TY - JOUR
T1 - Can perioperative pCO2 gaps predict complications in patients undergoing major elective abdominal surgery randomized to goal-directed therapy or standard care? A secondary analysis
AU - de Keijzer, Ilonka N
AU - Kaufmann, Thomas
AU - de Waal, Eric E C
AU - Frank, Michael
AU - de Korte-de Boer, Dianne
AU - Montenij, Leonard M
AU - Buhre, Wolfgang
AU - Scheeren, Thomas W L
PY - 2024/4
Y1 - 2024/4
N2 - The difference between venous and arterial carbon dioxide pressure (pCO
2 gap), has been used as a diagnostic and prognostic tool. We aimed to assess whether perioperative pCO
2 gaps can predict postoperative complications. This was a secondary analysis of a multicenter RCT comparing goal-directed therapy (GDT) to standard care in which 464 patients undergoing high-risk elective abdominal surgery were included. Arterial and central venous blood samples were simultaneously obtained at four time points: after induction, at the end of surgery, at PACU/ICU admission, and PACU/ICU discharge. Complications within the first 30 days after surgery were recorded. Similar pCO
2 gaps were found in patients with and without complications, except for the pCO
2 gap at the end of surgery, which was higher in patients with complications (6.0 mmHg [5.0–8.0] vs. 6.0 mmHg [4.1–7.5], p = 0.005). The area under receiver operating characteristics curves for predicting complications from pCO
2 gaps at all time points were between 0.5 and 0.6. A weak correlation between ScvO
2 and pCO
2 gaps was found for all timepoints (ρ was between − 0.40 and − 0.29 for all timepoints, p < 0.001). The pCO
2 gap did not differ between GDT and standard care at any of the selected time points. In our study, pCO
2 gap was a poor predictor of major postoperative complications at all selected time points. Our research does not support the use of pCO
2 gap as a prognostic tool after high-risk abdominal surgery. pCO
2 gaps were comparable between GDT and standard care. Clinical trial registration Netherlands Trial Registry NTR3380.
AB - The difference between venous and arterial carbon dioxide pressure (pCO
2 gap), has been used as a diagnostic and prognostic tool. We aimed to assess whether perioperative pCO
2 gaps can predict postoperative complications. This was a secondary analysis of a multicenter RCT comparing goal-directed therapy (GDT) to standard care in which 464 patients undergoing high-risk elective abdominal surgery were included. Arterial and central venous blood samples were simultaneously obtained at four time points: after induction, at the end of surgery, at PACU/ICU admission, and PACU/ICU discharge. Complications within the first 30 days after surgery were recorded. Similar pCO
2 gaps were found in patients with and without complications, except for the pCO
2 gap at the end of surgery, which was higher in patients with complications (6.0 mmHg [5.0–8.0] vs. 6.0 mmHg [4.1–7.5], p = 0.005). The area under receiver operating characteristics curves for predicting complications from pCO
2 gaps at all time points were between 0.5 and 0.6. A weak correlation between ScvO
2 and pCO
2 gaps was found for all timepoints (ρ was between − 0.40 and − 0.29 for all timepoints, p < 0.001). The pCO
2 gap did not differ between GDT and standard care at any of the selected time points. In our study, pCO
2 gap was a poor predictor of major postoperative complications at all selected time points. Our research does not support the use of pCO
2 gap as a prognostic tool after high-risk abdominal surgery. pCO
2 gaps were comparable between GDT and standard care. Clinical trial registration Netherlands Trial Registry NTR3380.
KW - Cardiac output
KW - Goal-directed therapy
KW - Hemodynamic monitoring
KW - Postoperative Complications
KW - pCO2 gap
U2 - 10.1007/s10877-023-01117-y
DO - 10.1007/s10877-023-01117-y
M3 - Article
SN - 1387-1307
VL - 38
SP - 469
EP - 477
JO - Journal of Clinical Monitoring and Computing
JF - Journal of Clinical Monitoring and Computing
IS - 2
ER -