Combination Of Central Venous-arterial Carbon Dioxide Difference With Central Venous Oxygen Saturation To Guide Sepsis And Septic Shock Fluid Resuscitation Treatment Collection Analysis

Objective：Central venous-arterial carbon dioxide difference （Pcv-aCO₂）is an addition fluid resuscitation parameter of patients with in severe sepsisand septic shock patients.In the process of fluid resuscitationprocess.Pcv-aCO₂was able to dynamically assess the state of themicrocirculation. The purpose of this study was to investigate whetherPcv-aCO₂could be an useful clinical parameter for the clinical significance ofPcv-aCO₂as a guide for fluid resuscitation of in patients with severe sepsisand septic shock. We also combined Pcv-aCO₂and ScvO₂in order to detectwhether it could be was an better fluid resuscitation parameter to direct fluidresuscitation of in patients with severe sepsis and septic shock.Methods: Patients who were diagnosed or suspected severe sepsis andseptic shock were enrolled in the study from January2012to February2012inICU of the fourth hospital of Hebei Medical University. After admitted in ICU,According to the principles of EGDT,the patients were treatedsymptomatically in time and fluid resuscitation was initiated as early aspossible referring to Surviving Sepsis Campaign guidance for management ofsevere sepsis and septic shock2008. We recorded general and clinicalcharacteristics of patients when admitting in ICU. Immediately before startingfluid resuscitation, after beginning fluid resuscitation6h,24h,vital signs andlaboratory parameters of patients with severe sepsis and septic shock weredetected. Arterial and central venous blood gas and lactate evaluation of tissueperfusion index were collected before fluid resuscitation, at6h,24h afterbeginning fluid resuscitation in order to evaluated the correlation of Pcv-aCO₂and reaction tissue perfusion indicators. They were divided in to four groupsaccording to ScvO₂and Pcv-aCO₂at24h after beginning fluid resuscitation, （1）ScvO₂＞70%and Pcv-aCO₂＜6mmHg;（2） ScvO₂≤70%and Pcv-aCO₂＜6mmHg;（3）ScvO₂＞70%and Pcv-aCO₂≥6mmHg;（4）ScvO₂≤70%andPcv-aCO₂≥6mmHg. Physiological indicators, laboratory parameters,clearance rate of lactate, and the amount of crystal solution infused werecomparied among the four groups.Results:1Comparison of vital physiological indicators, laboratory parameters atdifferent time pointsImmediately before starting fluid resuscitation, after beginning of fluidresuscitation6h and24h, heart rate （HR） was lower, and central venouspressure （CVP） was increased and lactate concentration （Lac） was decreased,and central venous oxygen saturation （ScvO₂） was gradually increased, andthe central venous-arterial carbon dioxide difference （Pcv-aCO₂） wasstatistically lower, and base excess （BE） was lower, and oxygenation index（PaO₂/FiO₂） was statistically higher （P <0.05）. There was no statisticallydifference in mean arterial pressure （MAP）, hemoglobin （Hb）,serum creatinine（Scr）,and pH（P>0.05）.2Correlations between Pcv-aCO₂and tissue perfusion indexThe correlation between Pcv-aCO₂and Lac was detected. At T0, therewas no correlation between Pcv-aCO₂and Lac, r=0.111, P=0.521. At T6,there was no correlation between Pcv-aCO₂and Lac,r=0.084, P=0.624. AtT24, there was no correlation between Pcv-aCO₂and Lac, r=0.293, P=0.082.The correlation between Pcv-aCO₂and BE was detected. At T0, there wasno correlation between Pcv-aCO₂and BE, r=－0.164, P=0.340. At T6, therewas no correlation between Pcv-aCO₂and BE, r=－0.059, P=0.733. At T24,there was no correlation between Pcv-aCO₂and BE, r=0.010, P=0.952.The correlation between Pcv-aCO₂and pH was detected. At T0, there wasno correlation between Pcv-aCO₂and pH, r=－0.134, P=0.436. At T6,there was no correlation between Pcv-aCO₂and pH,r=－0.003, p=0.987. AtT24, there was no correlation between Pcv-aCO₂and pH, r=0.243, P=0.154. The