Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock

Autor: Blanca Salazar, César Augusto Arango-Dávila, Diego F. Bautista-Rincón, Daniel De Backer, Marcela Granados, Mauricio Umaña, Glenn Hernandez, Alejandro Bruhn, Gustavo A. Ospina-Tascón, William F. Bermúdez
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Male
Resuscitation
Soins intensifs réanimation
Original
Lactic acid blood
Critical Care and Intensive Care Medicine
Septic shock
Consumo de oxígeno
Prospective Studies
Prospective cohort study
Blood gas analysis
Dióxido de carbono (CO2) atmosférico
musculoskeletal
neural
and ocular physiology
Shock
Middle Aged
Prognosis
Shock
Septic
Anesthesia
Shock (circulatory)
Terapia respiratoria
Female
medicine.symptom
circulatory and respiratory physiology
medicine.medical_specialty
Oxygen consumption
Medical sciences
Risk Assessment
Paciente crítico
Anesthesiology
parasitic diseases
medicine
Humans
In patient
Lactic Acid
Aged
Respiratory quotient
business.industry
Carbon Dioxide
medicine.disease
Survival Analysis
Oxygen
Venous-to-arterial carbon dioxide difference
Ciencias socio biomédicas
Lactate
Blood Gas Analysis
business
human activities
Biomarkers
Zdroj: Intensive care medicine, 41 (5
Intensive Care Medicine
Repositorio ICESI
Universidad ICESI
instacron:Universidad ICESI
Popis: Purpose: To evaluate the prognostic value of the Cv-aCO2/Da-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock. Methods: Prospective observational study in a 60-bed mixed ICU. One hundred and thirty-five patients with septic shock were included. The resuscitation protocol targeted mean arterial pressure, pulse pressure variations or central venous pressure, mixed venous oxygen saturation, and lactate levels. Patients were classified into four groups according to lactate levels and Cv-aCO2/Da-vO2 ratio at 6 h of resuscitation (T6): group 1, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 >1.0; group 2, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 ≤1.0; group 3, lactate 2/Da-vO2 >1.0; and group 4, lactate 2/Da-vO2 ≤1.0. Results: Combination of hyperlactatemia and high Cv-aCO2/Da-vO2 ratio was associated with the worst SOFA scores and lower survival rates at day 28 [log rank (Mantel–Cox) = 31.39, p 2/Da-vO2 ratio and lactate 2/Da-vO2 ratio. The multivariate analysis revealed that Cv-aCO2/Da-vO2 ratio at both T0 (RR 3.85; 95 % CI 1.60–9.27) and T6 (RR 3.97; 95 % CI 1.54–10.24) was an independent predictor for mortality at day 28, as well as lactate levels at T6 (RR 1.58; 95 % CI 1.13–2.22). Conclusion: Complementing lactate assessment with Cv-aCO2/Da-vO2 ratio during early stages of resuscitation of septic shock can better identify patients at high risk of adverse outcomes. The Cv-aCO2/Da-vO2 ratio may become a potential resuscitation goal in patients with septic shock.
SCOPUS: ar.j
info:eu-repo/semantics/published
Databáze: OpenAIRE
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