Venous-to-arterial carbon dioxide difference in the resuscitation of patients with severe sepsis and septic shock: A systematic review

Medicina intensiva
J J Diaztagle FernándezJ J Sprockel Díaz

Abstract

The way to assess tissue perfusion during the resuscitation of patients with severe sepsis and septic shock is a current subject of research and debate. Venous oxygen saturation and lactate concentration have been the most frequently used criteria, though they involve known limitations. The venous-to-arterial difference of carbon dioxide (pCO2 delta) is a parameter than can be used to indicate tissue perfusion, and its determination therefore may be useful in these patients. A qualitative systematic review of the literature was made, comprising studies that assessed pCO2 delta in adult patients with severe sepsis or septic shock, and published between January 1966 and November 2016 in the Medline-PubMed, Embase-Elsevier, Cochrane Library, and LILACS databases. There was no language restriction. The PRISMA statement was followed, and methodological quality was evaluated. Twelve articles were included, all of an observational nature, and including 10 prospective studies (9 published since 2010). Five documented greater mortality among patients with high pCO2 delta values, in 3 cases even when achieving venous oxygen saturation targets. In 4 studies, a high pCO2 delta was related to lower venous oxygen saturation and higher lactat...Continue Reading

Citations

Jun 15, 2019·Medizinische Klinik, Intensivmedizin und Notfallmedizin·D MomcicevicP Kovacevic
Jan 8, 2021·Vascular Health and Risk Management·Arnaldo DubinGonzalo Ferrara
Jul 4, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Charles I McDonaldKiran Shekar
Feb 26, 2021·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Charles I McDonaldKiran Shekar
Sep 1, 2021·Critical Care : the Official Journal of the Critical Care Forum·Zied LtaiefLucas Liaudet

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