Central venous-arterial p CO 2 difference as a tool in resuscitation of septic patients
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Paul A. van Beest Mariska C. Lont Nicole D. Holman Bert Loef Michae¨l A. Kuiper E. Christiaan Boerma
ORIGINAL
Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients
M. A. Kuiper Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, L.E.I.C.A. Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Results: The mixed pCO2 difference underestimated the central pCO2 difference by a mean bias of Ó Springer-Verlag Berlin Heidelberg and 0.03± 0.32 kPa (95 % limits of ESICM 2013 agreement: -0.62–0.58 kPa). We observed a weak relation between M. A. Kuiper HERMES Critical Care Group, pCO2 gap and CI. The in hospital Amsterdam, The Netherlands mortality rate was 21 % (6/29) for the low gap group and 29 % (7/24) for the Abstract Purpose: To investigate high gap group; the odds ratio was 1.6 (95 % CI 0.5–5.5), p = 0.53. the interchangeability of mixed and P. A. van Beest ()) central venous-arterial carbon dioxide At T = 4 the odds ratio was 5.3 Department of Anesthesiology, (95 % CI 0.9–30.7); p = 0.08. differences and the relation between University Medical Center Groningen, University of Groningen, 30001, the central difference (pCO2 gap) and Conclusions: From a practical perspective, the clinical utility of central 9700 RB Groningen, cardiac index (CI). We also investivenous pCO2 values is of potential The Netherlands gated the value of the pCO2 gap in interest in determining the venouse-mail: [email protected] outcome prediction. Methods: We Tel.: ?31-50-3616161 arterial pCO2 difference. The likeliperformed a post hoc analysis of a Fax: ?31-50-3613763 hood of a bad outcome seems to be well-defined population of 53 patients enhanced when a high pCO2 gap M. C. Lont M. A. Kuiper E. C. Boerma with severe sepsis or septic shock. persists after 24 h of therapy. Department of Intensive Care Medicine, Mixed and central venous pCO2 were Medical Center Leeuwarden, 888, determined earlier at a 6 h interval Keywords Central venous-arterial 8901 BR Leeuwarden, The Netherlands (T = 0 to T = 4) during the first pCO2 difference Cardiac index 24 h after intensive care unit (ICU) N. D. Holman B. Loef Septic shock Hemodynamics admittance. The population was Department of Intensive Care Medicine, divided into two groups based on Martini Hospital, 30033, 9700 RM pCO2 gap (cut off value 0.8 kPa). Groningen, The Netherlands Received: 8 July 2012 Accepted: 15 February 2013
Introduction Shock is defined as global tissue hypoxia secondary to an imbalance between systemic oxygen delivery (DO2) and oxygen demand (VO2). Global tissue hypoxia as a result of systemic inflammatory response or circulatory failure is an important indicator of serious illness preceding multiple organ failure. The development of organ failure
predicts the outcome of the septic patient [1]. Unrecognized and untreated global tissue hypoxia increases morbidity and mortality: decreased mixed venous oxygen saturation (SvO2) values or central venous oxygen saturation (ScvO2) values predict poor progno
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