手术后儿童队列中，动静脉二氧化碳分压差与通过MostCareTM估算的心指数不相关，但它能识别出具有复杂临床病程的患者，尤其是与其他直接和间接灌注变量相结合时。
