Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock
Mesquida, Jaume (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Saludes, Paula (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Gruartmoner de Vera, Guillem (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Espinal, Cristina (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Saludes, Paula (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Baigorri, Francisco (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Universitat Autònoma de Barcelona

Date:	2015
Abstract:	Since normal or high central venous oxygen saturation (ScvO) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (PCO gap) has been proposed. In the present study, we aimed to evaluate the ability of the PCO gap and the PCO/arterial-venous oxygen content difference ratio (PCO/CO) to predict lactate evolution in septic shock. Observational study. Septic shock patients within the first 24 hours of ICU admission. After restoration of mean arterial pressure, and central venous oxygen saturation, the PCO gap and the PCO/CO ratio were calculated. Consecutive arterial and central venous blood samples were obtained for each patient within 24 hours. Lactate improvement was defined as the decrease ≥ 10% of the previous lactate value. Thirty-five septic shock patients were studied. At inclusion, the PCO gap was 5. 6 ± 2. 1 mmHg, and the PCO/CO ratio was 1. 6 ± 0. 7 mmHg · dL/mL O. Those patients whose lactate values did not decrease had higher PCO/CO ratio values at inclusion (1. 8 ± 0. 8vs. 1. 4 ± 0. 5, p 0. 02). During the follow-up, 97 paired blood samples were obtained. No-improvement in lactate values was associated to higher PCO/CO ratio values in the previous control. The ROC analysis showed an AUC 0. 82 (p < 0. 001), and a PCO/CO ratio cut-off value of 1. 4 mmHg · dL/mL O showed sensitivity 0. 80 and specificity 0. 75 for lactate improvement prediction. The odds ratio of an adequate lactate clearance was 0. 10 (p < 0. 001) in those patients with an elevated PCO/CO ratio (≥1. 4). In a population of septic shock patients with normalized MAP and SO, the presence of elevated PCO/CO ratio significantly reduced the odds of adequate lactate clearance during the following hours.
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Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	Critical care, Vol. 19 (march 2015) , ISSN 1466-609X

DOI: 10.1186/s13054-015-0858-0
PMID: 25888382

7 p, 455.8 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles