Venous-arterial CO2 difference in children with sepsis and its correlation with myocardial dysfunction.

Jaime Fernández-Sarmiento,Ana Maria Eraso-Díaz Del Castillo,Pedro Barrera,Rafael Orozco,Nathalie Gualdrón,Joseph A Carcillo,María Angélica Rodríguez

doi:10.5339/qmj.2019.18

Jaime Fernández-Sarmiento, Ana Maria Eraso-Díaz Del Castillo + Show 5 more

Open Access

https://doi.org/10.5339/qmj.2019.18

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Abstract

Objective: This study aimed to determine the association between venous–arterial CO2 difference (Pv-aCO2) and clinical outcomes of interest in children with severe sepsis and septic shock. Design: An analytical observational study of a prospective cohort was conducted. Setting: The study was carried out from January 2015 to January 2018 in the pediatric intensive care unit of a referral hospital. Materials and methods: Of a total of 1159 patients who were admitted to pediatric critical care, 375 had severe sepsis and septic shock, of which 67 fulfilled the inclusion criteria. Arterial and venous gases were drawn simultaneously with a transthoracic echocardiogram, Pv-aCO2, and other measures of tissue perfusion such as arterial lactate, venous, and evolution to multiple organ failure. Measurements and main results: Half (53.7%) of the patients were under 24 months old, with a slight predominance of male patients. The main site of infection was the lungs in 56% of the cases, with a 91.2% survival rate. Patients who died had a higher venous lactate level (interquartile range 16.2–33.6, p = 0.02). However, there was no correlation between myocardial dysfunction seen on echocardiogram and a Pv-aCO2 greater than 6 mm Hg in children with severe sepsis and septic shock (r = 0.13). Pv-aCO2 and central venous saturation had low sensitivity to detect multiple organ failure and poor correlation with the number of compromised systems (r = 0.8). Conclusion: Pv-aCO2 was not associated with myocardial dysfunction, measured by echocardiogram, in children with severe sepsis and septic shock. It also did not correlate with the number of organs involved or mortality.

Highlights

Sepsis is one of the main causes of morbidity and mortality in the pediatric population and one of the main admitting diagnoses in intensive care
Out of the 1159 children admitted to the pediatric intensive care unit (PICU) during this time, 375 met the inclusion criteria of having severe sepsis and septic shock
In our experience with a cohort of pediatric patients with severe sepsis and septic shock, in whom we simultaneously sought to determine if there was a correlation between a Pv-aCO2 greater than six and myocardial dysfunction on echocardiogram, no correlation (r 1⁄4 0.13) was found when adjusted for demographic data, severity, and infection site

Summary

Introduction

Sepsis is one of the main causes of morbidity and mortality in the pediatric population and one of the main admitting diagnoses in intensive care. It causes almost 4300 pediatric deaths per year in the United States, accounting for almost 7% of all child mortality. Minimally invasive, and noninvasive tests have been used to evaluate myocardial function directly or indirectly; all of them have benefits and limitations. Various factors such as hypovolemia and anemia affect tissue perfusion, leading to mistaken interpretations when relating it to cardiac output. Studies in adults have suggested that the venous– arterial CO2 (Pv-aCO2) difference could be a good complement when there is a suggestive clinical picture and normal or altered central venous saturation.[6,7,8]

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