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Veno‐arterial carbon dioxide and pH gradients and survival in critical illness
Author(s) -
LIND L.
Publication year - 1995
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.1995.tb01549.x
Subject(s) - medicine , septic shock , carbon dioxide , cardiac index , sepsis , shock (circulatory) , gastroenterology , hemodynamics , cardiac output , cardiology , chemistry , organic chemistry
. Recent studies have shown that the veno‐arterial gradient for carbon dioxide (dVVApCO 2 ) is increased in the case of low cardiac index (CI). In order to further investigate this matter 220 haemody‐namic measurements from 34 patients with septic shock and from 28 patients in the post‐operative state without sepsis were evaluated. The arterio‐venous gradient for pH (dAVVpH) was also evaluated. CI was found to be inversely correlated to both dVVApCO 2 and dAVVpH when the two groups of patients were analysed separately ( r = ‐0.76 and r = ‐0.78, P < 0.001 for the relationship between CI and dVVApCO 2 , r = ‐0.58 and r = ‐0.69 P <0.001 for the relationship between CI and dAVVpH). When volume loading over 2 h was used to increase CI, 58–66% of_the patients in the two groups showed a decline in dVVApCO 2 > 10% when CI was increased by > 10%. The corresponding values for a reduction in dAVVpH> 10% during volume loading was 36–52%. While dAVVpH was found to be increased in non‐survivors ( n = 27) when compared to survivors (0.32 ± 0.01 vs. 0.24±0.1, P <0.05) at the second day in the IUC, dVVApCO 2 was not a significant predictor of mortality despite the fact that CI was found to be decreased in the non‐survivors (3.5 ±0.94 vs. 4.3±1.0 L min ‐1 m ‐2 , P <0.01). In conclusion, the veno‐arterial carbon dioxide gradient was found to be inversely correlated to cardiac performance in patients both in patients with septic shock and in non‐septic post‐operative patients. The arterio‐venous gradient for pH was increased in low flow states, but this association was weaker. However of these two indices evaluated, only a raised dAVVpH was a significant predictor of later mortality.