Clinical application progress of the P(v-a)CO2/C(a-v)O2 ratio in resuscitation of circulatory shock

doi:10.3877/cma.j.issn.2096-1537.2018.02.018

Abstract

Abstract:

the P(v-a)CO₂/C(a-v)O₂ ratio was calculated from the ratio of the CO₂ production and O₂ consumption, which reflect the respiratory quotient. The respiratory quotient would be infinite in the case of the anaerobic metabolism during which only CO₂ was produced without the consumption of O₂. Recently, attention is paid to use the P(v-a)CO₂/C(a-v)O₂ ratio to detect anaerobic metabolism in the resuscitation of the circulatory shock.

Key words: P(v-a)CO₂/C(a-v)O₂ ratio, Shock, Resuscitation

Huaiwu He, Rui Zhang, Yun Long, Dawei liu. Clinical application progress of the P(v-a)CO₂/C(a-v)O₂ ratio in resuscitation of circulatory shock[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(02): 200-204.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2018.02.018

https://icu.cma-cmc.com.cn/EN/Y2018/V04/I02/200

Figures/Tables 1

References 31

[1]	Shoemaker WC. Oxygen transport and oxygen metabolism in shock and critical illness. Invasive and noninvasive monitoring of circulatory dysfunction and shock [J]. Crit Care Clin, 1996, 12(4): 939-969.
[2]	Rivers E,Nguyen B,Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock [J]. New Engl J Med, 2001, 345(19): 1368-1377.
[3]	Rusconi AM,Bossi I,Lampard JG, et al. Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis [J]. Intern Emerg Med, 2015, 10(6): 731-743.
[4]	Jaehne AK,Salem D,Domecq Garces J. Early goal-directed therapy in the treatment of sepsis: the times have changed but not the therapy and benefit to patients [J]. Intens Care Med, 2015, 41(9): 1727-1728.
[5]	Marik PE. The demise of early goal-directed therapy for severe sepsis and septic shock [J]. Acta Anaesthesiol Scand, 2015, 59(5): 561-567.
[6]	He HW,Liu DW. Central venous-to-arterial CO₂ difference/arterial-central venous O₂ difference ratio: An experimental model or a bedside clinical tool? [J]. J Crit Care, 2016, 35: 219-220.
[7]	Gutierrez G. A mathematical model of tissue-blood carbon dioxide exchange during hypoxia [J]. Amer J Respir Crit Care Med, 2004, 169(4): 525-533.
[8]	Jakob SM,Groeneveld AB,Teboul JL. Venous-arterial CO₂ to arterial-venous O₂ difference ratio as a resuscitation target in shock states? [J]. Intensive Care Med, 2015, 41(5): 936-938.
[9]	Teboul JL,Scheeren T. Understanding the Haldane effect [J]. Intensive Care Med, 2017, 43(1): 91-93.
[10]	Saludes P,Proença L,Gruartmoner G, et al. Central venous-to-arterial carbon dioxide difference and the effect of venous hyperoxia: A limiting factor, or an additional marker of severity in shock? [J]. J Clin Monit Comput, 2017, 31(6): 1203-1211.
[11]	He HW,Liu DW,Ince C. Understanding elevated Pv-aCO₂ gap and Pv-aCO₂/Ca-vO₂ ratio in venous hyperoxia condition [J]. J Clin Monit Comput, 2017, 31(6): 1321-1323.
[12]	Cuschieri J,Rivers EP,Donnino MW, et al. Central venous-arterial carbon dioxide difference as an indicator of cardiac index [J]. Intensive Care Med, 2005, 31(6): 818-822.
[13]	Mesquida J,Saludes P,Gruartmoner G, et al. Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock [J]. Crit Care, 2015, 19: 126.
[14]	Mekontso-Dessap A,Castelain V,Anguel N, et al. Combination of venoarterial PCO₂ difference with arteriovenous O₂ content difference to detect anaerobic metabolism in patients [J]. Intensive Care Med, 2002, 28(3): 272-277.
[15]	Ospina-Tascon GA,Umana M,Bermudez W, et al. Combination of arterial lactate levels and venous-arterial CO₂ to arterial-venous O₂ content difference ratio as markers of resuscitation in patients with septic shock [J]. Intensive Care Med, 2015, 41(5): 796-805.
[16]	Mallat J,Lemyze M,Meddour M, et al. Ratios of central venous-to-arterial carbon dioxide content or tension to arteriovenous oxygen content are better markers of global anaerobic metabolism than lactate in septic shock patients [J]. Annal Intens Care, 2016, 6(1): 10.
[17]	He HW,Liu DW,Long Y, et al. High central venous-to-arterial CO₂ difference/arterial-central venous O₂ difference ratio is associated with poor lactate clearance in septic patients after resuscitation [J]. J Crit Care, 2016, 31(1): 76-81.
[18]	Gomez H,Kellum JA. Lactate in sepsis [J]. JAMA, 2015, 313(2): 194-195.
[19]	Rimachi R,Bruzzi de Carvahlo F,Orellano-Jimenez C, et al. Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock [J]. Anaesth Intensive Care, 2012, 40(3): 427-432.
[20]	Levy B,Gibot S,Franck P, et al. Relation between muscle Na^＋K^＋ ATPase activity and raised lactate concentrations in septic shock: a prospective study [J]. Lancet, 2005, 365(9462): 871-875.
[21]	Monnet X,Julien F,Ait-Hamou N, et al. Lactate and venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders [J]. Crit Care Med, 2013, 41(6): 1412-1420.
[22]	Du W,Long Y,Wang XT, et al. The use of the ratio between the veno-arterial carbon dioxide difference and the arterial-venous oxygen difference to guide resuscitation in cardiac surgery patients with hyperlactatemia and normal central venous oxygen saturation [J]. Chin Med J, 2015, 128(10): 1306-1313.
[23]	Mallat J,Lemyze M,Tronchon L, et al. Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock [J]. World J Crit Care Med, 2016, 5(1): 47-56.
[24]	Ospina-Tascon GA,Umana M,Bermudez WF, et al. Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock? [J]. Intensive Care Med, 2016, 42(2): 211-221.
[25]	De Backer D. VO₂/DO₂ relationship: how to get rid of methodological pitfalls? [J]. Intensive Care Med, 2000, 26(12): 1719-1722.
[26]	Waxman K,Annas C,Daughters K, et al. A method to determine the adequacy of resuscitation using tissue oxygen monitoring [J]. J Trauma, 1994, 36(6): 852-856; discussion 856-858.
[27]	Yu M,Morita SY,Daniel SR, et al. Transcutaneous pressure of oxygen: a noninvasive and early detector of peripheral shock and outcome [J]. Shock, 2006, 26(5): 450-456.
[28]	Yu M,Chapital A,Ho HC, et al. A prospective randomized trial comparing oxygen delivery versus transcutaneous pressure of oxygen values as resuscitative goals [J]. Shock, 2007, 27(6): 615-622.
[29]	He HW,Liu DW,Long Y, et al. The transcutaneous oxygen challenge test: a noninvasive method for detecting low cardiac output in septic patients [J]. Shock, 2012, 37(2): 152-155.
[30]	He HW,Liu DW,Long Y, et al. The peripheral perfusion index and transcutaneous oxygen challenge test are predictive of mortality in septic patients after resuscitation [J]. Crit Care, 2013, 17(3): R116.
[31]	Mari A,Vallee F,Bedel J, et al. Oxygen challenge test in septic shock patients: prognostic value and influence of respiratory status [J]. Shock, 2014, 41(6): 504-509.

