Combining central venous-to-arterial partial pressure of carbon dioxide difference and central venous oxygen saturation to guide resuscitation in septic shock.
OBJECTIVE
Central venous oxygen saturation (Scvo2) is a useful therapeutic target when treating septic shock. We hypothesized that combining Scvo2 and central venous-to-arterial partial pressure of carbon dioxide difference (△Pco2) may provide additional information about survival.


METHODS
We performed a retrospective analysis of 172 patients treated for septic shock. All patients were treated using goal-directed therapy to achieve Scvo2 ≥ 70%. After 6 hours of treatment, we divided patients into 4 groups based on Scvo2 (<70% or ≥ 70%) and △Pco2 (<6 mm Hg or ≥ 6 mm Hg).


RESULTS
Overall, 28-day mortality was 35.5%. For patients in whom the Scvo2 target was not achieved at 6 hours, mortality was 50.0%, compared with 29.5% in those in whom Scvo2 exceeded 70% (P = .009). In patients with Scvo2 ≥ 70%, mortality was lower if △Pco2 was <6 mm Hg than if △Pco2 was ≥ 6 mm Hg (56.1% vs 16.1%, respectively; P < .001) and 6-hour lactate clearance was superior (0.01 ± 0.61 vs 0.21 ± 0.31, respectively; P = .016).


CONCLUSIONS
The combination of Scvo2 and △Pco2 appears to predict outcome in critically ill patients resuscitated from septic shock better than Scvo2 alone. Patients who meet both targets appear to clear lactate more efficiently.
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Wei
W
Du
Da-Wei
DW
Liu
Xiao-Ting
XT
Wang
Yun
Y
Long
Wen-Zhao
WZ
Chai
Xiang
X
Zhou
Xi
X
Rui
D018806:APACHE; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D012151:Resuscitation; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D002245:Carbon Dioxide; D010100:Oxygen
Lactate clearance; Scvo(2); Septic shock; Venous-arterial Pco(2) difference