Analysis of P(v-a)CO2/C(a-v)O2 Ratio and Other Perfusion Markers in a Population of 98 Pediatric Patients Undergoing Cardiac Surgery

Author:

Taiana Matteo1,Tomasella Irene1,Russo Alessandro1,Lerose Annalisa2,Ceola Graziadei Marcello1,Corubolo Luisa1,Rama Jacopo1,Schweiger Vittorio3,Vignola Alessandro4,Polati Enrico3,Luciani Giovanni Battista5ORCID,Onorati Francesco5ORCID,Donadello Katia3,Gottin Leonardo1

Affiliation:

1. Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy

2. Anesthesia and Intensive Care Unit, Magalini Hospital ULSS 9 Scaligera, Villafranca, 37069 Verona, Italy

3. Anesthesia and Intensive Care Unit, Policlinico G.B. Rossi, Hospital and University Trust of Verona, P. le L. Scuro, 37129 Verona, Italy

4. Emergency Medicine Department, Hospital and University Trust of Verona, P. le A. Stefani, 37126 Verona, Italy

5. Cardiac Surgery Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37126 Verona, Italy

Abstract

Background: The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for better systemic perfusion. To date, serum lactate concentrations and central venous oxygen saturation (ScVO2) are the most commonly used perfusion markers, but they are not completely reliable in identifying a state of global tissue hypoxia. The study aims to evaluate whether the venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio [P(v-a)CO2/C(a-v)O2] can be a good index to predict the development of LCOS in the aforementioned patients, so as to treat it promptly. Methods: This study followed a population of 98 children undergoing corrective cardiac surgery from June 2018 to October 2020 at the Department of Cardiac Surgery of University Hospital Integrated Trust and their subsequent admission at the Postoperative Cardiothoracic Surgery Intensive Care Unit. During the study, central arterial and venous blood gas analyses were carried out before and after cardiopulmonary bypass (CPB) (pre-CPB and post-CPB), at admission to the intensive care unit, before and after extubation, and at any time of instability or modification of the patient’s clinical and therapeutic conditions. Results: The data analysis shows that 46.9% of the children developed LCOS (in line with the current literature) but that there is no statistically significant association between the P(v-a)CO2/C(a-v)O2 ratio and LCOS onset. Despite the limits of statistical significance, however, a 31% increase in the ratio emerged from the pre-CPB phase to the post-CPB phase when LCOS is present. Conclusions: This study confirms a statistically significant association between the most used markers in adult patients (serum lactate concentration, ScVO2, and oxygen extraction ratio—ERO2) measured in the pre-CPB phase and the incidence of LCOS onset, especially in patients with hemodynamic instability before surgery.

Publisher

MDPI AG

Subject

General Medicine

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