Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;23(10):449-453.
doi: 10.5005/jp-journals-10071-23262.

Value of Central Venous to Arterial CO2 Difference after Early Goal-directed Therapy in Septic Shock Patients

David Theophilo Araujo  1 , Vinicius Brenner Felice  1 , Andre Felipe Meregalli  1 , Gilberto Friedman  1
Affiliations

Value of Central Venous to Arterial CO2 Difference after Early Goal-directed Therapy in Septic Shock Patients

David Theophilo Araujo et al. Indian J Crit Care Med. 2019 Oct.

Abstract

Background and aims: Venous to arterial difference of carbon dioxide (Pv-aCO2) tracks tissue blood flow. We aimed to evaluate if Pv-aCO2 measured from a superior central vein sample is a prognostic index (ICU length of stay, SOFA score, 28th mortality rate) just after early goal-directed therapy (EGDT)comparing its ICU admission values between patients with normal and abnormal (>6 mm Hg) Pv-aCO2. As secondary objectives, we evaluated the relationship of Pv-aCO2 with other variables of perfusion during the 24 hours that followed EGDT.

Materials and methods: Prospective observational study conducted in an academic ICU adult septic shock patients after a 6-hour complete EGTD. Hemodynamic measurements, arterial/central venous blood gases, and arterial lactate were obtained on ICU admission and after 6, 18 and 24 hours.

Results: Sixty patients were included. Admission Pv-aCO2 values showed no prognostic value. Admission Pv-aCO2 (ROC curve 0.527 [CI 95% 0.394 to 0.658]) values showed low specificity and sensitivity as predictors of mortality. There was a difference observed in the mean Pv-aCO2 between nonsurvivors (NS) and survivors (S) after 6 hours. Central venous oxygen saturation (ScvO2) and Pv-aCO2 showed significant correlation (R2 = -0.41, P < 0.0001). Patients with normal ScvO2 (>70%) and abnormal Pv-aCO2 (>6 mm Hg) showed higher SOFA scores. Normal Pv-aCO2 group cleared their lactate levels in comparison to the abnormal Pv-aCO2 group.

Conclusion: In septic shock, admission Pv-aCO2 after EGDT is not related to worse outcomes. An abnormal Pv-aCO2 along with a normal ScvO2 is related to organ dysfunction.

How to cite this article: Araujo DT, Felice VB, Meregalli AF, Friedman G. Value of Central Venous to Arterial CO2 Difference after Early Goal-directed Therapy in Septic Shock Patients. Indian J Crit Care Med 2019;23(10):449-453.

Keywords: Central venous saturation; Lactate; Mortality; Septic shock; Venous to arterial difference of CO2.

PubMed Disclaimer

Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Figs 1A to C
Figs 1A to C
Venous to arterial CO2 difference (Pv–aCO2), central venous saturation (ScvO2) and blood lactate values in survivors (S) and non-survivors (NS) during 24 hours. *p < 0.05 S vs NS after 12 hours
Figs 2A and B
Figs 2A and B
Central venous O2 saturation (ScvO2) and blood lactate values among normal (Pv–aCO2 ≤ 6 mm Hg) and abnormal (Pv–aCO2 >6 mm Hg) venous-arterial carbon dioxide groups patients during 24 hours. *p < 0.05 abnormal vs normal. #p = 0.025 over 24 hours in abnormal group
See this image and copyright information in PMC

References

    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637. - PubMed
    1. Hernandez G, Cavalcanti AB, Ospina-Tascon G, Zampieri FG, Dubin A, Hurtado FJ, et al. Early goal-directed therapy using a physiological holistic view: the ANDROMEDA-SHOCK-a randomized controlled trial. Ann Intensive Care. 2018;8(1):52. - PMC - PubMed
    1. Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care. 2004;8(2):R60–R65. - PMC - PubMed
    1. Puskarich MA, Trzeciak S, Shapiro NI, Heffner AC, Kline JA, Jones AE. Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock. Resuscitation. 2011;82(10):1289–1293. - PMC - PubMed
    1. Friedman G, De Backer D, Shahla M, Vincent JL. Oxygen supply dependency can characterize septic shock. Intensive Care Med. 1998;24(2):118–123. - PubMed

LinkOut - more resources