correlation between Pcv-aCO₂and ScvO₂was detected. At T0, therewas a correlation between Pcv-aCO₂and ScvO₂,r=－0.755, P=0.000. At T6,there was a correlation between Pcv-aCO₂and ScvO₂, r=－0.920, P=0.000.At T24, there was a correlation between Pcv-aCO₂and ScvO₂, r=－0.858, P=0.000.The correlation between Pcv-aCO₂and clearance rate of lactate wasdetected. At T6, there was a correlation between Pcv-aCO₂and clearance rateof lactate, r=－0.365, P=0.029. At T24, there was a correlation betweenPcv-aCO₂and clearance rate of lactate, r=－0.864, P=0.000.At T0, T6and T24, Pcv-aCO₂had no correlation with Lac, BE, and pH.At T0, T6and T24, Pcv-aCO₂had correlation with ScvO₂.At T6andT24,Pcv-aCO₂had correlation with clearance rate of lactate.3Comparison of general condition at immediately before starting fluidresuscitation in patients among the four groupsThey were divided in to four groups according to ScvO₂and Pcv-aCO₂at24h after beginning fluid resuscitation. There were no statistically differencein age,six,APACHE â…¡ score, SOFA score within the first24h after beingenrolled in the groups, and suspected source of infection in the four groups（P>0.05）.4Comparison of baseline clinical data at immediately before starting fluidresuscitation in patients among the four groupsThere was no statistically difference in vital physiological index, such asMAP, HR at immediately before starting fluid resuscitation among the fourgroups. There was no statistically difference in laboratory parameters, such asHb, Scr, Lac, ScvO₂, Pcv-aCO₂, BE, pH, and PaO₂/FiO₂at immediately beforestarting fluid resuscitation among the four groups.（P>0.05）.5Comparison of the vital physiological indicators, laboratory parameters,lactate clearance rate, and fluid volume at24h after beginning of fluidresuscitation in patients among the four groupsThere was no statistically difference in vital physiological indicators,such as MAP, HR at24h after beginning fluid resuscitation among the four groups.There was no statistically difference in laboratory parameters, such asHb, Scr, Lac, ScvO₂, Pcv-aCO₂, BE, pH, and PaO₂/FiO₂at24h after beginningfluid resuscitation among the four groups（P>0.05）.There was statistically statistically difference in the clearance rate oflactate （P=0.000）. There was statistically statistically difference in theamount of crystal solution infused （P=0.003）. ScvO₂＞70%at24h afterbeginning fluid resuscitation was subgrouped according to whether or notPcv-aCO₂was standard. There was statistically statistically difference in theamount of crystal solution infused （P=0.04）, and there was statisticallystatistically difference in clearance rate of lactate （P=0.006）. Pcv-aCO₂＜6mmHg after fluid resuscitation was subgrouped according to whether or notScvO₂was standard. There was statistically statistically difference in theamount of crystal solution infused （P=0.005）, and there was statisticallystatistically difference in clearance rate of lactate （P=0.000）.6Comparison of prognosis in patients among the four groupsThere was no statistically different in length of mechanical ventilation,ICU stay days, hospital days, ICU mortality rate, and28-day mortality rate inpatients among the four groups （P>0.05）.Conclusions:1There was a correlation of Pcv-aCO₂and ScvO₂, so does Pcv-aCO₂and clearance rate of lactate.2The combination of Pcv-aCO₂and ScvO₂was an useful parameter influid resuscitation in patients with severe sepsis and septic shock. Theclearance rate of lactate and the amount of crystal solution infused at24h afterbeginning fluid resuscitation were the highest in the group of patientsachieving the goals of both ScvO₂>70ï¼…and Pcv-aCO₂<6mmHg.3The combination of Pcv-aCO₂and ScvO₂may direct fluid resuscitationin patients with severe sepsis and septic shock. It could be avoided inadequatefluid resuscitation when the ScvO₂goal was falsed to up to the standard．...