Venoarterial PCO<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study

Background: The identification of anaerobic metabolism in critically ill patients is a challenging task. Observational studies have suggested that the ratio of venoarterial PCO2 (Pv–aCO2) to arteriovenous oxygen content difference (Ca–vO2) might be a good surrogate for respiratory quotient (RQ). Yet...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Dubin, Arnaldo, Ferrara, Gonzalo, Kanoore Edul, Vanina Siham, Martins, Enrique Francisco, Canales, Héctor Saúl, Canullán, Carlos, Murias, Gastón, Pozo, Mario Omar, Estenssoro, Elisa
Formato: Articulo
Lenguaje:Inglés
Publicado: 2017
Materias:
Ciencias Médicas
Anaerobic metabolism
Carbon dioxide
Hemodilution
Hemorrhage
Oxygen
Respiratory quotient
Acceso en línea:http://sedici.unlp.edu.ar/handle/10915/87128
Aporte de:
SEDICI (UNLP) de Universidad Nacional de La Plata
id I19-R120-10915-87128
record_format dspace
institution Universidad Nacional de La Plata
institution_str I-19
repository_str R-120
collection SEDICI (UNLP)
language Inglés
topic Ciencias Médicas
Anaerobic metabolism
Carbon dioxide
Hemodilution
Hemorrhage
Oxygen
Respiratory quotient
spellingShingle Ciencias Médicas
Anaerobic metabolism
Carbon dioxide
Hemodilution
Hemorrhage
Oxygen
Respiratory quotient
Dubin, Arnaldo
Ferrara, Gonzalo
Kanoore Edul, Vanina Siham
Martins, Enrique Francisco
Canales, Héctor Saúl
Canullán, Carlos
Murias, Gastón
Pozo, Mario Omar
Estenssoro, Elisa
Venoarterial PCO<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study
topic_facet Ciencias Médicas
Anaerobic metabolism
Carbon dioxide
Hemodilution
Hemorrhage
Oxygen
Respiratory quotient
description Background: The identification of anaerobic metabolism in critically ill patients is a challenging task. Observational studies have suggested that the ratio of venoarterial PCO2 (Pv–aCO2) to arteriovenous oxygen content difference (Ca–vO2) might be a good surrogate for respiratory quotient (RQ). Yet Pv–aCO2/Ca–vO2 might be increased by other factors, regardless of anaerobic metabolism. At present, comparisons between Pv–aCO2/Ca–vO2 and RQ have not been performed. We sought to compare these variables during stepwise hemorrhage and hemodilution. Since anemia predictably produces augmented Pv–aCO2 and decreased Ca–vO2, our hypothesis was that Pv–aCO2/Ca–vO2 might be an inadequate surrogate for RQ. Methods: This is a subanalysis of a previously published study. In anesthetized and mechanically ventilated sheep (n = 16), we compared the effects of progressive hemodilution and hemorrhage by means of expired gases analysis. Results: There were comparable reductions in oxygen consumption and increases in RQ in the last step of hemodilution and hemorrhage. The increase in Pv–aCO2/Ca–vO2 was higher in hemodilution than in hemorrhage (1.9 ± 0.2 to 10.0 ± 0.9 vs. 1.7 ± 0.2 to 2.5 ± 0.1, P < 0.0001). The increase in Pv–aCO2 was lower in hemodilution (6 ± 0 to 10 ± 1 vs. 6 ± 0 to 17 ± 1 mmHg, P < 0.0001). Venoarterial CO2 content difference and Ca–vO2 decreased in hemodilution and increased in hemorrhage (2.6 ± 0.3 to 1.2 ± 0.1 vs. 2.8 ± 0.2 to 6.9 ± 0.5, and 3.4 ± 0.3 to 1.0 ± 0.3 vs. 3.6 ± 0.3 to 6.8 ± 0.3 mL/dL, P < 0.0001 for both). In hemodilution, Pv–aCO2/Ca–vO2 increased before the fall in oxygen consumption and the increase in RQ. Pv–aCO2/Ca–vO2 was strongly correlated with Hb (R2 = 0.79, P < 0.00001) and moderately with RQ (R2 = 0.41, P < 0.0001). A multiple linear regression model found Hb, RQ, base excess, and mixed venous oxygen saturation and PCO2 as Pv–aCO2/Ca–vO2 determinants (adjusted R2 = 0.86, P < 0.000001). Conclusions: In hemodilution, Pv–aCO2/Ca–vO2 was considerably increased, irrespective of the presence of anaerobic metabolism. Pv–aCO2/Ca–vO2 is a complex variable, which depends on several factors. As such, it was a misleading indicator of anaerobic metabolism in hemodilution.
format Articulo
Articulo
author Dubin, Arnaldo
Ferrara, Gonzalo
Kanoore Edul, Vanina Siham
Martins, Enrique Francisco
Canales, Héctor Saúl
Canullán, Carlos
Murias, Gastón
Pozo, Mario Omar
Estenssoro, Elisa
author_facet Dubin, Arnaldo
Ferrara, Gonzalo
Kanoore Edul, Vanina Siham
Martins, Enrique Francisco
Canales, Héctor Saúl
Canullán, Carlos
Murias, Gastón
Pozo, Mario Omar
Estenssoro, Elisa
author_sort Dubin, Arnaldo
title Venoarterial PCO<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study
title_short Venoarterial PCO<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study
title_full Venoarterial PCO<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study
title_fullStr Venoarterial PCO<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study
title_full_unstemmed Venoarterial PCO<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study
title_sort venoarterial pco<sub>2</sub>-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study
publishDate 2017
url http://sedici.unlp.edu.ar/handle/10915/87128
work_keys_str_mv AT dubinarnaldo venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT ferraragonzalo venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT kanooreedulvaninasiham venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT martinsenriquefrancisco venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT canaleshectorsaul venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT canullancarlos venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT muriasgaston venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT pozomarioomar venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
AT estenssoroelisa venoarterialpcosub2subtoarteriovenousoxygencontentdifferenceratioisapoorsurrogateforanaerobicmetabolisminhemodilutionanexperimentalstudy
bdutipo_str Repositorios
_version_ 1764820489660792835

Ejemplares similares