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Central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review.
Rev Bras Ter Intensiva. 2020 Mar; 32(1):115-122.RB

Abstract

The central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) has been proposed as a surrogate for respiratory quotient and an indicator of tissue oxygenation. Some small observational studies have found that a Pcv-aCO2/Ca-cvO2 > 1.4 was associated with hyperlactatemia, oxygen supply dependency, and increased mortality. Moreover, Pcv-aCO2/Ca-cvO2 has been incorporated into algorithms for tissue oxygenation evaluation and resuscitation. However, the evidence for these recommendations is quite limited and of low quality. The goal of this narrative review was to analyze the methodological bases, the pathophysiologic foundations, and the experimental and clinical evidence supporting the use of Pcv-aCO2/Ca-cvO2 as a surrogate for respiratory quotient. Physiologically, the increase in respiratory quotient secondary to critical reductions in oxygen transport is a life-threatening and dramatic event. Nevertheless, this event is easily noticeable and probably does not require further monitoring. Since the beginning of anaerobic metabolism is indicated by the sudden increase in respiratory quotient and the normal range of respiratory quotient is wide, the use of a defined cutoff of 1.4 for Pcv-aCO2/Ca-cvO2 is meaningless. Experimental studies have shown that Pcv-aCO2/Ca-cvO2 is more dependent on factors that modify the dissociation of carbon dioxide from hemoglobin than on respiratory quotient and that respiratory quotient and Pcv-aCO2/Ca-cvO2 may have distinct behaviors. Studies performed in critically ill patients have shown controversial results regarding the ability of Pcv-aCO2/Ca-cvO2 to predict outcome, hyperlactatemia, microvascular abnormalities, and oxygen supply dependency. A randomized controlled trial also showed that Pcv-aCO2/Ca-cvO2 is useless as a goal of resuscitation. Pcv-aCO2/Ca-cvO2 should be carefully interpreted in critically ill patients.

Authors+Show Affiliations

Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina.Hospital Británico, Buenos Aires, Argentina.Hospital Español-ASSE, Montevidéu, Uruguai.

Pub Type(s)

Journal Article
Review

Language

eng por

PubMed ID

32401981

Citation

Dubin, Arnaldo, et al. "Central Venous Minus Arterial Carbon Dioxide Pressure to Arterial Minus Central Venous Oxygen Content Ratio as an Indicator of Tissue Oxygenation: a Narrative Review." Revista Brasileira De Terapia Intensiva, vol. 32, no. 1, 2020, pp. 115-122.
Dubin A, Pozo MO, Hurtado J. Central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review. Rev Bras Ter Intensiva. 2020;32(1):115-122.
Dubin, A., Pozo, M. O., & Hurtado, J. (2020). Central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review. Revista Brasileira De Terapia Intensiva, 32(1), 115-122. https://doi.org/10.5935/0103-507x.20200017
Dubin A, Pozo MO, Hurtado J. Central Venous Minus Arterial Carbon Dioxide Pressure to Arterial Minus Central Venous Oxygen Content Ratio as an Indicator of Tissue Oxygenation: a Narrative Review. Rev Bras Ter Intensiva. 2020;32(1):115-122. PubMed PMID: 32401981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review. AU - Dubin,Arnaldo, AU - Pozo,Mario Omar, AU - Hurtado,Javier, Y1 - 2020/05/08/ PY - 2019/04/28/received PY - 2019/06/09/accepted PY - 2020/5/14/entrez PY - 2020/5/14/pubmed PY - 2021/5/15/medline SP - 115 EP - 122 JF - Revista Brasileira de terapia intensiva JO - Rev Bras Ter Intensiva VL - 32 IS - 1 N2 - The central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) has been proposed as a surrogate for respiratory quotient and an indicator of tissue oxygenation. Some small observational studies have found that a Pcv-aCO2/Ca-cvO2 > 1.4 was associated with hyperlactatemia, oxygen supply dependency, and increased mortality. Moreover, Pcv-aCO2/Ca-cvO2 has been incorporated into algorithms for tissue oxygenation evaluation and resuscitation. However, the evidence for these recommendations is quite limited and of low quality. The goal of this narrative review was to analyze the methodological bases, the pathophysiologic foundations, and the experimental and clinical evidence supporting the use of Pcv-aCO2/Ca-cvO2 as a surrogate for respiratory quotient. Physiologically, the increase in respiratory quotient secondary to critical reductions in oxygen transport is a life-threatening and dramatic event. Nevertheless, this event is easily noticeable and probably does not require further monitoring. Since the beginning of anaerobic metabolism is indicated by the sudden increase in respiratory quotient and the normal range of respiratory quotient is wide, the use of a defined cutoff of 1.4 for Pcv-aCO2/Ca-cvO2 is meaningless. Experimental studies have shown that Pcv-aCO2/Ca-cvO2 is more dependent on factors that modify the dissociation of carbon dioxide from hemoglobin than on respiratory quotient and that respiratory quotient and Pcv-aCO2/Ca-cvO2 may have distinct behaviors. Studies performed in critically ill patients have shown controversial results regarding the ability of Pcv-aCO2/Ca-cvO2 to predict outcome, hyperlactatemia, microvascular abnormalities, and oxygen supply dependency. A randomized controlled trial also showed that Pcv-aCO2/Ca-cvO2 is useless as a goal of resuscitation. Pcv-aCO2/Ca-cvO2 should be carefully interpreted in critically ill patients. SN - 1982-4335 UR - https://www.unboundmedicine.com/medline/citation/32401981/Central_venous_minus_arterial_carbon_dioxide_pressure_to_arterial_minus_central_venous_oxygen_content_ratio_as_an_indicator_of_tissue_oxygenation:_a_narrative_review_ DB - PRIME DP - Unbound Medicine ER -