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OBJECTIVE@#To evaluate the prognostic value of the difference between peripheral venous and arterial partial pressure of carbon dioxide in patients with septic shock following early resuscitation.@*METHODS@#This prospective study was conducted among the patients with septic shock treated in our department during the period from May, 2017 to May, 2018. Peripheral venous, peripheral arterial and central venous blood samples were collected simultaneously and analyzed immediately at bedside after 6-h bundle treatment. Arterial blood lactate concentration (Lac) and the arterial (PaCO), peripheral venous (PpvCO) and central venous partial pressure of carbon dioxide (PcvCO) were recorded. The differences between PpvCO and PaCO (Ppv-aCO) and between PcvCO and PaCO (Pcv-aCO) were calculated. Pearson correlation analysis was used to test the agreement between Pcv-aCO and Ppv-aCO. Multivariable logistic regression analysis was performed to analyze the possible risk factors for 28-day mortality, and the receiver-operating characteristic curve (ROC) was plotted to assess the prognostic values of these factors for 28-day mortality.@*RESULTS@#A total of 62 patients were enrolled in this study, among who 35 survived and 27 died during the 28-day period. Compared with the survivor group, the patients died within 28 days showed significantly higher Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score (24.2±6.0 20.5±4.9, =0.011), sequential organ failure assessment (SOFA) score (14.9±4.7 12.2±4.5, =0.027), PcvaCO (5.5±1.6 7.1±1.7, < 0.001), PpvaCO (7.1±1.8 10.0±2.7, < 0.001), and arterial lactate level (3.3±1.2 4.2±1.3, =0.003) after 6-h bundle treatment. Pearson correlation analysis showed that Ppv-aCO was significantly correlated with Pcv-aCO (=0.897, R= 0.805, < 0.001). Multiple logistic regression analysis identified Ppv-aCO (β=0.625, =0.001, OR=1.869, 95% CI: 1.311-2.664) and lactate level (β=0.584, =0.041, OR=1.794, 95%CI: 1.024-3.415) as the independent risk factors for 28-day mortality. The maximum area under the ROC (AUC) of Ppv-aCO was 0.814 (95%CI: 0.696- 0.931, < 0.001), and at the best cut- off value of 9.05 mmHg, Ppv-aCO had a sensitivity of 70.4% and a specificity of 88.6% for predicting 28-day mortality. The AUC of lactate level was 0.732 (95%CI: 0.607-0.858, =0.002), and its sensitivity for predicting 28-day mortality was 70.4% and the specificity was 74.3% at the best cut-off value of 3.45 mmol/L; The AUC of Pcv-aCO was 0.766 (95%CI: 0.642-0.891, < 0.001), and its sensitivity was 66.7% and the specificity was 80.0% at the best cut-off value of 7.05 mmHg.@*CONCLUSIONS@#A high Ppv-aCO after early resuscitation of septic shock is associated with poor outcomes. Ppv-aCO is well correlated with Pcv-aCO and can be used as an independent indicator for predicting 28-day mortality in patients with septic shock.
Subject(s)
Humans , APACHE , Carbon Dioxide , Cardiopulmonary Resuscitation , Lactic Acid , Blood , Organ Dysfunction Scores , Partial Pressure , Pilot Projects , Prognosis , Prospective Studies , ROC Curve , Regression Analysis , Shock, Septic , Blood , MortalityABSTRACT
Objective To investigate the predictive value of central venous-to-arterial carbon dioxide difference (Pcv-aCO2) on the prognosis of elderly patients with sepsis.Methods 208 elderly patients who met the diagnostic criteria of the Sepsis-3 and with the age of more than 60 years old, and admitted to intensive care unit (ICU) of Guangdong General Hospital from January to December in 2017 were enrolled. According to the prognosis, the patients were divided into death group (n = 46) and survival group (n = 162). The Pcv-aCO2, central venous oxygen saturation (ScvO2), serum procalcitonin (PCT), C-reactive protein (CRP), sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) were collected for all patients. The differences of each index between the two groups were compared. The correlations between Pcv-aCO2 and ScvO2, PCT, CRP, SOFA, APACHEⅡscores were analyzed respectively with Pearson correlation. The prognostic value of Pcv-aCO2 in elderly patients with sepsis was assessed by receiver operating characteristic curve (ROC).Results Compared with survival group, the Pcv-aCO2, PCT, CRP, SOFA and APACHEⅡscores in death group were significantly increased [Pcv-aCO2 (mmHg, 1 mmHg = 0.133 kPa): 6.13±3.33 vs. 4.40±2.65, PCT (μg/L): 31.41±12.83 vs. 3.01±2.69, CRP (mg/L): 130.51± 42.23 vs. 104.46±50.12, SOFA: 12.01±2.25 vs. 9.05±2.06, APACHEⅡ: 29.52±5.03 vs. 20.01±3.21, allP < 0.05], and ScvO2 in death group was significantly decreased (0.571±0.136 vs. 0.685±0.106,P < 0.01). Correlation analysis showed that the Pcv-aCO2 was negatively correlated with ScvO2 (r = -0.762,P = 0.001) and was positively correlated with PCT, CRP, SOFA and APACHEⅡscores (r value was 0.737, 0.625, 0.738, 0.713, respectively, allP < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of Pcv-aCO2 prediction of death in patients with sepsis was 0.826, the cut-off was 6.62 mmHg, the sensitivity was 84.7％, the specificity was 77.5％, the positive likelihood ratio was 3.76, and the negative likelihood ratio was 0.19.Conclusion Pcv-aCO2 has a great value in evaluating the prognosis of elderly patients with sepsis and can accurately determine the prognosis of sepsis.
