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REVIEW ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 4  |  Page : 1177-1184

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


1 Department of Anaesthesia and Intensive Care, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Anaesthesia and Intensive Care, Mehalla General Hospital, Al Gharbia, Egypt

Correspondence Address:
Ahmed A. M Abd El Aziz
Mehalla City, Al Gharbia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_406_18

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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.


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