Veno-arterial CO2 content gradient and veno-arterial CO2 to arterial-venous O2 content ratio for outcome prediction after pediatric cardiac surgery: a prospective study
Bibliographic record
Abstract
Abstract Introduction CO 2 -derived variables, veno-arterial CO 2 content gradient (ΔCCO 2 ) and the ratio of ΔCCO 2 with arterio-venous oxygen difference (AV-DO 2 ) (ΔCCO2/AV-DO 2 ), may have a potential role as indicators of low cardiac output and anaerobic metabolism, respectively. We sought to describe and evaluate the association of CO 2 -derived variables with patients’ outcomes in the post cardiopulmonary bypass (CPB) period in children. Methods Prospective, single-center, study enrolling children post-CPB with paired arterial and venous blood gases for determination of lactate, O 2 extraction, ΔCCO 2 , and ΔCCO 2 /AV-DO 2 at admission (H0), and at 6 (H6), 12 (H12) and 24 (H24) hours. Different clinical patterns were defined based on the presence of an anaerobic context or a hypoperfusion context, using both O 2 and CO 2 -derived variables. The presence of anaerobic metabolism was defined with a lactate > 2 mmol/l and ΔCCO 2 /AV-DO 2 > 1.8; the presence of hypoperfusion was defined with an O 2 extraction > 30% and ΔCCO 2 > 6 mL. The potential association of duration of amine support and mechanical ventilation was tested with CO 2 -derived variables and specific clinical patterns. Results A total of 51 patients with a median age of 36 (IQR 11–85) months were included. Median admission ΔCCO 2 was 9.3 mL (IQR 5.6–11.4) with 72% above 6 mL. Median ΔCCO 2 /AV-DO 2 was 2.1 (IQR 1.5–2.4) with 58% above 1.8. Admission ΔCCO 2 showed a significant association with the duration of mechanical ventilation (R2 21.6, p value = 0.001) but not with the duration of vasoactive support. Neither H0 ΔCCO 2 nor H0 ΔCCO 2 /AV-DO 2 improved outcome prediction by a model including lactate and O 2 extraction. Anaerobic metabolism context showed a significant association with prolonged vasoactive support [28.4 (CI 95% 12.2–44.6) p = 0.001] and mechanical ventilation duration [1.4 (95% CI 0.62–2.3) p = 0.003]. In hypoperfusion context, neither duration of vasoactive support nor mechanical ventilation appeared different in the subgroups analysis. Conclusion CO 2 -derived variables may improve outcome prediction after cardiac surgery in pediatric patients. Further evaluation in larger multicentered trials is necessary to improve its validation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".