Chest
Clinical Investigations in Critical CareVeno-arterial Carbon Dioxide Gradient in Human Septic Shock
Section snippets
Patients
The study included 64 consecutive adult patients (49 male, 15 female) who developed a first episode of septic shock. Septic shock was defined by systemic hypotension (systolic arterial pressure <90 mm Hg), oliguria (urine output <20 ml/h), impaired mental status, and lactic acidosis (arterial lactate concentration >2 mmol/L) in the presence of an abnormal temperature (above 38.5°C or below 35.5°C), an abnormal white blood cell count (above 13,000/cu mm or below 4,000/cu mm), and a documented
RESULTS
The age of the 64 patients (49 male, 15 female) ranged from 27 to 89 years (mean, 61 ± 13 years). Shock survival was 58 percent (n = 37). The sources of infection were as follows: the lungs (n = 23), the abdomen (n = 20), the urinary tract (n = 5), the central nervous system (n = 5), and other sources (n = 11). Of the 64 patients, 32 (50 percent) had positive blood cultures.
DISCUSSION
The veno-arterial difference in PCO2 is the net result of CO2 production and clearance. The produced CO2 is transported mainly as HCO3− in plasma or in red blood cells. Only a small part of the CO2 is transported as carbamino-CO2 (5 percent) or dissolved in plasma and red blood cells (5 percept). CO2 is removed from the circulation by the lungs, 80 percent being mediated by the dehydration of bicarbonate. Under normal conditions, dCO2 does not exceed 6 mm Hg.21, 22
The CO2 is essentially
ACKNOWLEDGMENTS
We are thankful to Francis Cantraine, Ph.D., for his help in the statistical analysis of the data.
REFERENCES (29)
- et al.
Right ventricular dysfunction and dilatation, similar to left ventricular changes, characterize the cardiac depression of septic shock in humans
Chest
(1990) - et al.
Ultimate survival from septic shock
Resuscitation
(1986) - et al.
Blood lactate levels are superior to oxygen derived variables in predicting outcome in human septic shock
Chest
(1991) - et al.
End-tidal CO, pressure in the monitoring of cardiac output during canine hemorrhagic shock
J Crit Care
(1990) - et al.
Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation
N Engl J Med
(1986) - et al.
Arteriovenous carbon dioxide and pH gradients during cardiac arrest
Circulation
(1986) - et al.
Mixed venous blood gases are superior to arterial blood gases in assessing acid-base status and oxygenation during acute cardiac tamponade in dogs
J Clin Invest
(1988) - et al.
Assessing acid-base status in circulatory failure
N Engl J Med
(1989) - et al.
Venous hypercarbia associated with severe sepsis and systemic hypoperfusion
Crit Care Med
(1990) - et al.
Right ventricular dysfunction in septic shock: assessment by measurements of right ventricular ejection fraction using the thermodilution technique
Acta Anaesthesiol Scand
(1989)
Cardiorespiratory patterns in complicated and uncomplicated septic shock: physiologic alterations and their therapeutic indications
Ann Surg
Correlations between metabolic and cardiopulmonary measurements in patients after trauma, general surgery and sepsis
J Trauma
Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis
Crit Care Med
Defective oxygen consumption in septic shock
Surg Gynecol Obstet
Cited by (184)
Pcv-aCO<inf>2</inf> and procalcitonin levels for the early diagnosis of bloodstream infections caused by gram-negative bacteria
2022, American Journal of the Medical SciencesDifferential Diagnosis of Hypoventilation/Hypercapnia
2022, Small Animal Critical Care MedicineVeno-arterial CO<inf>2</inf> difference and respiratory quotient after cardiac arrest: An observational cohort study
2021, Journal of Critical CareCorrelation and Agreement Between the CO2 Gap Obtained From Peripheral Venous Blood and From Mixed Venous Blood in Mechanically Ventilated Septic Patients
2024, Seminars in Cardiothoracic and Vascular AnesthesiaCan perioperative pCO<inf>2</inf> gaps predict complications in patients undergoing major elective abdominal surgery randomized to goal-directed therapy or standard care? A secondary analysis
2024, Journal of Clinical Monitoring and Computing