Persistently high venous-to-arterial carbon dioxide differences during early resuscitation are associated with poor outcomes in septic shock
| dc.contributor.author | Ospina Tascón, Gustavo A. | |
| dc.contributor.author | Bautista Rincón, Diego F. | |
| dc.contributor.author | Umaña, Mauricio. | |
| dc.contributor.author | Tafur, José D. | |
| dc.contributor.author | Gutiérrez, Alejandro. | |
| dc.contributor.author | García, Alberto F. | |
| dc.contributor.author | Bermúdez, William. | |
| dc.contributor.author | Granados, Marcela. | |
| dc.contributor.author | Arango Dávila, César. | |
| dc.contributor.author | Hernández P., Glenn | |
| dc.date.accessioned | 2019-10-17T18:24:13Z | |
| dc.date.available | 2019-10-17T18:24:13Z | |
| dc.date.issued | 2013 | |
| dc.date.updated | 2019-10-14T19:04:44Z | |
| dc.description.abstract | Abstract Introduction Venous-to-arterial carbon dioxide difference (Pv-aCO2) may reflect the adequacy of blood flow during shock states. We sought to test whether the development of Pv-aCO2 during the very early phases of resuscitation is related to multi-organ dysfunction and outcomes in a population of septic shock patients resuscitated targeting the usual oxygen-derived and hemodynamic parameters. Methods We conducted a prospective observational study in a 60-bed mixed ICU in a University affiliated Hospital. 85 patients with a new septic shock episode were included. A Pv-aCO2 value ≥ 6 mmHg was considered to be high. Patients were classified in four predefined groups according to the Pv-aCO2 evolution during the first 6 hours of resuscitation: (1) persistently high Pv-aCO2 (high at T0 and T6); (2) increasing Pv-aCO2 (normal at T0, high at T6); (3) decreasing Pv-aCO2 (high at T0, normal at T6); and (4) persistently normal Pv-aCO2 (normal at T0 and T6). Multiorgan dysfunction at day-3 was compared for predefined groups and a Kaplan Meier curve was constructed to show the survival probabilities at day-28 using a log-rank test to evaluate differences between groups. A Spearman-Rho was used to test the agreement between cardiac output and Pv-aCO2. Finally, we calculated the mortality risk ratios at day-28 among patients attaining normal oxygen parameters but with a concomitantly increased Pv-aCO2. Results Patients with persistently high and increasing Pv-aCO2 at T6 had significant higher SOFA scores at day-3 (p < 0.001) and higher mortality rates at day-28 (log rank test: 19.21, p < 0.001) compared with patients who evolved with normal Pv-aCO2 at T6. Interestingly, a poor agreement between cardiac output and Pv-aCO2 was observed (r2 = 0.025, p < 0.01) at different points of resuscitation. Patients who reached a central venous saturation (ScvO)2 ≥ 70% or mixed venous oxygen saturation (SvO2) ≥ 65% but with concomitantly high Pv-aCO2 at different developmental points (i.e., T0, T6 and T12) had a significant mortality risk ratio at day-28. Conclusion The persistence of high Pv-aCO2 during the early resuscitation of septic shock was associated with more severe multi-organ dysfunction and worse outcomes at day-28. Although mechanisms conducting to increase Pv-aCO2 during septic shock are insufficiently understood, Pv-aCO2 could identify a high risk of death in apparently resuscitated patients. | |
| dc.fuente.origen | Biomed Central | |
| dc.identifier.citation | Critical Care. 2013 Dec 13;17(6):R294 | |
| dc.identifier.doi | 10.1186/cc13160 | |
| dc.identifier.uri | https://repositorio.uc.cl/handle/11534/26852 | |
| dc.issue.numero | No. R294 | |
| dc.language.iso | en | |
| dc.nota.acceso | Contenido completo | |
| dc.pagina.final | 10 | |
| dc.pagina.inicio | 1 | |
| dc.revista | Critical Care | es_ES |
| dc.rights | acceso abierto | |
| dc.rights.holder | Ospina-Tascón et al.; licensee BioMed Central Ltd. | |
| dc.subject.ddc | 610 | |
| dc.subject.dewey | Medicina y salud | es_ES |
| dc.subject.other | Dióxido de carbono Uso - terapéutico | es_ES |
| dc.subject.other | Shock séptico | es_ES |
| dc.subject.other | Reanimacion | es_ES |
| dc.title | Persistently high venous-to-arterial carbon dioxide differences during early resuscitation are associated with poor outcomes in septic shock | es_ES |
| dc.type | artículo | |
| dc.volumen | Vol. 17 | |
| sipa.codpersvinculados | 98874 |