Journal Article

Use of COsub.2-Derived Variables in Cardiac Intensive Care Unit: Pathophysiology and Clinical Implications

Beghetti, Maurice, Cousin, Vladimir L, Wacker, Julie, Polito, Angelo, Joye, Raphael

2023

Overview

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[sub.2]) are usually used as shock biomarkers to monitor the efficacy of resuscitation efforts, but they are plagued by some limitations. Carbon dioxide (CO[sub.2])-derived parameters, namely veno-arterial CO[sub.2] difference (ΔCCO[sub.2]) and the VCO[sub.2]/VO[sub.2] 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[sub.2] or VCO[sub.2]/VO[sub.2] ratio and mortality. In children, particularly in CICU, few studies looked at these parameters, while they reported promising results on the use of CO[sub.2]-derived indices for patients' management after cardiac surgeries. This review focuses on the physiological and pathophysiological determinants of ΔCCO[sub.2] and VCO[sub.2]/VO[sub.2] ratio while summarizing the actual state of knowledge on the use of CO[sub.2]-derived indices as hemodynamical markers in CICU.

• Publisher: MDPI AG