Clinical Study Of Pv-a CO₂ In Fluid Management With Septic Shock

Objective: In our study,we prospective analysised the general situation,hemodynamic indicators and oxygen metabolism index of septic shock patients before and after EGDT,we sought to test Whether the developement of Pv-a CO2 during the very early phases of resuscitation is related to tissue perfusion and outcomes in septic shock patients.Methods: We contacted a prospective observational study in Department of PICU,Second Hospital of Lanzhou University in 2016.9-2018.2,collecting clinical data of 42 patients who have been diagnosed with septic shock and with EGDT immediately.According to the difference in Pv-a CO2 after 6 hours fluid resuscitation,patients were classified in two predefined groups: high Pv-a CO2 and low Pv-a CO2.A Pv-a CO2≥6mm Hg value was considered to be high.We collected clinical data of all patients and compared Lactic acid,MAP,CVP,Scv O2,Pv-a CO2.Finally,we compared laboratory tests,treatment and calculated the length of ICU stay and mortality rates at day-28 in two groups.Results: 1.After the implemented treatment in 6h and 24 h with EGDT,the trend in HR,RR,Lac,Pv-a CO2,Scv O2,MAP and CVP of 42 patients with septic shock had improved,the changes of these signs were of statistical significance(P < 0.05).There was no significant statistical difference between PO2 and PCIS scores(P>0.05).2.Lac,Pv-a CO2,Scv O2,CVP,and MAP were compared at T0 and T6,T0 and T24,and there was significant statistical difference(P < 0.05);Lac and Pv-a CO2 were compared at T6 and T24,and there was significant statistical difference(P < 0.05);Scv O2,CVP,MAP were compared at T6 and T24,and there was no significant statistical difference(P>0.05).3.After the recovery of 6h and 24 h,the blood lactate concentration in low Pv-a CO2 group was lower than that in high Pv-a CO2 group at the same time,and there was significant statistical difference(P < 0.05).The CVP of low Pv-a CO2 group was higher than that in high Pv-a CO2 group,and the difference was statistically significant(P < 0.05).There was no significant statistical difference between the two groups of Scv O2 and MAP at the same time(P>0.05).4.The usage time of vasoactive drugs and mechanical ventilation in low Pv-a CO2 group were shorter than that in high Pv-a CO2 group,and there was significant statistical difference(P <0.05);There was no significant statistical difference between the two groups in the length of ICU stay.The PCIS score and 6h lactate clearance rate of low Pv-a CO2 group were higher than in the high Pv-a CO2 group at admission,and the difference was statistically significant(P < 0.05).High Pv-a CO2 group showed a significant increase in the mortality rates at day-28 than low Pv-a CO2 group,and there was significant statistical difference(69.23% vs 34.48%,P=0.036).Conclusion: 1.Insufficient tissue perfusion was still exist when the fluid resuscitation of patients with septic shock was more than 70% of Scv O2;2.Patients with high Pv-a CO2 group had higher lactic acid concentration,lower lactate clearance rate and higher mortality rates at day-28 than low Pv-a CO2 group.3.The combined application of lactic acid,lactate clearance,Scv O2 and Pv-a CO2 will be more helpful in guiding the fluid resuscitation of septic shock;...