Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock

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• 作者：Gustavo A. Ospina-Tascón ; Mauricio Uma?a ; William Bermúdez…
• 关键词：Lactate ; Venous ; to ; arterial carbon dioxide difference ; Oxygen consumption ; Respiratory quotient ; Septic shock
• 刊名：Intensive Care Medicine
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：41
• 期：5
• 页码：796-805
• 全文大小：577 KB
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  20.Ospin
• 作者单位：Gustavo A. Ospina-Tascón (1) (2)
  Mauricio Uma?a (1)
  William Bermúdez (2)
  Diego F. Bautista-Rincón (1)
  Glenn Hernandez (3)
  Alejandro Bruhn (3)
  Marcela Granados (1)
  Blanca Salazar (2)
  César Arango-Dávila (1) (2)
  Daniel De Backer (4)
  
  1. Intensive Care Unit, Fundación Valle Del Lili - Universidad ICESI, Av. Simón Bolívar Cra. 98, Cali, Colombia
  2. Universidad Del Valle, Escuela de Ciencias Básicas, Cali, Colombia
  3. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
  4. Intensive Care Department. CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
  
• 刊物主题：Intensive / Critical Care Medicine; Anesthesiology; Emergency Medicine; Pneumology/Respiratory System; Pain Medicine; Pediatrics;
• 出版者：Springer Berlin Heidelberg
• ISSN：1432-1238

文摘

Purpose To evaluate the prognostic value of the Cv-aCO₂/Da-vO₂ ratio combined with lactate levels during the early phases of resuscitation in septic shock. Methods Prospective observational study in a 60-bed mixed ICU. One hundred and thirty-five patients with septic shock were included. The resuscitation protocol targeted mean arterial pressure, pulse pressure variations or central venous pressure, mixed venous oxygen saturation, and lactate levels. Patients were classified into four groups according to lactate levels and Cv-aCO₂/Da-vO₂ ratio at 6?h of resuscitation (T6): group?1, lactate ?.0?mmol/L and Cv-aCO₂/Da-vO₂ >1.0; group?2, lactate ?.0?mmol/L and Cv-aCO₂/Da-vO₂ ?.0; group?3, lactate <2.0?mmol/L and Cv-aCO₂/Da-vO₂ >1.0; and group?4, lactate <2.0?mmol/L and Cv-aCO₂/Da-vO₂ ?.0. Results Combination of hyperlactatemia and high Cv-aCO₂/Da-vO₂ ratio was associated with the worst SOFA scores and lower survival rates at day?28 [log rank (Mantel–Cox)?=?31.39, p?<?0.0001]. Normalization of both variables was associated with the best outcomes. Patients with a high Cv-aCO₂/Da-vO₂ ratio and lactate <2.0?mmol/L had similar outcomes to hyperlactatemic patients with low Cv-aCO₂/Da-vO₂ ratio. The multivariate analysis revealed that Cv-aCO₂/Da-vO₂ ratio at both T0 (RR 3.85; 95?% CI 1.60-.27) and T6 (RR 3.97; 95?% CI 1.54-0.24) was an independent predictor for mortality at day?28, as well as lactate levels at T6 (RR 1.58; 95?% CI 1.13-.22). Conclusion Complementing lactate assessment with Cv-aCO₂/Da-vO₂ ratio during early stages of resuscitation of septic shock can better identify patients at high risk of adverse outcomes. The Cv-aCO₂/Da-vO₂ ratio may become a potential resuscitation goal in patients with septic shock.