Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock?
| Autor: | Mauricio Umaña, César Augusto Arango-Dávila, Daniel De Backer, Gustavo A. Ospina-Tascón, Humberto J. Madriñán, Alejandro Bruhn, Diego F. Bautista-Rincón, Glenn Hernandez, Juan David Valencia, William F. Bermúdez |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Cardiac output Resuscitation Soins intensifs réanimation Original Hemodynamics 030204 cardiovascular system & hematology Colombia Microcirculatory blood flow Critical Care and Intensive Care Medicine Medical sciences Microcirculation Veins 03 medical and health sciences 0302 clinical medicine Septic shock Medicine Humans Prospective Studies Aged Aged 80 and over Catheter insertion business.industry Organ dysfunction 030208 emergency & critical care medicine Blood flow Arteries Models Theoretical Carbon Dioxide Middle Aged medicine.disease Shock Septic Venous-to-arterial carbon dioxide difference Anesthesia Ciencias socio biomédicas Female medicine.symptom Blood Gas Analysis business |
| Zdroj: | Intensive care medicine, 42 (2 Repositorio ICESI Universidad ICESI instacron:Universidad ICESI Intensive Care Medicine |
| Popis: | Purpose: Septic shock has been associated with microvascular alterations and these in turn with the development of organ dysfunction. Despite advances in video microscopic techniques, evaluation of microcirculation at the bedside is still limited. Venous-to-arterial carbon dioxide difference (Pv-aCO2) may be increased even when venous O2 saturation (SvO2) and cardiac output look normal, which could suggests microvascular derangements. We sought to evaluate whether Pv-aCO2 can reflect the adequacy of microvascular perfusion during the early stages of resuscitation of septic shock. Methods: Prospective observational study including 75 patients with septic shock in a 60-bed mixed ICU. Arterial and mixed-venous blood gases and hemodynamic variables were obtained at catheter insertion (T0) and 6 h after (T6). Using a sidestream dark-field device, we simultaneously acquired sublingual microcirculatory images for blinded semiquantitative analysis. Pv-aCO2 was defined as the difference between mixed-venous and arterial CO2 partial pressures. Results: Progressively lower percentages of small perfused vessels (PPV), lower functional capillary density, and higher heterogeneity of microvascular blood flow were observed at higher Pv-aCO2 values at both T0 and T6. Pv-aCO2 was significantly correlated to PPV (T0: coefficient −5.35, 95 % CI −6.41 to −4.29, p SCOPUS: ar.j info:eu-repo/semantics/published |
| Databáze: | OpenAIRE |
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