Value of Central Venous to Arterial CO 2 Difference after Early Goal-directed Therapy in Septic Shock Patients.

Autor: Araujo DT; Central ICU, Santa Casa Hospital, Porto Alegre, Rio Grande do Su, Brazil; Programa de Pós-graduação em Ciências Pneumológicas, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Su, Brazil., Felice VB; Central ICU, Santa Casa Hospital, Porto Alegre, Rio Grande do Su, Brazil; Programa de Pós-graduação em Ciências Pneumológicas, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Su, Brazil., Meregalli AF; Central ICU, Santa Casa Hospital, Porto Alegre, Rio Grande do Su, Brazil; Programa de Pós-graduação em Ciências Pneumológicas, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Su, Brazil., Friedman G; Central ICU, Santa Casa Hospital, Porto Alegre, Rio Grande do Su, Brazil; Programa de Pós-graduação em Ciências Pneumológicas, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Su, Brazil.
Jazyk: angličtina
Zdroj: Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine [Indian J Crit Care Med] 2019 Oct; Vol. 23 (10), pp. 449-453.
DOI: 10.5005/jp-journals-10071-23262
Abstrakt: Background and Aims: Venous to arterial difference of carbon dioxide (Pv-aCO 2 ) tracks tissue blood flow. We aimed to evaluate if Pv-aCO 2 measured from a superior central vein sample is a prognostic index (ICU length of stay, SOFA score, 28th mortality rate) just after early goal-directed therapy (EGDT)comparing its ICU admission values between patients with normal and abnormal (>6 mm Hg) Pv-aCO 2 . As secondary objectives, we evaluated the relationship of Pv-aCO 2 with other variables of perfusion during the 24 hours that followed EGDT.
Materials and Methods: Prospective observational study conducted in an academic ICU adult septic shock patients after a 6-hour complete EGTD. Hemodynamic measurements, arterial/central venous blood gases, and arterial lactate were obtained on ICU admission and after 6, 18 and 24 hours.
Results: Sixty patients were included. Admission Pv-aCO 2 values showed no prognostic value. Admission Pv-aCO 2 (ROC curve 0.527 [CI 95% 0.394 to 0.658]) values showed low specificity and sensitivity as predictors of mortality. There was a difference observed in the mean Pv-aCO 2 between nonsurvivors (NS) and survivors (S) after 6 hours. Central venous oxygen saturation (ScvO 2 ) and Pv-aCO 2 showed significant correlation (R2 = -0.41, P < 0.0001). Patients with normal ScvO 2 (>70%) and abnormal Pv-aCO 2 (>6 mm Hg) showed higher SOFA scores. Normal Pv-aCO 2 group cleared their lactate levels in comparison to the abnormal Pv-aCO 2 group.
Conclusion: In septic shock, admission Pv-aCO 2 after EGDT is not related to worse outcomes. An abnormal Pv-aCO 2 along with a normal ScvO 2 is related to organ dysfunction.
How to Cite This Article: Araujo DT, Felice VB, Meregalli AF, Friedman G. Value of Central Venous to Arterial CO 2 Difference after Early Goal-directed Therapy in Septic Shock Patients. Indian J Crit Care Med 2019;23(10):449-453.
Competing Interests: Source of support: Nil Conflict of interest: None
(Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.)
Databáze: MEDLINE
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