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Central venous-arterial carbon dioxide difference as an indicator of cardiac index.
Cuschieri, Joseph 1; Rivers, Emanuel P. 1,2; Donnino, Michael W. 2,3,4; Katilius, Marius 1; Jacobsen, Gordon 6; Nguyen, Bryant H. 1,2; Pamukov, Nikolai 1,5; Horst, Mathilda H. 1
[Article] Intensive Care Medicine. 31(6):818-822, June 2005.

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Objective: The mixed venous-arterial (v-a) pCO2 difference has been shown to be inversely correlated with the cardiac index (CI). A central venous pCO2, which is easier to obtain, may provide similar information. The purpose of this study was to examine the correlation between the central venous-arterial pCO2 difference and CI.

Design: Prospective, cohort study.

Setting: Intensive care unit of an urban tertiary care hospital.

Patients and participants: Eighty-three consecutive intensive care unit patients.

Measurements: Simultaneous blood gases from the arterial, pulmonary artery (PA), and central venous (CV) catheters were obtained. At the same time point, cardiac indices were measured by the thermodilution technique (an average of three measurements). The cardiac indices obtained by the venous-arterial differences were compared with those determined by thermodilution.

Results: The correlation (R2) between the mixed venous-arterial pCO2 difference and cardiac index was 0.903 (p <0.0001), and the correlation between the central venous-arterial pCO2 difference and cardiac index was 0.892 (p <0.0001). The regression equations for these relationships were natural log (CI)=1.837-0.159 (v-a) CO2 for the PA and natural log (CI)=1.787-0.151 (v-a) CO2 for the CV (p <0.0001 for both). The root-mean-squared error for the PA and CV regression equations were 0.095 and 0.101, respectively.

Conclusion: Venous-arterial pCO2 differences obtained from both the PA and CV circulations inversely correlate with the cardiac index. Substitution of a central for a mixed venous-arterial pCO2 difference provides an accurate alternative method for calculation of cardiac output.