López PHR, Sandoval AJ, Salinas MC, Poblano MM, Sánchez CC, Aguirre SJ, Franco GJ

Language: Spanish
References: 12
Page: 13-17
PDF size: 56.22 Kb.

ABSTRACT

Aims: To determinate the correlations between ΔPCO₂ and the reanimation indices such as mean blood pressure (MBP), pulmonary artery occlusion pressure (PAOP), central venous pressure (CVP); Mixed Venous Oxygen Saturation (SvO₂),cardiac index (CI), lactate difference (ΔLac) and the outcomes scales such Euro-score and APACHE II in the first 24 hrs in the ICU.
Patients and methods: Twenty-six patients in the early postoperative period of cardiac surgery were included, preoperative Euro-score and APACHE II score at admission were calculated. The blood samples were obtained from the arterial line, pulmonary artery (PA) and central venous catheters (CV). Measurements of MBP, ΔPCO₂, ΔLac, PAOP; SvO₂ were performed at admission and every 12 h over 24 h (T0, T12, T24); the CI was measured by the thermodilution technique with a Swan-Ganz catheter in 23 patients and by arterial pulse contour analysis with arterial line in three. The variables were recorded to determine their correlation with ΔPCO₂ and mortality. Statistical correlation of variables with ΔCO₂ was assessed by bivariate correlation (Pearson Test), and ROC curve for discrimination of the test. A p value of less than 0.05 was considered to be statistically significant.
Results: In a one year period (2008), 9 Men and 16 women were included, with a mean age of 63 ± 8.9 years; The operations performed were coronary Bypass in 10 patients, mitral valve in 6, aortic valve in 8, one thoracic aortic surgery and one interauricular surgery; the meaning preoperative Euro-score were 6.3 ± 3.2 with a meaning cardiopulmonary bypass time of 77 ± 20 min, aortic cross clamping time of 49 min ± 17 min, with two off pump coronary bypass; the mean of ΔPCO₂ was 6.19 mmHg ± -2.6 mmHg at admission, with a APACHE II of 11 points ± 3.66. The ΔPCO₂ at the admission (T0) and the 12 h (T12) showed a positive correlation with the aortic cross clamping and bypass time (p = 0.02 and p = 0.042), and a negative correlation with the mortality (p = 0.012); in the ΔPCO₂ at T12 and T24 had a positive correlation with the SvO₂ of T12 and T24 (p = 0.012 and p = .029); in the same way the CI of T12 and T24 had a positive correlation with the SVO₂ of T12 and T24 (p = 0.002 and p = 0.009). There were two dead. The Sensibility and Specificity for mortality was with a cutoff value of DCO₂ at admission of 9.5 mmHg and it had a 100 % of sensibility (CI 95%) and a specificity of 95% (CI 95 %-AUC 1.00); at the 24 h post-surgery the DCO₂ cutoff value of 5.5 had a sensibility and specificity of 100% and 62.5 respectively (AUC .760; CI 95%); A Euro-score value of 8.5 had a sensibility of 100% and a specificity of 83% (AUC .917,CI 95%).
Conclusions: The ΔPCO₂ could be a simple and useful indicator of postsurgical reanimation in cardiovascular care, this study tried to correlate it with scales like the Euro-score and APACHE II as well as indicators of resuscitation as SvO₂, CI, CVP, lactate, PAOP. This study showed that a cutoff value of ΔPCO₂ more than 6 mmHg in the first 24 h of post-surgical is consistent with a poor prognostic and showing the likely need for more intensive reanimation. Nevertheless more patients are necessary to validate these conclusions.

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