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Central Venous-arterial Carbon Dioxide Difference (pCO2 gap) as a Guide to Predict Complications in Postoperative
Amandeep Kaur1, Gunchan Paul1, Parshotam L Gautam1
1Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Background And Aims:
The pCO2 gap, calculated by the difference between central venous and arterial partial pressure of carbon dioxide, has been evaluated as a global index of tissue perfusion. We aimed to evaluate whether the pCO2 gap could be used to identify patients in the immediate postoperative period following high-risk major abdominal surgery to predict the occurrence of postoperative complications.
Patients And Methods:
A prospective observational study included all postoperative high-risk adult surgical patients admitted to the intensive care unit (ICU) after major abdominal surgery. The pCO2 gap, central venous oxygen saturation (ScvO2), lactate levels, and postoperative complications were recorded at ICU admission, and after 12-24 hours.
Results:
Sixty-three patients undergoing major abdominal surgery were included in the study. The mean age of the study population was 53 ± 20 years. The patients who had persistently high pCO2 gap >6 mm Hg at 24 hours postoperatively had a higher incidence of complications (n = 19.31%) compared to the group of patients with pCO2 gap <6 mm Hg (n = 41.68%). The mean pCO2 gap in the postoperative period at 24 hours was higher in patients with complications than those without complications (7.30 ± 0.60 vs 4.24 ± 1.30 mm Hg). Higher pCO2 gap and higher sequential organ failure assessment (SOFA) score were independently associated with postoperative complications. The pCO2 gap at ICU admission had a higher sensitivity and specificity than ScvO2 and lactate for differentiating between patients who did and who did not develop complications.
Conclusion:
High pCO2 gap (>6 mm Hg) can be used as a complementary tool to predict postoperative complications in high-risk patients following major abdominal surgery.
How To Cite This Article:
Kaur A, Paul G, Gautam PL, Sama A, Singh VP. Central Venous-arterial Carbon Dioxide Difference (pCO2 gap) as a Guide to Predict Complications in Postoperative High-risk Surgical Patients: A Prospective Observational Study. Indian J Crit Care Med 2026;30(1):62-67.
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