Prognostic value of venous to arterial carbon dioxide difference during early resuscitation in critically ill patients with septic shock

Abstract

Context:The partial pressure of venous to arterial carbon dioxide gradient (PCO2 gap) is considered as an alternative marker of tissue hypoperfusion and has been used to guide treatment for shock.Aims:The aim of this study was to investigate the prognostic value of venous-to-arterial carbon dioxide difference during early resuscitation of patients with septic shock and compared it with that of lactate clearance and Acute Physiology and Chronic Health Evaluation II (APACHE-II) score.Settings and Design:Forty patients admitted to one Intensive Care Unit were enrolled.Subjects and Methods:APACHE-II score was calculated on admission. An arterial blood gas, central venous, and lactate samples were obtained on admission and after 6 h, and lactate clearance was calculated. Patients were classified retrospectively into Group I (survivors) and Group II (nonsurvivors). Pv-aCO2 difference in the two groups was evaluated.Statistical Analysis Used:Data were fed to the computer and analyzed using IBM SPSS software package version 20.0.Results:At T0, Group II showed high PCO2 gap (8.37 ± 1.36 mmHg) than Group I (7.55 ± 0.95 mmHg) with statistically significant difference (P = 0.030). While at T6, Group II showed higher PCO2 gap (9.48 ± 1.47 mmHg) with statistically significant difference (P < 0.001) and higher mean lactate values (62.71 ± 23.66 mg/dl) with statistically significant difference (P < 0.001) than Group I where PCO2 gap and mean lactate values became much lower, 5.91 ± 1.12 mmHg and 33.61 ± 5.80 mg mg/dl, respectively. Group I showed higher lactate clearance (25.42 ± 6.79%) with statistically significant difference (P < 0.001) than Group II (−69.40–15.46%).Conclusions:High PCO2 gap >7.8 mmHg after 6 h from resuscitation of septic shock patients is associated with high mortality.

Delta de CO2 como predictor de lesión renal aguda (LRA) en pacientes con diagnóstico de síndrome de distrés respiratorio del adulto (SDRA) por COVID-19 y choque séptico

“…Se han realizado múltiples estudios científicos internacionales donde el DCO 2 mayor de 6 mmHg se asoció a mayor mortalidad e hipoperfusión. 32 Estos hallazgos podrían ser resultado de la alteración del flujo sanguíneo secundario a una disminución del GC o alteración de la microcirculación, 33 como consecuencia, los tejidos recibirán menor perfusión y se mantendrán hipoxémicos. 34 Debido a que en nuestra población no fue posible el monitoreo invasivo del GC, éste se calculó de forma no invasiva (fórmula de Fick) y se observó una media de 8.2L/min, sin presentar diferencia entre ambos grupos; sin embargo, los pacientes con DCO 2 menor de 6 mmHg desarrollaron mayor número de casos de LRA.…”

A Cross Sectonal Observational Study of Prognostic Value of Veno-Arterial Carbon Dioxide Difference in Septic Shock Patients in ICU

“…Our study also showed similar results with (5.70 + 1.29 mmol/l.vs 9.09+1.58mmo/l at T6, 3.9+1.18mmol/l. vs 8.94+1.34mmo/l at T12 and 2.45+1.09 mmol/l.vs 8.79+1.33mmo/l in survivors and nonsurvivors with p<0.0001 Mahajan RK et al 16 studied patterns of scvo2 lactate and (v-a)co2 difference in the prognosis of septic shock patients and concluded that in septic patients, baseline vaCO 2 of ≤ 6 mmHg was associated with higher mortality, but only in those patients with ScvO 2 >70%. This was thought to be due to impaired mitochondrial respiration in sepsis with nonutilization of oxygen by the cell may decrease CO 2 production, since anaerobic metabolism is less efficient in producing CO 2.…”

“…Our study is in agreement with this study as the non-survivors had higher v-a co2difference (9.78+0.78 mm Hg) and non-survivors had lower v-a co2difference at T6 p<0.0001. In their study of prognostic value of venous-toarterial carbon dioxide difference during early resuscitation of patients with septic shock, Helmy TA et al 16 and compared venous-to-arterial carbon dioxide difference with that of lactate clearance and concluded that At T0, non survivors showed high PCO2 gap (8.37±1.36 mmHg) than survivors (7.55±0.95 mmHg) with (P=0.030). At T6, showed higher PCO2 gap (9.48±1.47 mmHg) with (P < 0.001) and higher mean lactate values (62.71±23.66 mg/dl) with statistically significant difference (P<0.001) than survivors where PCO2 gap and mean lactate values became much lower, 5.91±1.12 mmHg and 33.61±5.80 mg/dl, respectively.…”

Mystery of PCO2 Gap in Sepsis

“…Exactly 2 years ago, an article was published in Indian Journal of Critical Care Medicine, which showed that high PCO 2 gap after 6 hours of resuscitation of septic shock patients was associated with high mortality. 1 The study by Arajuo et al, that is being published in this issue of Indian Journal of Critical Care Medicine fails to show any such correlation. 2…”