Potential clinical value of P(cv-a)CO2/C(a-v)O2 ratio in early goal-directed resuscitation of septic shock

doi:10.3877/cma.j.issn.2096-1537.2022.01.003

Abstract

Abstract:

Objective

To investigate the application possibility of septic shock's early goal-directed resuscitation therapy by monitoring the gap of central venous partial pressure of carbon dioxide (PcvCO₂) and arterial partial pressure of carbon dioxide (PaCO₂)/the gap of arterial oxygen content (CaO₂) and venous oxygen content (CvO₂) [P(cv-a)CO₂/C(a-v)O₂].

Methods

A total of 44 samples of patients who received treatment in the intensive care department with septic shock in our hospital from June 2018 to June 2019 were collected and divided into two groups, according to the P(cv-a)CO₂/C(a-v)O₂ ratio, the patients' P(cv-a)CO₂/C(a-v)O₂ ratio＜1.6 were divided into group A, and the patients' P(cv-a)CO₂/C(a-v)O₂ ratio≥1.6 were divided into group B. The patients were monitored immediately after the establishment of superior vena cave in the ICU, and the comparisons between patient common material, basic parameters, oxygen metabolic parameters, and outcome were conducted.

Results

There was no significant difference at baseline between two groups (P＞0.05), but significantly difference were observed in P(cv-a)CO₂/C(a-v)O₂ ratio, arterial oxygen partial pressure, lactic acid, P(cv-a)CO₂(gap) at 0 h (P＜0.05), and lactate clearance rate between two groups at 6 h (P＜0.05). The APACHEⅡ score and SOFA score at 1, 3, 5, 7 d did not have a significant difference (P＞0.05), and the duration of vasoactive drugs (norepinephrine), mechanical ventilation, length of stay, and 28-day mortality also showed no differences (P＞0.05).

Conclusion

P(cv-a)CO₂/C(a-v)O₂ ratio can be used as a supplementary index to evaluate tissue hypoxia metabolism and guide treatment.

Key words: Septic shock, Central venous blood partial pressure of carbon dioxide, Arterial blood partial pressure of carbon dioxide, Arterial blood content of oxygen, Venous blood content of oxygen, Early goal-directed resuscitation, Lactic acid clearance rate

Danbin Xu, Longxiang Su, Bayinchahan·Boranyi, Lu Wang, Mutalifu·Maihemuti, Jingjing Wang, Caihong Wang, Genan Wang, Yun Long. Potential clinical value of P(cv-a)CO₂/C(a-v)O₂ ratio in early goal-directed resuscitation of septic shock[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(01): 23-30.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2022.01.003

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Figures/Tables 4

基线资料	A组（23例）	B组（21例）	统计值	P值
性别（例）			-	0.078
男	15	18
女	8	3
年龄（岁， $x ¯$ ±s）	61.00±15.96	51.90±15.59	t=0.992	0.336
感染部位（例）			-	0.913
肺部	7	4
腹部	8	14
胸腔	3	1
其他	5	3
APACHEⅡ评分（分， $x ¯$ ±s）	18.38±6.54	18.15±5.76	t=0.782	0.443
SOFA评分（分， $x ¯$ ±s）	8.31±3.21	10.42±5.85	t=0.402	0.692

基线资料	A组（23例）	B组（21例）	统计值	P值
性别（例）			-	0.078
男	15	18
女	8	3
年龄（岁， $x ¯$ ±s）	61.00±15.96	51.90±15.59	t=0.992	0.336
感染部位（例）			-	0.913
肺部	7	4
腹部	8	14
胸腔	3	1
其他	5	3
APACHEⅡ评分（分， $x ¯$ ±s）	18.38±6.54	18.15±5.76	t=0.782	0.443
SOFA评分（分， $x ¯$ ±s）	8.31±3.21	10.42±5.85	t=0.402	0.692

