Key result
The venous-to-arterial partial pressure of CO2 difference (ΔPCO2) reflects cardiac output and can be used to titrate inotropes and differentiate the effects of dobutamine in patients in shock.
Monitoring venous-to-arterial PCO2 difference complements traditional markers of tissue hypoxia to better assess cardiac output and guide inotrope therapy in shock.
The central venous O2 saturation value and lactic acid levels are part of the diagnostic and therapeutic work up of patients in shock. These usual indicators of tissue hypoxia don’t fully describe the adequacy of tissue perfusion. There is ample evidence that supplementing this data with the venous-to-arterial partial pressure of CO2 (PCO2) difference (ΔPCO2) complements the clinician’s tools when treating patients with shock. Based on a modified Fick equation as it applies to CO2, in patients in a steady state, the ΔPCO2 reflects the cardiac output (CO). This observation has been shown to be of clinical value in resuscitating patients in shock. Moreover, the ΔPCO2 can be used to titrate inotropes, and differentiate the hemodynamic from the metabolic effect of dobutamine.
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Nassar et al. (2019) conducted a review in Shock. Venous-to-arterial partial pressure of CO2 difference (ΔPCO2) was evaluated. The venous-to-arterial partial pressure of CO2 difference (ΔPCO2) reflects cardiac output and can be used to titrate inotropes and differentiate the effects of dobutamine in patients in shock.
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