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

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Abstract

© 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.
Original languageEnglish
Article number126
JournalCritical Care
Volume19
Issue number1
DOIs
Publication statusPublished - 28 Mar 2015

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