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Use of CO2-Derived Variables in Cardiac Intensive Care Unit: Pathophysiology and Clinical Implications

Vladimir L Cousin1, Raphael Joye2, Julie Wacker2

  • 1Réanimation Pédiatrique, Women, Child and Adolescent Department, Geneva University Hospital, 1205 Geneva, Switzerland.

Journal of Cardiovascular Development and Disease
|May 26, 2023
PubMed

Insights

Carbon dioxide (CO2)-derived parameters like the veno-arterial CO2 difference (ΔCCO2) show promise as sensitive biomarkers for monitoring shock in pediatric cardiac intensive care unit patients. These CO2 indices may offer a valuable alternative to traditional markers like lactate and ScVO2.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Physiology

Background:

  • Shock is a critical condition requiring prompt recognition and management.
  • Pediatric patients with congenital heart disease undergoing cardiac surgery are at high risk for low cardiac output syndrome (LCOS) and shock.
  • Traditional shock biomarkers like blood lactate and venous oxygen saturation (ScVO2) have limitations.

Purpose of the Study:

  • To review the physiological and pathophysiological basis of CO2-derived parameters.
  • To summarize current knowledge on CO2-derived indices as hemodynamic markers in the cardiac intensive care unit (CICU).
  • To explore the potential of CO2-derived parameters as sensitive biomarkers for shock monitoring in pediatric CICU patients.

Main Methods:

  • Literature review focusing on CO2-derived parameters (ΔCCO2 and VCO2/VO2 ratio).
  • Analysis of studies in adult populations and their relevance to pediatric CICU settings.
  • Synthesis of existing research on the application of CO2 indices in post-cardiac surgery pediatric patients.

Main Results:

  • CO2-derived parameters, specifically ΔCCO2 and VCO2/VO2 ratio, have shown strong associations with mortality in adult shock patients.
  • Preliminary studies in pediatric CICU populations suggest promising results for CO2-derived indices in managing patients post-cardiac surgery.
  • These parameters may offer sensitive insights into tissue perfusion and cellular oxygenation.

Conclusions:

  • CO2-derived indices represent a potentially valuable addition to traditional shock biomarkers in the CICU.
  • Further research is warranted to fully establish the role of ΔCCO2 and VCO2/VO2 ratio in pediatric shock management.
  • CO2-derived parameters could enhance the monitoring of hemodynamic status and tissue perfusion in critically ill children after cardiac surgery.

Keywords:
CICUVCO2/VO2 ratiocongenital cardiac abnormalitiespediatricveno-arterial CO2 difference

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