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

Jaume Mesquida; Paula Saludes; Guillem Gruartmoner; Cristina Espinal; Eva Torrents; Francisco Baigorri; Antonio Artigas

doi:10.1186/s13054-015-0858-0

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

Jaume Mesquida, Paula Saludes, Guillem Gruartmoner, Cristina Espinal, Eva Torrents, Francisco Baigorri, Antonio Artigas

Departament de Medicina

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© Mesquida et al. Introduction: Since normal or high central venous oxygen saturation (ScvO<inf>2</inf>) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (P<inf>cva</inf>CO<inf>2</inf> gap) has been proposed. In the present study, we aimed to evaluate the ability of the P<inf>cva</inf>CO<inf>2</inf> gap and the P<inf>cva</inf>CO<inf>2</inf>/arterial-venous oxygen content difference ratio (P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf>) to predict lactate evolution in septic shock. Methods: 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 P<inf>cva</inf>CO<inf>2</inf> gap and the P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf> 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. Results: Thirty-five septic shock patients were studied. At inclusion, the P<inf>cva</inf>CO<inf>2</inf> gap was 5.6 ± 2.1 mmHg, and the P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf> ratio was 1.6 ± 0.7 mmHg dL/mL O<inf>2</inf>. Those patients whose lactate values did not decrease had higher P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf> 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 P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf> ratio values in the previous control. The ROC analysis showed an AUC 0.82 (p < 0.001), and a P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf> ratio cut-off value of 1.4 mmHg dL/mL O<inf>2</inf> 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 P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf> ratio (≥1.4). Conclusion: In a population of septic shock patients with normalized MAP and S<inf>cv</inf>O<inf>2</inf>, the presence of elevated P<inf>cva</inf>CO<inf>2</inf>/C<inf>av</inf>O<inf>2</inf> ratio significantly reduced the odds of adequate lactate clearance during the following hours.

Idioma original	Anglès
Número d’article	126
Revista	Critical Care
Volum	19
Número	1
DOIs	https://doi.org/10.1186/s13054-015-0858-0
Estat de la publicació	Publicada - 28 de març 2015

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10.1186/s13054-015-0858-0

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Mesquida, J., Saludes, P., Gruartmoner, G., Espinal, C., Torrents, E., Baigorri, F., & Artigas, A. (2015). 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. Critical Care, 19(1), Article 126. https://doi.org/10.1186/s13054-015-0858-0

@article{043e880a064b4add8afbfb4f42a047e2,

title = "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",

abstract = "{\textcopyright} Mesquida et al. Introduction: Since normal or high central venous oxygen saturation (ScvO2) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (PcvaCO2 gap) has been proposed. In the present study, we aimed to evaluate the ability of the PcvaCO2 gap and the PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) to predict lactate evolution in septic shock. Methods: 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 PcvaCO2 gap and the PcvaCO2/CavO2 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. Results: Thirty-five septic shock patients were studied. At inclusion, the PcvaCO2 gap was 5.6 ± 2.1 mmHg, and the PcvaCO2/CavO2 ratio was 1.6 ± 0.7 mmHg dL/mL O2. Those patients whose lactate values did not decrease had higher PcvaCO2/CavO2 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 PcvaCO2/CavO2 ratio values in the previous control. The ROC analysis showed an AUC 0.82 (p < 0.001), and a PcvaCO2/CavO2 ratio cut-off value of 1.4 mmHg dL/mL O2 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 PcvaCO2/CavO2 ratio (≥1.4). Conclusion: In a population of septic shock patients with normalized MAP and ScvO2, the presence of elevated PcvaCO2/CavO2 ratio significantly reduced the odds of adequate lactate clearance during the following hours.",

author = "Jaume Mesquida and Paula Saludes and Guillem Gruartmoner and Cristina Espinal and Eva Torrents and Francisco Baigorri and Antonio Artigas",

year = "2015",

month = mar,

day = "28",

doi = "10.1186/s13054-015-0858-0",

language = "English",

volume = "19",

number = "1",

}

Mesquida, J, Saludes, P, Gruartmoner, G, Espinal, C, Torrents, E, Baigorri, F & Artigas, A 2015, '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', Critical Care, vol. 19, núm. 1, 126. https://doi.org/10.1186/s13054-015-0858-0

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; Saludes, Paula; Gruartmoner, Guillem et al.
In: Critical Care, Vol. 19, Núm. 1, 126, 28.03.2015.

Producció científica: Contribució a revista › Article › Recerca › Avaluat per experts

TY - JOUR

T1 - 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

AU - Mesquida, Jaume

AU - Saludes, Paula

AU - Gruartmoner, Guillem

AU - Espinal, Cristina

AU - Torrents, Eva

AU - Baigorri, Francisco

AU - Artigas, Antonio

PY - 2015/3/28

Y1 - 2015/3/28

N2 - © Mesquida et al. Introduction: Since normal or high central venous oxygen saturation (ScvO2) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (PcvaCO2 gap) has been proposed. In the present study, we aimed to evaluate the ability of the PcvaCO2 gap and the PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) to predict lactate evolution in septic shock. Methods: 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 PcvaCO2 gap and the PcvaCO2/CavO2 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. Results: Thirty-five septic shock patients were studied. At inclusion, the PcvaCO2 gap was 5.6 ± 2.1 mmHg, and the PcvaCO2/CavO2 ratio was 1.6 ± 0.7 mmHg dL/mL O2. Those patients whose lactate values did not decrease had higher PcvaCO2/CavO2 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 PcvaCO2/CavO2 ratio values in the previous control. The ROC analysis showed an AUC 0.82 (p < 0.001), and a PcvaCO2/CavO2 ratio cut-off value of 1.4 mmHg dL/mL O2 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 PcvaCO2/CavO2 ratio (≥1.4). Conclusion: In a population of septic shock patients with normalized MAP and ScvO2, the presence of elevated PcvaCO2/CavO2 ratio significantly reduced the odds of adequate lactate clearance during the following hours.

AB - © Mesquida et al. Introduction: Since normal or high central venous oxygen saturation (ScvO2) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (PcvaCO2 gap) has been proposed. In the present study, we aimed to evaluate the ability of the PcvaCO2 gap and the PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) to predict lactate evolution in septic shock. Methods: 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 PcvaCO2 gap and the PcvaCO2/CavO2 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. Results: Thirty-five septic shock patients were studied. At inclusion, the PcvaCO2 gap was 5.6 ± 2.1 mmHg, and the PcvaCO2/CavO2 ratio was 1.6 ± 0.7 mmHg dL/mL O2. Those patients whose lactate values did not decrease had higher PcvaCO2/CavO2 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 PcvaCO2/CavO2 ratio values in the previous control. The ROC analysis showed an AUC 0.82 (p < 0.001), and a PcvaCO2/CavO2 ratio cut-off value of 1.4 mmHg dL/mL O2 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 PcvaCO2/CavO2 ratio (≥1.4). Conclusion: In a population of septic shock patients with normalized MAP and ScvO2, the presence of elevated PcvaCO2/CavO2 ratio significantly reduced the odds of adequate lactate clearance during the following hours.

U2 - 10.1186/s13054-015-0858-0

DO - 10.1186/s13054-015-0858-0

M3 - Article

SN - 1466-609X

VL - 19

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 126

ER -