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Observational Study
. 2021 Sep 10;16(9):e0257314.
doi: 10.1371/journal.pone.0257314. eCollection 2021.

Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients

Charalampos Pierrakos  1 , David De Bels  1 , Thomas Nguyen  1 , Dimitrios Velissaris  2 , Rachid Attou  1 , Jacques Devriendt  1 , Patrick M Honore  1 , Fabio Silvio Taccone  3 , Daniel De Backer  4
Affiliations
Observational Study

Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients

Charalampos Pierrakos et al. PLoS One. .

Abstract

Background: In this prospective observational study, we evaluated the effects of fluid bolus (FB) on venous-to-arterial carbon dioxide tension (PvaCO2) in 42 adult critically ill patients with pre-infusion PvaCO2 > 6 mmHg.

Results: FB caused a decrease in PvaCO2, from 8.7 [7.6-10.9] mmHg to 6.9 [5.8-8.6] mmHg (p < 0.01). PvaCO2 decreased independently of pre-infusion cardiac index and PvaCO2 changes during FB were not correlated with changes in central venous oxygen saturation (ScvO2) whatever pre-infusion CI. Pre-infusion levels of PvaCO2 were inversely correlated with decreases in PvaCO2 during FB and a pre-infusion PvaCO2 value < 7.7 mmHg could exclude a decrease in PvaCO2 during FB (AUC: 0.79, 95%CI 0.64-0.93; Sensitivity, 91%; Specificity, 55%; p < 0.01).

Conclusions: Fluid bolus decreased abnormal PvaCO2 levels independently of pre-infusion CI. Low baseline PvaCO2 values suggest that a positive response to FB is unlikely.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Evolution of central venous-to-arterial carbon dioxide tension difference (PvaCO2) during fluid bolus.
Fig 2
Fig 2. Relationship between absolute changes in PvaCO2 (Δ PvaCO2) during fluid bolus and absolute changes in cardiac index (Δ CI).
Panel A: Patients with CI ≤ 2.2 L/min/m2; Panel B: Patients with CI > 2.2 L/min/m2. d CI: relative to baseline values changes in CI. The horizontal dotted line corresponds to Δ PvaCO2−2 mmHg. Triangle points represent “Fluid responders” (d CI > 15%) and circle points “Fluid non-responders” (d CI ≤ 15%).
Fig 3
Fig 3. Relationship between baseline PvaCO2 and changes in PvaCO2 (Δ PvaCO2) during fluid bolus.
Panel A: Patients with CI ≤ 2.2 L/min/m2; Panel B: Patients with CI > 2.2 L/min/m2. The vertical dotted line corresponds to the baseline PvaCO2 8mmHg. The horizontal dotted line corresponds to Δ PvaCO2−2 mmHg.
See this image and copyright information in PMC

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