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01.09.2008 | Original

Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients

verfasst von: Guillermo Gutierrez, Pablo Comignani, Luis Huespe, F. Javier Hurtado, Arnaldo Dubin, Vinayak Jha, Yanina Arzani, Silvio Lazzeri, Lombardo Sosa, Juan Riva, Wolf Kohn, Daniela Suarez, Gonzalo Lacuesta, Daniela Olmos, Carlos Mizdraji, Alejandra Ojeda

Erschienen in: Intensive Care Medicine | Ausgabe 9/2008

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Abstract

Objective

Blood O₂ saturation and lactate concentration gradients from superior vena cava (SVC) to pulmonary artery (PA) occur in critically ill patients. These gradients (ΔSO₂ and Δ[Lac]) may be positive or negative. We tested the hypothesis that positive ΔSO₂ and Δ[Lac] are associated with improved survival in critically ill patients.

Design and setting

Multinational, prospective observational study conducted in six medical and surgical ICUs.

Patients

Consecutive sample of 106 adults requiring insertion of a pulmonary artery catheter (PAC). Average age was 59.5 ± 15.5 years, APACHE II score was 15.5 ± 6.7 (mean ± SD). Main outcome measure was 28-day mortality.

Interventions

None.

Measurements and results

We drew blood samples from the proximal and distal ports of PACs every 6 h from the time of PAC insertion (Initial measurement) until its removal (Final measurement). Samples were analyzed for SO₂, [Lac], glucose concentration and blood gases. Hemodynamic measurements were obtained after blood samples. We monitored patients for 30.9 ± 11.0 h. Overall mortality rate was 25.5%. More survivors had mean and final ΔSO₂ ≥ 0 and Δ[Lac] ≥ 0 than decedents (p < 0.01; p < 0.05 respectively). On the average, ΔSO₂ and Δ[Lac] were positive in survivors and negative in decedents. Survival odds ratios for final measurements of ΔSO₂ ≥ 0 and Δ[Lac] ≥ 0 were 19.22 and 7.70, respectively (p < 0.05).

Conclusions

A strong association exists between positive ΔSO₂ and Δ[Lac] and survival in critically ill patients. Whether therapy aimed at increasing ΔSO₂ and Δ[Lac] results in improved ICU survival remains to be determined.

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Titel: Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients
verfasst von: Guillermo Gutierrez
Pablo Comignani
Luis Huespe
F. Javier Hurtado
Arnaldo Dubin
Vinayak Jha
Yanina Arzani
Silvio Lazzeri
Lombardo Sosa
Juan Riva
Wolf Kohn
Daniela Suarez
Gonzalo Lacuesta
Daniela Olmos
Carlos Mizdraji
Alejandra Ojeda
Publikationsdatum: 01.09.2008
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 9/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1128-2

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Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients