Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study.
Eur J Anaesthesiol
; 36(4): 279-289, 2019 04.
Article
em En
| MEDLINE
| ID: mdl-30664011
ABSTRACT
BACKGROUND:
Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting.OBJECTIVES:
We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2âh after admission to the ICU as predictors of MPC.DESIGN:
A prospective, observational cohort study.SETTING:
Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24âh. MAIN OUTCOMEMEASURES:
The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48âh following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2âh, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC.RESULTS:
MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2âh, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2âh for MPC prediction was 0.64 (95% CI 0.57 to 0.70, Pâ<â0.001).CONCLUSION:
After cardiac surgery with cardiopulmonary bypass, ΔPCO2 measured 2âh after ICU admission was the only dysoxia biomarker independently associated with MPC, but with limited performance. TRIAL REGISTRATION ClinicalTrials.gov, NCT03107572.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Ponte Cardiopulmonar
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Procedimentos Cirúrgicos Cardíacos
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Hipóxia
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article