• Joseph Cuschieri, Emanuel P Rivers, Michael W Donnino, Marius Katilius, Gordon Jacobsen, H Bryant Nguyen, Nikolai Pamukov, and H Mathilda Horst.
• Department of Surgery, Henry Ford Health Systems, Detroit, MI, USA.
• Intensive Care Med. 2005 Jun 1;31(6):818-22.

ObjectiveThe mixed venous-arterial (v-a) pCO(2) difference has been shown to be inversely correlated with the cardiac index (CI). A central venous pCO(2), which is easier to obtain, may provide similar information. The purpose of this study was to examine the correlation between the central venous-arterial pCO(2) difference and CI.DesignProspective, cohort study.SettingIntensive care unit of an urban tertiary care hospital.Patients And ParticipantsEighty-three consecutive intensive care unit patients.MeasurementsSimultaneous 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.ResultsThe correlation (R(2)) between the mixed venous-arterial pCO(2) difference and cardiac index was 0.903 (p <0.0001), and the correlation between the central venous-arterial pCO(2) 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) CO(2) for the PA and natural log (CI)=1.787-0.151 (v-a) CO(2) 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.ConclusionVenous-arterial pCO(2) differences obtained from both the PA and CV circulations inversely correlate with the cardiac index. Substitution of a central for a mixed venous-arterial pCO(2) difference provides an accurate alternative method for calculation of cardiac output.

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