作者/年份	病例数	Ratio相关计算参数		AUC	阈值
Mekontso-Dessap等^[14]/2002	89例＋148次测量（回顾性）	P（v-a）CO₂，SvO₂	0.85	1.4	乳酸>2 mmol/L
Monnet等^[21]/2013	25例（有容量反应性）	P（v-a）CO₂，ScvO₂	0.94	1.8	扩容后VO₂增加>15%
Mesquida等^[13]/2015	35例＋97次测量（前瞻性）	P（v-a）CO₂，ScvO₂	0.82	1.4	3＋2 h内乳酸清除>10%
Ospina-Tascon等^[15]/2015	135例（前瞻性）	C（v-a）CO₂，SvO₂	N/A	1	28 d死亡率
He等^[17]/2016	84例＋168次测量（前瞻性）	P（v-a）CO₂，ScvO₂	0.72	1.23	8 h-乳酸清除>10%
Du等^[22]/2015	72例（回顾性研究）	P（v-a）CO₂，ScvO₂	0.77	1.6	DO₂>10%后，VO₂增加（>0%）
Mallat等^[16]/2016	51例（有容量反应性）（前瞻性）	P（v-a）CO₂，ScvO₂	0.96	1.68	扩容后VO₂增加>15%
?	?	C（v-a）CO₂，ScvO₂	0.96	1.02	扩容后VO₂增加>15%

