Values of central venous oxygen saturation and difference of central venous-arterial partial pressure of carbon dioxide in early goal-directed treatment in patients with septic shock

doi:10.3877/cma.j.issn.2096-1537.2021.02.008

Abstract

Abstract:

Objective

To evaluate the value of early goal-directed treatment (EGDT) with the target of central venous oxygen saturation (ScvO₂) and difference of central venous–arterial partial pressure of carbon dioxide (Pcv-aCO₂) in patients with septic shock.

Methods

A prospective study was conducted from Jun 2018 to Jun 2020 which enrolled 74 septic shock patients admitted to Beijing Shijitan Hospital affiliated Capital Medical University. EGDT was performed in all the patients immediately after enrollment with the target of ScvO₂ ≥0.7. All patients were divided into two groups by the values of Pcv-aCO₂ at 6 hours after ICU admission. High Pcv-aCO₂ group with ScvO₂ ≥0.7 and Pcv-aCO₂ ≥6 mmHg, Low Pcv-aCO₂ group with ScvO₂ ≥0.7 and Pcv-aCO₂＜6 mmHg. Then the parameters of hemodynamics, the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, the sequential organ failure assessment (SOFA) score, lactate and outcome of the patients in different groups were collected.

Results

74 cases were included, among which 28 in high Pcv-aCO₂ group and 46 in low Pcv-aCO₂ group. Compared with the low Pcv-aCO₂ group, the high Pcv-aCO₂ group had lower cardiac index (CI) and stroke volume index (SVI), higher extravascular lung water index (EVLWI). The APACHEⅡ score, SOFA score, blood lactate level in high Pcv-aO₂ group were significantly higher at 6, 24, 48 hours after ICU admission. The duration of ICU stay, ICU mortality in high Pcv-aCO₂ group was significantly higher. The differences were all statistically significant (P＜0.05).

Conclusion

Pcv-aCO₂＜6 mmHg as EGDT target can improve tissue perfusion and severity of patients with septic shock after reaching the standard of ScvO₂. Increasing cardiac ejection function may reduce the Pcv-aCO₂.

Key words: Central vein, Oxyhemoglobin saturation, CO₂ partial pressure difference, Sepsis shock, Early goal-directed treatment

Guomin Zhao, Feiping Lu. Values of central venous oxygen saturation and difference of central venous-arterial partial pressure of carbon dioxide in early goal-directed treatment in patients with septic shock[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(02): 137-141.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.02.008

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I02/137

Figures/Tables 4

组别	例数	性别［例（%）］		年龄（岁， $x ¯$ ±s）	感染部位［例（%）］				APACHEⅡ（分， $x ¯$ ±s）	SOFA （分， $x ¯$ ±s）	机械通气［例（%）］	CRRT［例（%）］
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	肺部	腹腔	尿道	中枢神经	APACHEⅡ（分， $x ¯$ ±s）	SOFA （分， $x ¯$ ±s）	机械通气［例（%）］	CRRT［例（%）］
高Pcv-aCO₂组	28	20 （71.4）	8 （28.6）	76±14	16 （57.1）	5 （17.9）	5 （17.9）	2 （7.1）	24.2±2.3	12.9±2.6	14 （50.0）	3 （10.7）
低Pcv-aCO₂组	46	32 （69.6）	14 （30.4）	72±16	27 （58.7）	8 （17.4）	6 （13.0）	5 （10.9）	23.6±2.1	12.2±2.1	15 （32.6）	4 （8.7）
统计值		χ²=0.011		t=0.647					t=0.261	t=0.472	χ²=0.048	χ²=0.254
P值		0.996		0.541					0.771	0.616	0.835	0.112

组别	例数	性别［例（%）］		年龄（岁， $x ¯$ ±s）	感染部位［例（%）］				APACHEⅡ（分， $x ¯$ ±s）	SOFA （分， $x ¯$ ±s）	机械通气［例（%）］	CRRT［例（%）］
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	肺部	腹腔	尿道	中枢神经	APACHEⅡ（分， $x ¯$ ±s）	SOFA （分， $x ¯$ ±s）	机械通气［例（%）］	CRRT［例（%）］
高Pcv-aCO₂组	28	20 （71.4）	8 （28.6）	76±14	16 （57.1）	5 （17.9）	5 （17.9）	2 （7.1）	24.2±2.3	12.9±2.6	14 （50.0）	3 （10.7）
低Pcv-aCO₂组	46	32 （69.6）	14 （30.4）	72±16	27 （58.7）	8 （17.4）	6 （13.0）	5 （10.9）	23.6±2.1	12.2±2.1	15 （32.6）	4 （8.7）
统计值		χ²=0.011		t=0.647					t=0.261	t=0.472	χ²=0.048	χ²=0.254
P值		0.996		0.541					0.771	0.616	0.835	0.112

组别	例数	HR（次/分）	CVP（mmHg）	MAP（mmHg）	SVI（ml/m²）	CI［L/（min•m²］	SVRI［KP_a•S/（L•m²）］	ITBVI（ml/m²）	EVLWI（ml/kg）
高Pcv-aCO₂组	28	118.6±14.5	6.4±0.2	57.6±10.4	32.6±5.2	2.8±0.4	118.6±8.4	965±56	8.2±1.4
低Pcv-aCO₂组	46	115.4±12.6	8.1±0.6	58.4±11.2	39.4±6.1	4.1±0.6	119.2±11.2	982±61	6.1±1.5
t值		2.052	1.804	2.221	2.763	9.832	1.300	1.653	4.462
P值		0.096	0.110	0.078	0.021	0.000	0.256	0.130	0.001

组别	时间点	例数	APACHEⅡ（分）	SOFA（分）	血乳酸（mmol/L）
高Pcv-aCO₂组	T6	28	20.7±6.2^a	12.1±4.3^a	5.2±2.6^a
	T24	28	18.6±5.3^a	11.6±3.6^a	3.7±2.8^a
	T48	28	17.4±4.8^a	10.8±5.2^a	2.1±1.1^a
低Pcv-aCO₂组	T6	46	17.4±5.6	9.2±4.6	3.4±1.2
	T24	46	14.8±3.6	9.6±3.8	2.3±0.8
	T48	46	14.3±3.2	8.4±2.2	1.6±0.6

组别	例数	ICU住院时间（d， $x ¯$ ±s）	ICU病死［例（%）］
高Pcv-aCO₂组	28	5.8±3.1	9 （32.1）
低Pcv-aCO₂组	46	4.3±2.2	3 （6.5）
统计值		t=3.692	χ²=12.584
P值		0.026	0.002

组别	例数	ICU住院时间（d， $x ¯$ ±s）	ICU病死［例（%）］
高Pcv-aCO₂组	28	5.8±3.1	9 （32.1）
低Pcv-aCO₂组	46	4.3±2.2	3 （6.5）
统计值		t=3.692	χ²=12.584
P值		0.026	0.002

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