基本参数	A组（23例）	B组（21例）	统计值	P值
CVP（mmHg）
0 h	8.96±5.83	9.96±4.20	t=0.767	0.452
6 h	9.03±4.86	9.54±4.54	t=0.582	0.567
12 h	8.88±5.36	10.73±5.17	t=1.212	0.240
24 h	9.46±4.46	9.73±5.58	t=0.227	0.822
MAP（mmHg）
0 h	81.81±16.56	86.23±11.93	t=0.056	0.956
6 h	86.22±17.62	89.00±13.23	t=0.433	0.670
12 h	87.00±15.97	89.88±9.82	t=1.070	0.298
24 h	92.81±19.29	91.04±11.77	t=0.585	0.565
小时尿量（ml/h）
0 h	116.41±117.61	126.38±76.77	t=0.038	0.970
6 h	125.63±78.41	136.58±73.58	t=0.852	0.404
12 h	161.41±109.36	119.62±74.87	t=1.988	0.061
24 h	124.06±76.07	145.19±95.04	t=0.853	0.404
血管活性药物使用量［μg/（kg·min）］
0 h	0.14±0.12	0.19±0.27	t=1.028	0.316
6 h	0.15±0.16	0.20±0.27	t=0.821	0.421
12 h	0.14±0.16	0.18±0.16	t=0.732	0.473
24 h	0.12±0.11	0.14±0.13	t=0.890	0.384
24 h出入量［ml，M（Q₂₅，Q₇₅）］
入量	4590.00（3866.01，5390.51）	4940.00（4236.48，5730.18）	Z=0.493	0.628
出量	3658.00（3180.67，4787.58）	3953.00（3341.55，5186.74）	Z=0.482	0.635
血红蛋白（g/L）
0 h	10.71±2.91	9.97±2.67	t=1.024	0.318
6 h	10.13±2.81	10.01±2.83	t=0.314	0.757
12 h	10.23±2.60	9.44±2.31	t=1.426	0.169
24 h	10.19±2.59	9.62±2.18	t=1.331	0.198
乳酸（mmol/L）
0 h	2.46（2.02，3.89）	3.21（2.71，4.26）	Z=2.245	0.037
6 h	2.80（2.65，4.22）	2.04（1.99，3.81）	Z=1.795	0.089
12 h	2.42（2.30，3.70）	1.99（1.78，2.83）	Z=1.464	0.160
24 h	1.95（1.71，2.47）	1.450（1.31，2.11）	Z=1.269	0.220

基本参数	A组（23例）	B组（21例）	统计值	P值
PaO₂（mmHg）
0 h	88.09±26.60	114.60±49.04	t=2.748	0.013
6 h	103.00±48.38	107.60±41.98	t=0.350	0.730
12 h	99.52±30.86	102.05±29.68	t=0.418	0.681
24 h	95.91±26.04	108.75±27.90	t=1.465	0.159
SaO₂（%）
0 h	96.00（90.20，97.17）	98.00（94.49，98.30）	Z=1.454	0.162
6 h	98.00（94.36，97.47）	98.00（93.97，98.12）	Z=0.039	0.969
12 h	97.00（95.41，97.63）	97.50（95.51，97.88）	Z=0.285	0.779
24 h	98.00（96.12，97.70）	98.50（96.75，98.55）	Z=1.372	0.186
PcvO₂（mmHg）
0 h	35.26±7.48	39.45±8.82	t=1.944	0.067
6 h	39.22±7.90	37.70±5.61	t=0.489	0.630
12 h	38.13±7.44	38.90±5.71	t=0.449	0.658
24 h	40.04±8.02	40.25±4.71	t=0.095	0.925
ScvO₂（%）
0 h	64.63±13.41	69.58±13.26	t=1.380	0.184
6 h	69.78±8.92	69.60±10.41	t=0.126	0.901
12 h	69.66±9.74	69.45±7.54	t=0.035	0.972
24 h	71.50±10.05	72.85±6.70	t=0.150	0.882
P（cv-a）CO₂（mmHg）
0 h	4.82±2.76	8.20±2.55	t=4.173	0.001
6 h	6.52±3.68	5.85±2.83	t=1.347	0.194
12 h	5.74±3.61	6.15±3.67	t=0.281	0.782
24 h	6.87±3.65	6.90±3.32	t=0.221	0.827
C（a-v）O₂（ml/100 ml）
0 h	4.50±1.79	3.79±1.45	t=1.321	0.203
6 h	3.77±1.58	3.68±1.37	t=0.238	0.814
12 h	3.97±1.75	3.41±0.72	t=1.301	0.209
24 h	3.50±1.77	3.30±1.03	t=0.444	0.662
P（v-a）CO₂/C（a-v）O₂ ratio
0 h	1.04±0.37	2.33±0.59	t=8.270	0.001
6 h	1.94±1.10	1.71±0.89	t=1.369	0.187
12 h	1.40±0.97	1.76±0.97	t=0.357	0.725
24 h	2.00±1.33	2.17±1.40	t=0.137	0.892
氧合指数
0 h	171.50±83.28	232.55±92.48	t=2.296	0.033
6 h	208.97±113.37	231.42±106.05	t=0.430	0.672
12 h	190.90±76.35	230.16±95.37	t=0.817	0.424
24 h	186.01±72.01	238.27±136.09	t=2.095	0.050
氧摄取率（%）
0 h	35.45±13.75	27.70±11.81	t=2.198	0.041
6 h	30.18±10.18	33.60±19.93	t=0.951	0.353
12 h	29.20±11.14	30.12±8.09	t=0.272	0.788
24 h	27.26±9.84	28.02±6.27	t=0.025	0.980
乳酸清除率［%，M（Q₂₅，Q₇₅）］
6 h	-16.67（-80.28，-3.93）	25.30（3.20，33.91）	Z=3.679	0.001
12 h	26.67（-9.68，27.53）	14.57（-25.57，25.17）	Z=0.758	0.458

