• Mouhamed D Moussa, Arthur Durand, Guillaume Leroy, Liu Vincent, Antoine Lamer, Guillaume Gantois, Olivier Joulin, Slimane Ait-Ouarab, Delphine Deblauwe, Brandt Caroline, Christophe Decoene, André Vincentelli, Benoit Vallet, Julien Labreuche, Eric Kipnis, and Emmanuel Robin.
• From the CHU Lille, Pôle d'Anesthésie-Réanimation (MDM, AD, GL, LV, GG, OJ, SA-O, DD, BC, CD, EK, ER), University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID (MDM, AV, ER), University Lille, INSERM, CHU Lille, CIC-IT 1403 (AL), University Lille, UDSL EA 2694 (AL, BV), CHU Lille, Service de Chirurgie Cardiaque (AV) and Department of Biostatistics, University Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France (JL).
• Eur J Anaesthesiol. 2019 Apr 1; 36 (4): 279-289.

BackgroundRapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting.ObjectivesWe evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC.DesignA prospective, observational cohort study.SettingSingle-centre, academic hospital cardiovascular ICU.PatientsWe included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h.Main Outcome MeasuresThe primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC.ResultsMPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P < 0.001).ConclusionAfter cardiac surgery with cardiopulmonary bypass, ΔPCO2 measured 2 h after ICU admission was the only dysoxia biomarker independently associated with MPC, but with limited performance.Trial RegistrationClinicalTrials.gov, NCT03107572.

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