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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
SMART SUMMER SMART 2006 - Milan, May 10-12, 2006
Minerva Anestesiologica 2006 June;72(6):597-604
Meaning of arterio-venous PCO2 difference in circulatory shock
Lamia B., Monnet X., Teboul J. L.
Unit of Medical Intensive Care Bicetre University Hospital University Paris XI, Paris, France
The arterovenous difference in carbon dioxide tension (∆PCO2) can be calculated after simultaneous sampling of arterial blood (PaCO2) and of mixed venous blood from the distal of a pulmonary artery catheter (PvCO2). Under physiological conditions, ∆PCO2 ranges from 2 to 5 mmHg. The ∆PCO2 depends on carbon dioxide and cardiac output by a complex fashion. In this article, we detail the influence of these factors on ∆PCO2 in normoxic conditions and in hypoxic conditions. We bring evidence that ∆PCO2 cannot serve as a marker of tissue hypoxia contrary to what was initially thought. However, ∆PCO2 can be considered as a marker of the adequacy of venous blood flow (i.e. cardiac output) to remove the total CO2 produced by the peripheral tissues. In this regard, the knowledge of ∆PCO2 should help the clinicians for the decision of giving therapy aimed at increasing cardiac output.