Cousin Vladimir L, Joye Raphael, Wacker Julie, Beghetti Maurice, Polito Angelo
Réanimation Pédiatrique, Women, Child and Adolescent Department, Geneva University Hospital, 1205 Geneva, Switzerland.
Pediatric Cardiology Unit, Women, Child and Adolescent Department, Geneva University Hospital, 1205 Geneva, Switzerland.
J Cardiovasc Dev Dis. 2023 May 10;10(5):208. doi: 10.3390/jcdd10050208.
Shock is a life-threatening condition, and its timely recognition is essential for adequate management. Pediatric patients with congenital heart disease admitted to a cardiac intensive care unit (CICU) after surgical corrections are particularly at risk of low cardiac output syndrome (LCOS) and shock. Blood lactate levels and venous oxygen saturation (ScVO) are usually used as shock biomarkers to monitor the efficacy of resuscitation efforts, but they are plagued by some limitations. Carbon dioxide (CO)-derived parameters, namely veno-arterial CO difference (ΔCCO) and the VCO/VO ratio, may represent a potentially valuable addition as sensitive biomarkers to assess tissue perfusion and cellular oxygenation and may represent a valuable addition in shock monitoring. These variables have been mostly studied in the adult population, with a strong association between ΔCCO or VCO/VO ratio and mortality. In children, particularly in CICU, few studies looked at these parameters, while they reported promising results on the use of CO-derived indices for patients' management after cardiac surgeries. This review focuses on the physiological and pathophysiological determinants of ΔCCO and VCO/VO ratio while summarizing the actual state of knowledge on the use of CO-derived indices as hemodynamical markers in CICU.
休克是一种危及生命的状况，及时识别对于妥善处理至关重要。接受手术矫正后入住心脏重症监护病房（CICU）的先天性心脏病儿科患者尤其有发生低心排血量综合征（LCOS）和休克的风险。血乳酸水平和静脉血氧饱和度（ScVO）通常用作休克生物标志物以监测复苏效果，但它们存在一些局限性。二氧化碳（CO）衍生参数，即静脉 - 动脉CO差值（ΔCCO）和VCO/VO比值，可能作为评估组织灌注和细胞氧合的敏感生物标志物，为休克监测增添潜在的有价值信息。这些变量大多在成年人群中进行研究，ΔCCO或VCO/VO比值与死亡率之间存在密切关联。在儿童中，特别是在CICU，很少有研究关注这些参数，不过他们报告了在心脏手术后使用CO衍生指标进行患者管理方面取得的有前景的结果。本综述重点关注ΔCCO和VCO/VO比值的生理和病理生理决定因素，同时总结关于在CICU中使用CO衍生指标作为血流动力学标志物的实际知识状况。