作者/年份	病例数	Ratio相关计算参数		AUC	阈值
Mekontso-Dessap等^[14]/2002	89例＋148次测量（回顾性）	P（v-a）CO₂，SvO₂	0.85	1.4	乳酸>2 mmol/L
Monnet等^[21]/2013	25例（有容量反应性）	P（v-a）CO₂，ScvO₂	0.94	1.8	扩容后VO₂增加>15%
Mesquida等^[13]/2015	35例＋97次测量（前瞻性）	P（v-a）CO₂，ScvO₂	0.82	1.4	3＋2 h内乳酸清除>10%
Ospina-Tascon等^[15]/2015	135例（前瞻性）	C（v-a）CO₂，SvO₂	N/A	1	28 d死亡率
He等^[17]/2016	84例＋168次测量（前瞻性）	P（v-a）CO₂，ScvO₂	0.72	1.23	8 h-乳酸清除>10%
Du等^[22]/2015	72例（回顾性研究）	P（v-a）CO₂，ScvO₂	0.77	1.6	DO₂>10%后，VO₂增加（>0%）
Mallat等^[16]/2016	51例（有容量反应性）（前瞻性）	P（v-a）CO₂，ScvO₂	0.96	1.68	扩容后VO₂增加>15%
?	?	C（v-a）CO₂，ScvO₂	0.96	1.02	扩容后VO₂增加>15%

Please choose a citation manager

Content to export

Clinical application progress of the P(v-a)CO₂/C(a-v)O₂ ratio in resuscitation of circulatory shock

RichHTML

PDF (PC)

Knowledge

Cited

Abstract

Cite this article

share this article

Figures/Tables 1

References 31

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Junxian Wu, Junjie Zeng, Youyin Xu, Bo Yuan. Effect of extracorporeal shock wave therapy on post-operative shoulder stiffness after rotator cuff suture [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 571-576.
[2]	Yingying Kong, Lutao Xie, Xiaochi Lu, Jiefeng Xu, Guangju Zhou, Mao Zhang. Protective effect and mechanism of sodium butyrate on cardio-brain injury after cardiac arrest resuscitation in pigs [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(05): 355-362.
[3]	Pediatric Burn Study Group, Burn Surgery Branch of Chinese Medical Association. Expert consensus on fluid resuscitation of early pediatric burn shock (version 2023) [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(05): 371-376.
[4]	Huixin Xu, Bo Liu, Lijun Tang. Development of a prediction model for failed extracorporeal shock wave lithotripsy of proximal ureteral stones larger than 1 cm [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 506-511.
[5]	Hongli Xu, Yulin Yang, Qing Xue, Qian Zhang, Lihong Ma, Zhengang Qiu. Efficacy of extracorporeal shock wave for non-specific low back pain: a systematic review and Meta-analysis [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 307-314.
[6]	Jiaquan Liao, Bo Wu, Changmin Tang. Effect of extracorporeal shock wave combined with myoelectric biofeedback on foot drop after stroke [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(05): 286-292.
[7]	Yang Yu, Xiaojie Liu, LiJuan Wang, Yuchen Gao, Yao Ding, Hushan Ao. Training model for cardiopulmonary resuscitation under the background of regular control of COVID-19 [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 483-486.
[8]	Yuzheng Du. Development course of Xingnao Kaiqiao acupuncture and acupuncture and moxibustion siscipline in 50 years [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 133-137.
[9]	Zhilong Zhang. An analysis on treating spirit with Xingnao Kaiqiao acupuncture [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 138-141.
[10]	Zhihong Meng. Current status of research on the mechanism of Xingnao Kaiqiao acupuncture for diseases of multipel systems [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 142-145.
[11]	Lina Ning, Jie Xiong. The therapeutic evaluation research on treating dysarthria after cerebral infarction with Xingnao Kaiqiao acupuncture and tongue acupuncture therapy [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 146-150.
[12]	Shoufa Zhao, Shu Wang, Larissa Miare Vados, Alberto Cantidio Ferreira. Observation on the efficacy of Xingnao Kaiqiao acupuncture combined with rehabilitation therapy in the treatment of ischemic stroke in the recorvery period [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 151-155.
[13]	Ruiyu Li, Lingyong Xiao, Yuexin Zhang, Zhiying Li, Xiaoyu Dai. An analysis of the idea construction and protocol design of acupuncture timing study for the treatment of limb dysfunction in cerebral infarction using Xingnao Kaiqiao acupuncture [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 156-160.
[14]	Jing Ding, Peiwen Li, Yingchun Xu. The application of Xingnao Kaiqiao acupuncture in severe neurological emergencies [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 161-164.
[15]	Anna Jing, Bo Li, Yuzhen Wu, Ying Cui, Yuping Ma, Yuxian Li, Shiyi Jiang, Yutong Zhou. A study on the indications of Xingnao Kaiqiao acupuncture based on clinical evidence [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(04): 167-172.

模态框（Modal）标题

Please choose a citation manager

Content to export