{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T04:12:11Z","timestamp":1748578331492,"version":"3.37.3"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T00:00:00Z","timestamp":1575417600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007397","name":"Univerzita Karlova v Praze","doi-asserted-by":"publisher","award":["Q37"],"award-info":[{"award-number":["Q37"]}],"id":[{"id":"10.13039\/100007397","id-type":"DOI","asserted-by":"publisher"}]},{"name":"FNKV University Hospital","award":["Q37"],"award-info":[{"award-number":["Q37"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Critical Care Research and Practice"],"published-print":{"date-parts":[[2019,12,4]]},"abstract":"<jats:p><jats:italic>Introduction<\/jats:italic>. There is an inverse relationship between cardiac output and the central venous-arterial difference of partial pressures of carbon dioxide (pCO<jats:sub>2<\/jats:sub> gap), and pCO<jats:sub>2<\/jats:sub> gap has been used to guide early resuscitation of septic shock. It can be hypothesized that pCO<jats:sub>2<\/jats:sub> gap can be used outside the context of sepsis to distinguish type A and type B lactic acidosis and thereby avoid unnecessary fluid resuscitation in patients with high lactate, but without organ hypoperfusion. <jats:italic>Methods<\/jats:italic>. We performed a structured review of the literature enlightening the physiological background. Next, we retrospectively selected a series of case reports of nonseptic critically ill patients with elevated lactate, in whom both arterial and central venous blood gases were simultaneously measured and the diagnosis of either type A or type B hyperlactataemia was conclusively known. In these cases, we calculated venous-arterial CO<jats:sub>2<\/jats:sub> and O<jats:sub>2<\/jats:sub> content differences and pCO<jats:sub>2<\/jats:sub> gap. <jats:italic>Results<\/jats:italic>. Based on available physiological data, pCO<jats:sub>2<\/jats:sub> can be considered as an acceptable surrogate of venous-arterial CO<jats:sub>2<\/jats:sub> content difference, and it should better reflect cardiac output than central venous saturation or indices based on venous-arterial O<jats:sub>2<\/jats:sub> content difference. In our case report of nonseptic patients, we observed that if global hypoperfusion was present (i.e., in type A lactic acidosis), pCO<jats:sub>2<\/jats:sub> gap was elevated (&gt;1\u2009kPa), whilst in the absence of it (i.e., in type B lactic acidosis), pCO<jats:sub>2<\/jats:sub> gap was low (&lt;0.5\u2009kPa). <jats:italic>Conclusion<\/jats:italic>. Physiological rationale and a small case series are consistent with the hypothesis that low pCO<jats:sub>2<\/jats:sub> gap in nonseptic critically ill is suggestive of the absence of tissue hypoperfusion, mandating the search for the cause of type B lactic acidosis rather than administration of fluids or other drugs aimed at increasing cardiac output.<\/jats:p>","DOI":"10.1155\/2019\/5364503","type":"journal-article","created":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T18:34:38Z","timestamp":1575484478000},"page":"1-8","source":"Crossref","is-referenced-by-count":4,"title":["Using pCO<sub>2<\/sub> Gap in the Differential Diagnosis of Hyperlactatemia Outside the Context of Sepsis: A Physiological Review and Case Series"],"prefix":"10.1155","volume":"2019","author":[{"given":"Petr","family":"Waldauf","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine, The Third Faculty of Medicine, Charles University and FNKV University Hospital, 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