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Objective To investigate the use of PLR induced VTI changes combined with P(cv-a)CO2 in sepsis shock early fluid resuscitation. Methods 54 patients with sepsis shock admitted in Chancheng district central hospital from March 2016 to May 2017 were randomly divided into the treatment group (n=26) and the control group (n=28). The treatment group were monitored by the PLR induced VTI changes combined with P(cv-a)CO2, while the control group were monitored by CVP. The changes of 6 h, 12 h, 24 h, CVP, BNP and LAC levels, the time of vasoactive drugs, the time of mechanical ventilation, ICU hospitalization time and mortality were compared between the two groups. Results There were no statistic difference in fluid infusion within 6h, CVP, BNP, and LAC levels in the two groups; Fluid infusion within 12 h and 24 h, CVP and BNP in the treatment group were lower than those in the control group (P<0.05); the two groups for the treatment of 12 h,24 h plasma, LAC levels were no significant difference; The application time of vasoactive drugs, the time of mechanical ventilation and the length of hospitalization in ICU in the treatment group were shorter than those in the control group (P<0.05); The 28 day mortality was not statistically different between the two groups. Conclusion PLR induced VTI changes combined with P (cv-a) CO2 in septic shock early fluid resuscitation monitoring is superior to CVP, which has the important research significance.
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Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.
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Objective To explore the relationship between early changes of central venous-toarterial carbon dioxide difference (Pcv-aCO2) and the prognostic in patients with septic shock.Methods One hundred and three patients with septic shock were retrospectively analyzed.The patients were divided into death group (37 cases) and survival group (66 cases) according to prognosis.The patients were divided into four groups according to the changes of 0 and 6 h Pcv-aCO2:Pcv-aCO2 persistently high group (16 cases),Pcv-aCO2 increased group (19 cases),Pcv-aCO2 decreased group (22 cases),Pcv-aCO2 persistently normal group (46 cases).All the patients were treated with early goal-directed therapy (EGDT),and central venous oxygen saturation (ScvO2) ≥0.70 was the target.The acute physiology and chronic health evaluation (APACHE) Ⅲ score,sepsis related organ failure assessment (SOFA) and mortality were compared.Results There was no statistical difference in 0 h Pcv-aCO2 (P ＞ 0.05).The Pcv-aCO2 in 6,12 and 24 h in survival group was significantly lower than that in death group [(5.0 ± 1.8) mmHg (1 mmHg =0.133 kPa) vs.(6.8 ± 2.3) mmHg,(4.7 ± 2.3) mmHg vs.(7.2 ± 3.0) mmHg,(3.2 ± 1.5) mmHg vs.(7.5 ± 3.3) mmHg],and there was statistical difference (P ＜ 0.05 or ＜ 0.01).The APACHE Ⅲ score in survival group was significantly lower than that in death group [(51.6 ± 23.8) scores vs.(87.7 ± 35.9) scores],and there was statistical difference (P ＜ 0.05).The time of mechanical ventilation,APACHE Ⅲ score,SOFA,length of stay in hospital and mortality in Pcv-aCO2 persistently high group and Pcv-aCO2 increased group were significantly higher than those in Pcv-aCO2 decreased group and Pcv-aCO2 persistently normal group,and there were statistical differences (P ＜ 0.05 or ＜ 0.01).Conclusion The Pcv-aCO2 persistently high during the early resuscitation of septic shock is associated with multi-organ dysfunction and worse prognosis,and provides guidance for clinical treatment.