Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O 2 content difference ratio as markers of resuscitation in patients with septic shock

Intensive Care Medicine
Gustavo A Ospina-TasconDaniel De Backer

Abstract

To evaluate the prognostic value of the Cv-aCO2/Da-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock. Prospective observational study in a 60-bed mixed ICU. One hundred and thirty-five patients with septic shock were included. The resuscitation protocol targeted mean arterial pressure, pulse pressure variations or central venous pressure, mixed venous oxygen saturation, and lactate levels. Patients were classified into four groups according to lactate levels and Cv-aCO2/Da-vO2 ratio at 6 h of resuscitation (T6): group 1, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 >1.0; group 2, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 ≤1.0; group 3, lactate <2.0 mmol/L and Cv-aCO2/Da-vO2 >1.0; and group 4, lactate <2.0 mmol/L and Cv-aCO2/Da-vO2 ≤1.0. Combination of hyperlactatemia and high Cv-aCO2/Da-vO2 ratio was associated with the worst SOFA scores and lower survival rates at day 28 [log rank (Mantel-Cox) = 31.39, p < 0.0001]. Normalization of both variables was associated with the best outcomes. Patients with a high Cv-aCO2/Da-vO2 ratio and lactate <2.0 mmol/L had similar outcomes to hyperlactatemic patients with low Cv-aCO2/Da-vO2 ratio. The multivariate analysis revealed that Cv-aCO2/Da-vO2 ratio at...Continue Reading

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Citations

Oct 21, 2016·Intensive Care Medicine·Gustavo A Ospina-TascónMaurizio Cecconi
Sep 24, 2015·Intensive Care Medicine·Armand Mekontso DessapLila Bouadma
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Apr 5, 2016·Intensive Care Medicine·Elisa EstenssoroGlenn Hernández
Apr 9, 2015·Intensive Care Medicine·Stephan M JakobJean-Louis Teboul
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Feb 12, 2019·Intensive Care Medicine·Daniel De BackerKeith R Walley
Jul 12, 2019·Journal of Clinical Monitoring and Computing·Philippe PortranJean-Luc Fellahi
Jul 2, 2019·The Journal of International Medical Research·Huaiwu HeCan Ince
Jun 16, 2019·Critical Care : the Official Journal of the Critical Care Forum·Daniel De Backer, Pierre Foulon
Mar 25, 2017·Journal of Applied Physiology·Gustavo A Ospina-TascónDaniel De Backer
Apr 17, 2020·Annals of Intensive Care·Gustavo A Ospina-TascónJan Bakker
Nov 19, 2015·Intensive Care Medicine·Gustavo A Ospina-TascónDaniel De Backer
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