Use of venous parameters (PvCO₂, ΔPCO₂, ScvO₂) in hemodynamic decision-making in the emergency department
DOI:
https://doi.org/10.5281/zenodo.20014037Keywords:
Hemodynamic Monitoring, Septic Shock, Venous Blood Gas, Central Venous Saturation, CO₂ GapAbstract
Hemodynamic monitoring in critically ill patients has evolved beyond traditional macro-hemodynamic parameters, consolidating the use of venous variables as essential tools in the emergency room and intensive care. This systematic review synthesizes evidence on central venous oxygen saturation (ScvO₂), the venous-to-arterial carbon dioxide gradient (ΔPCO₂), and the ΔPCO₂/C(a-v)O₂ ratio in clinical decision-making. ScvO₂ acts as an early marker of the relationship between oxygen delivery and consumption, with values below 70% independently associated with higher mortality. In parallel, ΔPCO₂ stands out as a superior flow indicator for detecting circulatory stagnation and guiding resuscitation, especially when pressure targets have already been met. The integration of the ΔPCO₂/C(a-v)O₂ ratio allows for the early identification of anaerobic metabolism and the prediction of lactate clearance. It is concluded that the combined analysis of these venous parameters provides a multidimensional view of microcirculatory perfusion, allowing for more precise and individualized interventions.
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Copyright (c) 2026 Marilia Pinheiro Palmejani, Lara Ferreira Passianoto, Laura Beatriz Debesa Torres, Rodrigo Silva Quadros
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