Assessment of the central venous-to-arterial carbon dioxide tension difference (pCO₂ delta) in adult patients with sepsis: a systematic review

Authors

Abd El Rahman A Ahmed, Menoufia University
Ahmed A. M Abd El Aziz, Mehalla General HospitalFollow
Khaled M. Gaballah, Menoufia University
Yasser I. Mohamed, Menoufia University

Subject Area

Plastic Surgery

Article Type

Review

Abstract

Objective The aim was to review studies that assessed the central venous-to-arterial carbon dioxide tension difference (pCO₂ delta) in septic adult patients, published between 1990 and 2016 in the MEDLINE (PubMed, Medscape, and Science Direct) and EMF-Portal, and methodological quality was evaluated. Materials and methods A systematic search of MEDLINE (PubMed, Medscape, and Science Direct), EMF-portal, and Internet was conducted on all articles published from 1990 to 2016. English-language reports of pCO₂ delta in patients with sepsis were reviewed. The initial search presented 135 articles, where 30 fulfilled the inclusion criteria. Articles not reporting on pCO₂ in patients with sepsis in the title or abstract were not included. A total of 11 independent investigators extracted data on methods. Comparisons were made by structured review, with the results tabulated. Ten studies emphasized old and new definitions of sepsis, pCO₂ delta, and mortality; seven about pCO₂ delta and tissue perfusion variables; seven about pCO₂ delta and cardiac output; and nine about pCO₂ delta and therapeutic interventions. Findings High pCO₂ delta values were seen to be associated with poorer clinical outcomes, including worsened hemodynamic parameters, poorer tissue perfusion, and greater in-hospital mortality and mortality after 28 days. Higher serum lactate levels and lower SvcO₂ values were seen when the patients presented with pCO₂ delta greater than 6 mmHg, compared with those showing pCO₂ delta less than 6 mmHg. The usefulness of pCO₂ delta alone or other tissue perfusion variables for assessing tissue perfusion in sepsis and septic shock is limited. Conclusion Delta pCO₂ is a valuable complementary tool to guide tissue perfusion in sepsis and septic shock with previous tissue perfusion variables, but this pCO₂ delta parameter is not enough alone to detect tissue perfusion and or to be used alone as a marker of prognosis in severe sepsis and septic shock.

Recommended Citation

Ahmed, Abd El Rahman A; Abd El Aziz, Ahmed A. M; Gaballah, Khaled M.; and Mohamed, Yasser I. (2019) "Assessment of the central venous-to-arterial carbon dioxide tension difference (pCO₂ delta) in adult patients with sepsis: a systematic review," Menoufia Medical Journal: Vol. 32: Iss. 4, Article 4.
DOI: https://doi.org/10.4103/mmj.mmj_406_18