Correlation of central venous-arterial and mixed venous-arterial carbon dioxide tension gradient with cardiac output during neurosurgical procedures in the sitting position.
Summary of "Correlation of central venous-arterial and mixed venous-arterial carbon dioxide tension gradient with cardiac output during neurosurgical procedures in the sitting position."
BACKGROUND AND
OBJECTIVE:
The study was conducted to evaluate the correlation of central venous-arterial and mixed venous-arterial pCO2 gradient with cardiac output in patients being operated in the sitting position.
METHODS:
Fifty-one patients, aged 41-69 years, classified as American Society of Anesthesiologists physical status II and III, scheduled to undergo elective neurosurgical procedures in the sitting position, were enrolled in this prospective cohort study. Simultaneous blood gas samples from arterial, central venous and pulmonary artery catheters were collected at four different time points during supine and sitting position. Cardiac index (CI) determination was accomplished simultaneously, with continuous cardiac output technique. The mixed venous-arterial pCO2 and central venous-arterial pCO2 gradients were calculated and related to CI at the specific time points, thus a total of 204 points of comparison were obtained.
RESULTS:
Changing from the supine to the sitting position induced a significant deterioration of CI, right atrial pressure, mean pulmonary arterial pressure and pulmonary wedge pressure. The mean delta pCO2 difference (bias) in the four time points ranged between -0.07 and -0.27. The upper (1.59-1.71 mmHg) and lower limits of agreement (-2.16 to -1.82 mmHg) were quite narrow, suggesting an acceptable overall agreement between the mixed and central venous pCO2 differences. The coefficient of determination (R) between the venous-arterial pCO2 and CI for mixed and central venous circulations was 0.830 and 0.760 (P < 0.001 for both), respectively. In contrast, R values between mixed and central venous oxygen saturation values and CI were 0.324 and 0.286, respectively (P < 0.001 for both), illustrating a rather weak relationship.
CONCLUSION:
It seems that venous-arterial pCO2 values obtained from mixed and central venous circulations can be reliably interchanged in estimating CI in patients undergoing neurosurgical procedures in the sitting position. Thus, central venous-arterial pCO2 gradient could serve as a useful and simple method for estimating cardiac performance, in which further invasive monitoring is not strongly indicated.
Affiliation
From the Department of Anaesthesiology and Intensive Care, AHEPA University Hospital, Thessaloniki, Greece.
Journal Details
This article was published in the following journal.
Name: European journal of anaesthesiology
ISSN: 1365-2346
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20671558
- DOI: http://dx.doi.org/10.1097/EJA.0b013e32833d126f
Medical and Biotech [MESH] Definitions
Venous Insufficiency
Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
Catheterization, Central Venous
Placement of an intravenous catheter in the subclavian, jugular, or other central vein for central venous pressure determination, chemotherapy, hemodialysis, or hyperalimentation.
Cerebral Infarction
The formation of an area of NECROSIS in the CEREBRUM caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., INFARCTION, ANTERIOR CEREBRAL ARTERY), and etiology (e.g., embolic infarction).
Central Nervous System Venous Angioma
A vascular anomaly characterized by a radial or wedge-shaped arrangement of dilated VEINS draining into a larger vein in the brain, spinal cord, or the meninges. Veins in a venous angioma are surrounded by normal nervous tissue, unlike a CENTRAL NERVOUS SYSTEM CAVERNOUS HEMANGIOMA that lacks intervening nervous tissue. Drainage of venous angioma is fully integrated with the body's venous system, therefore, in most cases there is no clinical signs and rare bleeding.
Cor Triatriatum
A malformation of the heart in which the embryonic common PULMONARY VEIN was not incorporated into the LEFT ATRIUM leaving behind a perforated fibromuscular membrane bisecting the left atrium, a three-atrium heart. The opening between the two left atrium sections determines the degree of obstruction to pulmonary venous return, pulmonary venous and pulmonary arterial hypertension.
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