基本参数	A组（23例）	B组（21例）	统计值	P值
PaO₂（mmHg）
0 h	88.09±26.60	114.60±49.04	t=2.748	0.013
6 h	103.00±48.38	107.60±41.98	t=0.350	0.730
12 h	99.52±30.86	102.05±29.68	t=0.418	0.681
24 h	95.91±26.04	108.75±27.90	t=1.465	0.159
SaO₂（%）
0 h	96.00（90.20，97.17）	98.00（94.49，98.30）	Z=1.454	0.162
6 h	98.00（94.36，97.47）	98.00（93.97，98.12）	Z=0.039	0.969
12 h	97.00（95.41，97.63）	97.50（95.51，97.88）	Z=0.285	0.779
24 h	98.00（96.12，97.70）	98.50（96.75，98.55）	Z=1.372	0.186
PcvO₂（mmHg）
0 h	35.26±7.48	39.45±8.82	t=1.944	0.067
6 h	39.22±7.90	37.70±5.61	t=0.489	0.630
12 h	38.13±7.44	38.90±5.71	t=0.449	0.658
24 h	40.04±8.02	40.25±4.71	t=0.095	0.925
ScvO₂（%）
0 h	64.63±13.41	69.58±13.26	t=1.380	0.184
6 h	69.78±8.92	69.60±10.41	t=0.126	0.901
12 h	69.66±9.74	69.45±7.54	t=0.035	0.972
24 h	71.50±10.05	72.85±6.70	t=0.150	0.882
P（cv-a）CO₂（mmHg）
0 h	4.82±2.76	8.20±2.55	t=4.173	0.001
6 h	6.52±3.68	5.85±2.83	t=1.347	0.194
12 h	5.74±3.61	6.15±3.67	t=0.281	0.782
24 h	6.87±3.65	6.90±3.32	t=0.221	0.827
C（a-v）O₂（ml/100 ml）
0 h	4.50±1.79	3.79±1.45	t=1.321	0.203
6 h	3.77±1.58	3.68±1.37	t=0.238	0.814
12 h	3.97±1.75	3.41±0.72	t=1.301	0.209
24 h	3.50±1.77	3.30±1.03	t=0.444	0.662
P（v-a）CO₂/C（a-v）O₂ ratio
0 h	1.04±0.37	2.33±0.59	t=8.270	0.001
6 h	1.94±1.10	1.71±0.89	t=1.369	0.187
12 h	1.40±0.97	1.76±0.97	t=0.357	0.725
24 h	2.00±1.33	2.17±1.40	t=0.137	0.892
氧合指数
0 h	171.50±83.28	232.55±92.48	t=2.296	0.033
6 h	208.97±113.37	231.42±106.05	t=0.430	0.672
12 h	190.90±76.35	230.16±95.37	t=0.817	0.424
24 h	186.01±72.01	238.27±136.09	t=2.095	0.050
氧摄取率（%）
0 h	35.45±13.75	27.70±11.81	t=2.198	0.041
6 h	30.18±10.18	33.60±19.93	t=0.951	0.353
12 h	29.20±11.14	30.12±8.09	t=0.272	0.788
24 h	27.26±9.84	28.02±6.27	t=0.025	0.980
乳酸清除率［%，M（Q₂₅，Q₇₅）］
6 h	-16.67（-80.28，-3.93）	25.30（3.20，33.91）	Z=3.679	0.001
12 h	26.67（-9.68，27.53）	14.57（-25.57，25.17）	Z=0.758	0.458

转归	A组（23）	B组（21）	Z值	P值
血管活性药物使用时间（h）	144.00（88.00，262.00）	127.00（65.00，198.50）	1.873	0.086
机械通气时间（h）	225.00（76.50，277.00）	144.00（37.00，293.00）	0.621	0.557
APACHEⅡ评分（分）
24 h	17.00（14.00，25.00）	20.00（14.00，22.50）	0.782	0.443
48 h	15.00（12.00，25.00）	17.00（13.50，20.00）	1.105	0.282
72 h	15.00（11.00，23.00）	15.00（9.00，19.00）	1.246	0.227
96 h	15.00（9.00，25.00）	13.00（9.00，19.00）	2.065	0.052
SOFA评分（分）
24 h	9.00（6.00，11.00）	9.00（7.00，13.00）	0.402	0.692
48 h	9.00（7.00，11.00）	8.00（6.00，11.00）	0.328	0.746
72 h	8.00（5.00，11.00）	7.00（4.00，11.00）	0.741	0.467
96 h	7.00（3.00，11.00）	7.00（2.50，9.00）	1.350	0.192
住ICU时间（d）	11.00（6.00，15.00）	8.00（4.50，19.00）	0.663	0.515
住院时间（d）	28.00（14.00，33.00）	25.00（15.00，52.00）	1.343	0.194
28 d病死率（%）	0（0，1.00）	0（0，1.00）	1.000	0.329

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Potential clinical value of P(cv-a)CO₂/C(a-v)O₂ ratio in early goal-directed resuscitation of septic shock

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