The Significance Of Central Venous-arterial Carbon Dioxide Partial Pressure And Oxygen Metabolism Monitoring In Assessing Fluid Resuscitation In Patients With Septic Shock

Objective: Early goal-directed therapy (EGDT) has became an international consensusin the fluid resuscitation of septic shock now, although there is sufficient evidence to supportits advantages, but there are also some studies takes the opposite point of view. They foundthe best time, end-point, fluid volume and assessment indicators of EGDT need to be furtheramended and refined. In our study, we retrospective analysised the septic shock patients whowere implemented EGDT, and attempt to compare the difference between the LCR and theprognosis in different P(cv-a)CO2and VO2patients. We try to provide some additionalguidances on fluid resuscitation in patients with septic shock.Methods: We retrospective analysised the date of89patients in the intensive care unit(ICU) during September2013to December2014in the Second Hospital of Jilin University.All the patients enrolled in were diagnosed as septic shock, and immediately implementedEGDT after hospitalization.We excluded some cases who did not meet the researchrequirements and imperfect information, and ultimately29patients as our object ofstudy.According to the difference in P(cv-a)CO2and VO2after six hours fluid resuscitation,the patients were divided into four groups, namely group1: P(cv-a)CO2≤6mmHg and VO2≥170ml min-1·m-2; Group2: P(cv-a)CO2≤6mmHg and VO2＜170ml min-1·m-2; group3:P(cv-a)CO2＞6mmHg and VO2≥170ml min-1·m-2; group4: P (cv-a) CO2＞6mmHg andVO2＜170ml min-1·m-2.We compared the difference among the four groups of patients, suchas the basic situation, the important physiological indicators, laboratory parameters beforeand after fluid resuscitation, the LCR, the fluid volume and the vasoactive drugs, thehormone dosages etc.Results:1) There was no significant statistical difference in age, weight, sex, site ofinfection, complications among four groups.2) All patients after implemented acomprehensive treatments such as positive EGDT and stabilize internal environment, whoseScvO2、CVP、CI、PaO2、pH、Lac、Na+、K+、UO、DO2、P(cv-a)CO2have improved,and the changes of MAP、CVP、PaO2、pH、Lac、Na+、UO、DO2、P(cv-a)CO2were ofstatistical significance (P＜0.05).3) After six hours early fluid resuscitation, compared with the patients of P(cv-a)CO2＞6mmHg, the patients of P(cv-a)CO2≤6mmHg were a lower28-day mortality rate and APACH II score, and a higher LCR (P＜0.05).4) After six hours earlyfluid resuscitation, compared to the patients of VO2＜170ml/min.m2, the patients of VO2≥170ml/min.m2appear a lower28day mortality rate and a higher LCR (P＜0.05), butAPACH II score no significant difference.5) After six hours early fluid resuscitation, therewas a statistically significant difference in28-day mortality rate, LCR and APACH II score(P＜0.01) among the four groups, but no significant difference in DO2. Group1had thelowest28-day mortality and APACH II score, the highest LCR.6) After six hours early fluidresuscitation, the improvement of group1was more pronounced than the group4in Lac、PH、HR、VO2、P(cv-a)CO2、LCR、APACH II score (P＜0.05).7) Compared to group1,group4need more fluid (including crystals, colloids), and a higher dose of norepinephrine,dobutamine and hormones, only the amount of norepinephrine (P＜0.05).Conclusions:1) Patients implemented EGDT, who appeared a higer LCR, showed ahigher survival rates, and who reached the recovery of standard in P(v-a)CO2and VO2havethe highest LCR and28-days survival rate;2) For the septic shock patients, the higher goal offluid resuscitation should be improving in microcirculatory perfusion and oxygen metabolism.