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Pathophysiology and Clinical Implications of the Veno-arterial PCO2 Gap

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Annual Update in Intensive Care and Emergency Medicine 2021

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Circulatory shock is common among patients admitted to the intensive care unit and, despite improved medical management, remains associated with a high mortality rate. Under these circumstances, tissue perfusion and cellular oxygenation are commonly assessed by blood lactate and venous oxygen saturation (SvO2). Venous-to-arterial difference in CO2 partial pressure (Pv-aCO2 gap) is another parameter, which can easily be obtained (through simultaneous sampling of central or mixed venous and arterial blood) and appears to have prognostic abilities in several types of shock. The Pv-aCO2 gap can provide insight into the adequacy of cardiac output relative to oxygen consumption and represents a link between the macro- and microcirculation. Correct interpretation of the Pv-aCO2 gap at the bedside, however, requires an understanding of CO2 physiology and of elements modulating the relationship between CO2 content and its partial pressure (Haldane effect, acidosis, anemia...). In this chapter, we review the physiological basis underlying CO2 production, transport and blood content, as well as the clinical implications of an increased Pv-aCO2 gap. We review the evidence linking Pv-aCO2 gap to clinical outcomes and, finally, we propose algorithms guiding the interpretation of Pv-aCO2 in different types of dysoxia.

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Author information

Authors and Affiliations

  1. Service of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland

    Z. Ltaief, A. G. Schneider & L. Liaudet

  2. Unit of Pathophysiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland

    L. Liaudet

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  1. Z. Ltaief
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  2. A. G. Schneider
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  3. L. Liaudet
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Correspondence to A. G. Schneider .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Ltaief, Z., Schneider, A.G., Liaudet, L. (2021). Pathophysiology and Clinical Implications of the Veno-arterial PCO2 Gap. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2021. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-73231-8_8

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  • DOI: https://doi.org/10.1007/978-3-030-73231-8_8

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