Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review
Cardiogenic shock (CS) is a critical condition with high mortality, characterized by reduced cardiac output (CO) and tissue hypoperfusion, despite advancements in treatment. Traditional hemodynamic markers like CO measurements, monitoring of mixed venous oxygen saturation (SvO₂) and lactate levels h...
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Elsevier
2025-02-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000072 |
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| _version_ | 1825199279927459840 |
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| author | Oskar Kjærgaard Hørsdal |
| author_facet | Oskar Kjærgaard Hørsdal |
| author_sort | Oskar Kjærgaard Hørsdal |
| collection | DOAJ |
| description | Cardiogenic shock (CS) is a critical condition with high mortality, characterized by reduced cardiac output (CO) and tissue hypoperfusion, despite advancements in treatment. Traditional hemodynamic markers like CO measurements, monitoring of mixed venous oxygen saturation (SvO₂) and lactate levels have limitations, particularly in detecting microcirculatory dysfunction. The venous-to-arterial carbon dioxide tension difference (V-A PCO₂ gap, also known as P(V-A)CO2 and delta PCO2 or ∆PCO2) has been established as a sensitive marker of tissue perfusion and CO adequacy in septic shock but lacks extensive exploration in CS.This narrative review evaluates the possible uses of V-A PCO₂ gap in contemporary management of CS. Based on the available literature, it elucidates how the V-A PCO2 gap may offer valuable insight into tissue perfusion and CO adequacy in patients with CS. Elevated V-A PCO₂ gaps may reflect impaired clearance of CO₂ due to reduced CO and tissue hypoxia, serving as a reliable early indicator of circulatory failure. Integrating V-A PCO₂ gap monitoring into contemporary hemodynamic assessments holds potential to improve clinical decision-making, enabling more timely interventions and better stratification of patients at risk of deterioration.The sparse evidence suggests an association between elevated V-A PCO₂ gaps and poor outcomes in cardiac patients, including increased mortality and prolonged ventilation needs. Further research is needed to validate the use of this marker in CS and explore its potential to enhance treatment protocols by providing a more nuanced understanding of tissue-level perfusion, especially when macrocirculatory function appears normalized. |
| format | Article |
| id | doaj-art-9a89a412c8794c06b6d60ab9ed91806d |
| institution | Kabale University |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-9a89a412c8794c06b6d60ab9ed91806d2025-02-08T05:01:23ZengElsevierAmerican Heart Journal Plus2666-60222025-02-0150100504Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative reviewOskar Kjærgaard Hørsdal0Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Aarhus N, Denmark.; Department of Cardiology, Aarhus University Hospital, Aarhus, N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, DenmarkCardiogenic shock (CS) is a critical condition with high mortality, characterized by reduced cardiac output (CO) and tissue hypoperfusion, despite advancements in treatment. Traditional hemodynamic markers like CO measurements, monitoring of mixed venous oxygen saturation (SvO₂) and lactate levels have limitations, particularly in detecting microcirculatory dysfunction. The venous-to-arterial carbon dioxide tension difference (V-A PCO₂ gap, also known as P(V-A)CO2 and delta PCO2 or ∆PCO2) has been established as a sensitive marker of tissue perfusion and CO adequacy in septic shock but lacks extensive exploration in CS.This narrative review evaluates the possible uses of V-A PCO₂ gap in contemporary management of CS. Based on the available literature, it elucidates how the V-A PCO2 gap may offer valuable insight into tissue perfusion and CO adequacy in patients with CS. Elevated V-A PCO₂ gaps may reflect impaired clearance of CO₂ due to reduced CO and tissue hypoxia, serving as a reliable early indicator of circulatory failure. Integrating V-A PCO₂ gap monitoring into contemporary hemodynamic assessments holds potential to improve clinical decision-making, enabling more timely interventions and better stratification of patients at risk of deterioration.The sparse evidence suggests an association between elevated V-A PCO₂ gaps and poor outcomes in cardiac patients, including increased mortality and prolonged ventilation needs. Further research is needed to validate the use of this marker in CS and explore its potential to enhance treatment protocols by providing a more nuanced understanding of tissue-level perfusion, especially when macrocirculatory function appears normalized.http://www.sciencedirect.com/science/article/pii/S2666602225000072Cardiogenic shockVenous to arterial PCO2 gapMicrocirculationHemodynamics |
| spellingShingle | Oskar Kjærgaard Hørsdal Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review American Heart Journal Plus Cardiogenic shock Venous to arterial PCO2 gap Microcirculation Hemodynamics |
| title | Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review |
| title_full | Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review |
| title_fullStr | Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review |
| title_full_unstemmed | Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review |
| title_short | Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review |
| title_sort | can utilization of the venous to arterial carbon dioxide difference improve patient outcomes in cardiogenic shock a narrative review |
| topic | Cardiogenic shock Venous to arterial PCO2 gap Microcirculation Hemodynamics |
| url | http://www.sciencedirect.com/science/article/pii/S2666602225000072 |
| work_keys_str_mv | AT oskarkjærgaardhørsdal canutilizationofthevenoustoarterialcarbondioxidedifferenceimprovepatientoutcomesincardiogenicshockanarrativereview |