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01.12.2008 | Original

Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock?

verfasst von: Fabrice Vallée, Benoit Vallet, Olivier Mathe, Jacqueline Parraguette, Arnaud Mari, Stein Silva, Kamran Samii, Olivier Fourcade, Michèle Genestal

Erschienen in: Intensive Care Medicine | Ausgabe 12/2008

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Abstract

Objective

To test the hypothesis that, in resuscitated septic shock patients, central venous-to-arterial carbon dioxide difference [P(cv-a)CO₂] may serve as a global index of tissue perfusion when the central venous oxygen saturation (ScvO₂) goal value has already been reached.

Design

Prospective observational study.

Setting

A 22-bed intensive care unit (ICU).

Patients

After early resuscitation in the emergency unit, 50 consecutive septic shock patients with ScvO₂ > 70% were included immediately after their admission into the ICU (T0). Patients were separated in Low P(cv-a)CO₂ group (Low gap; n = 26) and High P(cv-a)CO₂ group (High gap; n = 24) according to a threshold of 6 mmHg at T0.

Measurements

Measurements were performed every 6 h over 12 h (T0, T6, T12).

Results

At T0, there was a significant difference between Low gap patients and High gap patients for cardiac index (CI) (4.3 ± 1.6 vs. 2.7 ± 0.8 l/min/m², P < 0.0001) but not for ScvO₂ values (78 ± 5 vs. 75 ± 5%, P = 0.07). From T0 to T12, the clearance of lactate was significantly larger for the Low gap group than for the High gap group (P < 0.05) as well as the decrease of SOFA score at T24 (P < 0.01). At T0, T6 and T12, CI and P(cv-a)CO₂ values were inversely correlated (P < 0.0001).

Conclusion

In ICU-resuscitated patients, targeting only ScvO₂ may not be sufficient to guide therapy. When the 70% ScvO₂ goal-value is reached, the presence of a P(cv-a)CO₂ larger than 6 mmHg might be a useful tool to identify patients who still remain inadequately resuscitated.

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Titel: Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock?
verfasst von: Fabrice Vallée
Benoit Vallet
Olivier Mathe
Jacqueline Parraguette
Arnaud Mari
Stein Silva
Kamran Samii
Olivier Fourcade
Michèle Genestal
Publikationsdatum: 01.12.2008
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 12/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1199-0

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Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock?