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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 3/2004

01.03.2004 | Original

Effects of fluid challenge on gastric mucosal PCO2 in septic patients

verfasst von: Eliézer Silva, Daniel De Backer, Jacques Creteur, Jean-Louis Vincent

Erschienen in: Intensive Care Medicine | Ausgabe 3/2004

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Abstract

Objective

To determine the effects of fluid challenge on systemic hemodynamic variables and gastric intramucosal partial pressure of carbon dioxide (PCO2) in septic patients.

Design

Short-term interventional study.

Setting

Medical-surgical intensive care unit in a university hospital.

Patients

Twenty-four adult patients with severe sepsis or septic shock requiring volume replacement. All patients were studied within 24 h of onset of severe sepsis or septic shock.

Interventions

Five hundred milliliters of a 6% hydroxyethyl starch (HES) solution were administered in 30 min.

Measurements and results

Complete hemodynamic data, blood samples, and gastric mucosal PCO2 (automatic gas capnometry) determinations were obtained at baseline and 15 min after the end of fluid infusion. After fluid challenge, cardiac index (CI) increased from 3.8 (range 2.9–4.2) to 4.2 (range 3.1–4.9) l/min m−2 (p<0.05). The PCO2 gap decreased from 9.8 (range 6.9–26.0) to 8.5 (range 6.6–17.4) mm Hg (p<0.05), but important individual variations were observed. We failed to observe significant relationships between changes in CI and in PCO2 gap, or between indices of preload (pulmonary artery occluded pressure, right atrial pressure, and pulse pressure variations) and changes in PCO2 gap. In addition, changes in PCO2 gap and in (v-a) CO2 were not related; however, changes in PCO2 gap were related to baseline PCO2 gap (p=0.003), PEEP (p=0.02), and cumulative doses of vasopressors (p=0.02).

Conclusions

The effects of fluid challenge on gastric mucosal PCO2 are variable and related to baseline PCO2 gap rather than to systemic variables. In general, rapid volume infusion decreases PCO2 gap, but this effect is more pronounced in patients with presumably impaired mucosal perfusion.
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Metadaten
Titel
Effects of fluid challenge on gastric mucosal PCO2 in septic patients
verfasst von
Eliézer Silva
Daniel De Backer
Jacques Creteur
Jean-Louis Vincent
Publikationsdatum
01.03.2004
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 3/2004
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-2115-2

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