Improving the prognostic value of ∆PCO₂ following cardiac surgery: a prospective pilot study

Conflicting results have been published on prognostic significance of central venous to arterial PCO₂ difference (∆PCO₂) after cardiac surgery. We compared the prognostic value of ∆PCO₂ on intensive care unit (ICU) admission to an original algorithm combining ∆PCO₂, ERO₂ and lactate to identify different risk profiles. Additionally, we described the evolution of ∆PCO₂ and its correlations with ERO₂ and lactate during the first postoperative day (POD1). In this monocentre, prospective, and pilot study, 25 patients undergoing conventional cardiac surgery were included. Central venous and arterial blood gases were collected on ICU admission and at 6, 12 and 24 h postoperatively. High ∆PCO₂ (≥ 6 mmHg) on ICU admission was found to be very frequent (64% of patients). Correlations between ∆PCO₂ and ERO₂ or lactate for POD1 values and variations were weak or non-existent. On ICU admission, a high ∆PCO₂ did not predict a prolonged ICU length of stay (LOS). Conversely, a significant increase in both ICU and hospital LOS was observed in high-risk patients identified by the algorithm: 3.5 (3.0-6.3) days versus 7.0 (6.0-8.0) days (p = 0.01) and 12.0 (8.0-15.0) versus 8.0 (8.0-9.0) days (p < 0.01), respectively. An algorithm incorporating ICU admission values of ∆PCO₂, ERO₂ and lactate defined a high-risk profile that predicted prolonged ICU and hospital stays better than ∆PCO₂ alone.