Diferencia veno-arterial de dióxido de carbono como predictor de gasto cardiaco disminuido en modelo experimental.

Author
Díaz, Franco; Medicina Intensiva Infantil. Facultad de Medicina Clínica Alemana Universidad del Desarrollo. Hospital Padre Hurtado

Donoso, Alejandro; Medicina Intensiva Infantil. Facultad de Medicina Clínica Alemana Universidad del Desarrollo. Hospital Padre Hurtado

Carvajal, Cristóbal; Residente Becario de Cirugía. Facultad de Medicina Clínica Alemana Universidad del Desarrollo. Hospital Padre Hurtado

Salomón, Tatiana; Enfermería Intensiva Infantil. Facultad de Medicina Clínica Alemana Universidad del Desarrollo. Hospital Padre Hurtado

Torres, María; Licenciado en Ingeniería en Biotecnología MolecularFacultad de Medicina Clínica Alemana Universidad del Desarrollo. Hospital Padre Hurtado

Erranz, Benjamín; Licenciado en Ingeniería en Biotecnología MolecularFacultad de Medicina Clínica Alemana Universidad del Desarrollo. Hospital Padre Hurtado

Cruces, Pablo; Medicina Intensiva Infantil. Universidad del Desarrollo. Hospital Padre Hurtado

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http://www.revistamedicadechile.cl/ojs/index.php/rmedica/article/view/1403
Abstract
VENO-ARTERIAL PCO2 DIFFERENCE TO PREDICT LOW CARDIAC OUTPUT IN AN EXPERIMENTAL PIGLET MODEL Background: Cardiac output (CO) measurement is not a standard of care for critically ill children, but it can be estimated by indirect methods such as veno-arterial pCO2 difference (?VACO2). Aim: To determine the correlation between CO and ?VACO2 and evaluate the usefulness of ?VACO2 in the diagnosis of low CO in an experimental pediatric model. Material and methods: Thirty piglets weighing 4.8±0.35 kg, were anesthetized and monitored with transpulmonary thermodilution. Lung injury was induced with tracheal instillation of Tween 20®. Serial measurements of central venous and arterial blood gases, as well as CO, were obtained at baseline, 1, 2 and 4 h after lung injury induction. Low cardiac output (LCO) was defined as CO lower than 2.5 L/min/m2.  Results: There was an inverse correlation between CO and ?VACO2 (r= -0.36, p< 0.01).  ?VACO2 was 14 ± 8 mmHg in LCO state and 8 ± 6 mmHg when this condition was not present (p< 0.01).  Area under the receiver operating characteristic (ROC) curves of ?VACO2 and LCO state was 0.78 (0.68-0.86). The best cut-point was 8.9 mmHg to determine LCO with a sensibility 0.78, specificity 0.7, positive predictive value 0.27 and negative predictive value 0.96. Conclusions: In this model there was an inverse correlation between ?VACO2 and CO. The best cutoff value to discard LCO was ?VACO2 of 8.9 mmHg, indicating that under this value the presence of LCO is very unlikely.  
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