PCO2 gap, its ratio to arteriovenous oxygen content, ScvO2 and lactate in high-risk abdominal surgery patients: An observational study

Enrique Guilherme; Marie-Charlotte Delignette; Hadrien Pambet; Thibault Lebreton; Aurélie Bonnet; Pierre Pradat; Camille Boucheny; Céline Guichon; Fréderic Aubrun; Mathieu Gazon

doi:10.1016/j.accpm.2022.101033

PCO₂ gap, its ratio to arteriovenous oxygen content, ScvO₂ and lactate in high-risk abdominal surgery patients: An observational study

Anaesth Crit Care Pain Med. 2022 Apr;41(2):101033. doi: 10.1016/j.accpm.2022.101033. Epub 2022 Feb 14.

Affiliations

¹ Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France. Electronic address: enrique.guilherme@chu-lyon.fr.
² Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.
³ Clinical Research Center, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.
⁴ Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; Research on Healthcare Performance (RESHAPE), U1290 - INSERM & Claude Bernard University Lyon 1, France.

PMID: 35176527
DOI: 10.1016/j.accpm.2022.101033

Abstract

Background: The difference between arterial and central venous carbon dioxide partial pressure (PCO₂ gap), a marker of oxygen delivery (DO₂) and oxygen consumption (VO₂) adequacy, has been evaluated as a promising prognostic tool in intensive care unit (ICU) patients. We therefore sought to study the association between intraoperative PCO₂ gap and postoperative complications (POC) in the perioperative setting of elective major abdominal surgery.

Methods: We conducted a single-centre prospective observational study. All adult patients who underwent major planned abdominal surgery were eligible. PCO₂ gap was measured every 2 h during surgery, at ICU admission and repeated 12 h and 24 h later. Severe POC within 28 days after surgery were defined as complications graded 3 or more according to Clavien-Dindo classification. Following a univariate analysis, a multivariable analysis using a logistic regression model was performed.

Results: Ninety patients were included and divided into two groups according to the occurrence of POC. No significant difference was found between groups regarding baseline characteristics at inclusion. Thirty-nine (43%) patients developed postoperative complications. The median [IQR] intraoperative PCO₂ gap was significantly higher in patients who had complications (6.5 [5.5-7.3] mmHg) compared to those who did not (5.0 [3.9-5.8] mmHg; p < 0.001). The area under the receiver operating characteristic curve for occurrence of POC was 0.78 for the PCO₂ gap. After multivariable analysis, PCO₂ gap was found independently associated with POC (OR: 14.9, 95% CI [4.68-60.1], p < 0.001) with a threshold value of 6.2 mmHg. The duration of surgery (OR: 1.01, 95% CI [1.00; 1.01], p = 0.04) and the need for vasoactive support during surgery (OR: 5.76, 95% CI [1.72; 24.1], p = 0.006) were also independently associated with POC.

Conclusion: Intraoperative PCO₂ gap is a relevant predictive factor of severe postoperative complications in high-risk elective surgery patients.

Trial registration: ClinicalTrials.gov, NCT03914976.

Keywords: Major surgery; PCO(2) gap; Postoperative complications; Tissue hypoxia.

Publication types

Observational Study

MeSH terms

Blood Gas Analysis / adverse effects
Carbon Dioxide*
Humans
Lactic Acid*
Oxygen
Postoperative Complications / epidemiology
Postoperative Complications / etiology

Substances

Carbon Dioxide
Lactic Acid
Oxygen

Associated data

ClinicalTrials.gov/NCT03914976