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. 2024 Apr;28(4):349-354.
doi: 10.5005/jp-journals-10071-24680.

The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study

Kapil G Zirpe  1 , Anand M Tiwari  1 , Atul P Kulkarni  2 , Hrishikesh S Vaidya  1 , Sushma K Gurav  1 , Abhijit M Deshmukh  1 , Prasad B Suryawanshi  1 , Upendrakumar S Kapse  1 , Abhaya P Bhoyar  1 , Piyush A Dhawad  1 , Shameek Mukherjee  1
Affiliations

The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study

Kapil G Zirpe et al. Indian J Crit Care Med. 2024 Apr.

Abstract

Introduction: The usual methods of perfusion assessment in patients with shock, such as capillary refill time, skin mottling, and serial serum lactate measurements have many limitations. Veno-arterial difference in the partial pressure of carbon dioxide (PCO2 gap) is advocated being more reliable. We evaluated serial change in PCO2 gap during resuscitation in circulatory shock and its effect on ICU outcomes.

Materials and methods: This prospective observational study included 110 adults with circulatory shock. Patients were resuscitated as per current standards of care. We recorded invasive arterial pressure, urine output, cardiac index (CI), PCO2 gap at ICU admission at 6, 12, and 24 hours, and various patient outcomes.

Results: Significant decrease in PCO2 gap was observed at 6 h and was accompanied by improvement in serum lactate, mean arterial pressure, CI and urine output in (n = 61). We compared these patients with those in whom this decrease did not occur (n = 49). Mortality and ICU LOS was significantly lower in patients with low PCO2 gap, while more patients with high PCO2 gap required RRT.

Conclusion: We found that a persistently high PCO2 gap at 6 and 12 h following resuscitation in patients with shock of various etiologies, was associated with increased mortality, need for RRT and increased ICU LOS. High PCO2 gap had a moderate discriminative ability to predict mortality.

How to cite this article: Zirpe KG, Tiwari AM, Kulkarni AP, Vaidya HS, Gurav SK, Deshmukh AM, et al. The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study. Indian J Crit Care Med 2024;28(4):349-354.

Keywords: Cardiac index; Circulatory shock; Hemodynamic resuscitation; PCO2 gap; Serum lactate.

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Conflict of interest statement

Source of support: Nil Conflict of interest: Dr. Kapil G Zirpe and Dr. Atul P Kulkarni are associated as the Editorial Board Member of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of these Editorial Board Members and their research group.

Figures

Fig. 1
Fig. 1
Patient flow in study
Figs 2A to D
Figs 2A to D
Changes in variables over 24 hours in entire cohort
Figs 3A to D
Figs 3A to D
Comparisons of changes in variables in high vs low PCO2 groups
Figs 4A and B
Figs 4A and B
ROC curve for PCO2 gap @ (A) 6 h; (B) 12 h with ICU mortality
None
See this image and copyright information in PMC

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