Persistent hyperlactatemia-high central venous-arterial carbon dioxide to arterial-venous oxygen content ratio is associated with poor outcomes in early resuscitation of septic shock - 29/07/17
, Li Li b, Haixiang Zhang b, Minjia Wang bAbstract |
Objective |
Several studies reported Pv-aCO2/Ca-vO2 ratio as a surrogate of VCO2/VO2 to detect global tissue hypoxia. The present study aimed to evaluate the prognostic value of Pv-aCO2/Ca-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock.
Methods |
A retrospective study was conducted in 144 septic shock patients in a 30-bed mixed ICU. A Pv-aCO2/Ca-vO2 ratio>1.4 was considered abnormal. Patients were classified into four predefined groups according to lactate levels and Pv-aCO2/Ca-vO2 ratio after the first 6h of resuscitation. Sequential Organ Failure Assessment (SOFA) score at day 3 was assessed. A Kaplan-Meier curve showed the survival probabilities at day 28 using a log-rank test to evaluate the differences between groups. A receiver operating characteristics (ROC) curve evaluated the ability of lactate, Pv-aCO2/Ca-vO2 ratio and Pv-aCO2/Ca-vO2 ratio combined with lactate to predict mortality at day 28.
Results |
Combination of hyperlactatemia and high Pv-aCO2/Ca-vO2 ratio was associated with poor SOFA scores and low survival rates at day 28 (P<0.001). The Cox multivariate survival analysis demonstrated that Pv-aCO2/Ca-vO2 ratio and lactate at T6 were independent predictors of mortality at day 28. The area under the ROC curve of the Pv-aCO2/Ca-vO2 ratio combined with lactate for predicting mortality at day 28 was highest and superior to that of lactate and Pv-aCO2/Ca-vO2 ratios.
Conclusion |
Combination of Pv-aCO2/Ca-vO2 ratio and lactate at early stages of resuscitation of septic shock can better predict the prognosis of patients. The Pv-aCO2/Ca-vO2 ratio may become a useful parameter supplementary to lactate in the resuscitation of septic shock.
Il testo completo di questo articolo è disponibile in PDF.Keywords : CO2 gap, Lactate, Respiratory quotient, Anaerobic metabolism, Acute circulatory failure, Tissue hypoxia, Septic shock
Mappa
Vol 35 - N° 8
P. 1136-1141 - agosto 2017 Ritorno al numero
Articolo precedente
- Utility of the simplified Wells and revised Geneva scores to exclude pulmonary embolism in femur fracture patients
- Youn-Jung Kim, Dae-Hee Choi, Eu Sun Lee, Seung Mok Ryoo, Shin Ahn, Chang Hwan Sohn, Dong-Woo Seo, Kyoung Soo Lim, Won Young Kim
- C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial
- Jacek Smereka, Jerzy R. Ladny, Amanda Naylor, Kurt Ruetzler, Lukasz Szarpak
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?