title: [Assessment of central venous-to-arterial CO(2) difference during early goal-directed therapy in patients with septic shock].
abstract: OBJECTIVE
  To detect the changes of central venous-to-arterial carbon dioxide difference (P(cv-a)CO(2)) during early goal-directed therapy (EGDT) in patients with septic shock and evaluate its' value in predicting adequate resuscitation and prognosis.
  
  
  METHODS
  From April 2009 to October 2010, 26 septic shock patients were enrolled in the study. EGDT was performed in all the patients immediately after enrollment. According to the whether they achieved early goal with in the 6 hour or not, patients were separated to EGDT achievement and un-achievement groups. At the onset and after the 6 hours EGDT, mean arterial pressure (MAP), cardiac index (CI), central venous oxygen saturation (ScvO(2)), oxygen delivery (DO(2)), oxygen consumption (VO(2)), oxygen extraction ratio (O(2) ext), lactate, P(cv-a)CO(2) were recorded. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and 28 day mortality were compared between 2 groups.
  
  
  RESULTS
  There were no significant difference of age and sex between the 15 patients who achieved early goals and 11 patients who did not. EGDT un-achievement patients had higher APACHE II score (21 ± 5) and 28 day mortality (9/11) when compared with EGDT achievement patients (t = 2.985, χ(2) = 4.547, P < 0.05). In EGDT un-achievement group, MAP, CI, DO(2), VO(2), O(2)ext, ScvO(2), Lac, P(cv-a)CO(2) were comparable between the onset and 6 hours after EGDT. However, in EGDT achievement group, MAP ((90 ± 9) mmHg (1 mmHg = 0.133 kPa)), CI ((4.0 ± 1.8) L×min(-1)×m(-2)), DO(2) ((596 ± 274) ml×min(-1)×m(-2)), ScvO(2) (76.9% ± 4.1%) increased, and P(cv-a)CO(2) ((4.2 ± 2.7) mmHg) decreased significantly after 6 hours of EGDT (t values were -3.393, -2.985, -2.103 and -3.195 respectively, all P < 0.05). The changes of P(cv-a)CO(2) between the onset and 6 hours after EGDT, demonstrated high value for predictability of outcome, according to the area under the ROC curve (AUC) was 0.839 (P = 0.004). As a predictor for death, increasing of P(cv-a)CO(2) after 6 hours of EGDT has a sensibility of 100% and specificity of 60%.
  
  
  CONCLUSIONS
  Increasing of P(cv-a)CO(2) after EGDT purports inadequate tissue perfusion in patients with septic shock. Changes of P(cv-a)CO(2) during EGDT demonstrated a useful tool to evaluate adequate resuscitation and prognosis.
authors.affiliation: Department of Critical Medicine , Southeast University, Nanjing, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.forename: Hong-jie
authors.initials: HJ
authors.lastname: Zhao
authors.forename: Ying-zi
authors.initials: YZ
authors.lastname: Huang
authors.forename: Song-qiao
authors.initials: SQ
authors.lastname: Liu
authors.forename: Cong-shan
authors.initials: CS
authors.lastname: Yang
authors.forename: Feng-mei
authors.initials: FM
authors.lastname: Guo
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Qiu
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012151:Resuscitation; D012772:Shock, Septic / Q000097:blood* / Q000628:therapy
chemical_list: D002245:Carbon Dioxide