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[Central venous-to-arterial carbon dioxide difference in critically ill pediatric patients with septic shock].
Zhonghua Er Ke Za Zhi. 2014 Dec; 52(12):918-22.ZE

Abstract

OBJECTIVE

To assess the value of central venous-to-arterial carbon dioxide difference [ P(cv-a) CO₂] in evaluation of disease severity and prognosis in children with septic shock who already had central venous oxygen saturation (ScvO₂) higher than 70% after early resuscitation.

METHOD

In this prospective study, 48 septic shock children seen in Shanghai Children's Hospital, Shanghai Jiao Tong University were enrolled from Jun 2012 to May 2014. 36(75.0%) were male, 12 (25.0%) were female, the average age was (31.9 ± 24.5) months. The critically ill patients with septic shock were treated to achieve ScvO₂greater than 70% depending on early goal-directed therapy (EGDT). All patients were divided into two groups, based on P(cv-a)CO₂, low P(cv-a)CO₂group with P(cv-a)CO₂< 6 mmHg (1 mmHg = 0.133 kPa) and high P(cv-a)CO₂group with P(cv-a)CO₂≥ 6 mmHg. The parameters of hemodynamics including mean blood pressure (MAP), heart rate (HR), central venous pressure (CVP), perfusion-related parameters [ScvO₂, P(cv-a)CO₂, serum lactate (Lac), Lac clearance rate], pediatric critical illness score, PRISMIII score, and 28 days in-hospital mortality were recorded for all patients.

RESULT

Of the 48 cases with septic shock whose ScvO₂was higher than 70%, 17 patients (35.4%) had high P(cv-a)CO₂(≥ 6 mmHg) and 31 (65.6%) had lower P(cv-a)CO₂(<6 mmHg). There were no significant differences between the 2 groups of patients in age, PRISMIII score and PCIS (P > 0.05), but Lac and P(cv-a)CO₂values were significantly different (P < 0.05). Low P(cv-a) CO₂group patients had lower 28 days mortality than high P(cv-a) CO₂group[11/17 vs. 32.3% (10/31), P < 0.05]; 24 h after resuscitation, compared with high P(cv-a) CO₂group, low P(cv-a) CO₂group patients had lower Lac values [(2.0 ± 1.3) vs.(2.7 ± 1.2) mmol/L, P < 0.05]. Low P(cv-a) CO₂group patients had shorter duration of vasoactive drugs use [(16 ± 14) vs. (44 ± 21)h, P < 0.05], 24 h Lac clearance rate was significantly higher for low P(cv-a) CO₂group than for high P(cv-a) CO₂group[ (31 ± 10) % vs. (26 ± 6)%, P < 0.05].

CONCLUSION

When ScvO₂> 70% was achieved after early resuscitation in septic shock children, P(cv-a) CO₂is a sensitive biomarker to assess tissue perfusion, and high P(cv-a) CO₂group patients had poor outcome.

Authors+Show Affiliations

Chen R
Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China.
Zhang Y
Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China. Email: zyucai2018@126.com.
Cui Y
Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China.
Miao H
Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China.
Xu L
Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China.
Rong Q
Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China.

MeSH

Arterial PressureBlood Gas AnalysisCarbon DioxideCentral Venous PressureChild, PreschoolChinaCritical IllnessFemaleHeart RateHemodynamicsHospital MortalityHumansInfantLactic AcidMaleOximetryPrognosisProspective StudiesResuscitationSeverity of Illness IndexShock, Septic

Pub Type(s)

Journal Article

Language

chi

PubMed ID

25619349

Citation

Chen, Rongxin, et al. "[Central Venous-to-arterial Carbon Dioxide Difference in Critically Ill Pediatric Patients With Septic Shock]." Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics, vol. 52, no. 12, 2014, pp. 918-22.
Chen R, Zhang Y, Cui Y, et al. [Central venous-to-arterial carbon dioxide difference in critically ill pediatric patients with septic shock]. Zhonghua Er Ke Za Zhi. 2014;52(12):918-22.
Chen, R., Zhang, Y., Cui, Y., Miao, H., Xu, L., & Rong, Q. (2014). [Central venous-to-arterial carbon dioxide difference in critically ill pediatric patients with septic shock]. Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics, 52(12), 918-22.
Chen R, et al. [Central Venous-to-arterial Carbon Dioxide Difference in Critically Ill Pediatric Patients With Septic Shock]. Zhonghua Er Ke Za Zhi. 2014;52(12):918-22. PubMed PMID: 25619349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Central venous-to-arterial carbon dioxide difference in critically ill pediatric patients with septic shock]. AU - Chen,Rongxin, AU - Zhang,Yucai, AU - Cui,Yun, AU - Miao,Huijie, AU - Xu,Liang, AU - Rong,Qunfang, PY - 2015/1/27/entrez PY - 2015/1/27/pubmed PY - 2015/3/31/medline SP - 918 EP - 22 JF - Zhonghua er ke za zhi = Chinese journal of pediatrics JO - Zhonghua Er Ke Za Zhi VL - 52 IS - 12 N2 - OBJECTIVE: To assess the value of central venous-to-arterial carbon dioxide difference [ P(cv-a) CO₂] in evaluation of disease severity and prognosis in children with septic shock who already had central venous oxygen saturation (ScvO₂) higher than 70% after early resuscitation. METHOD: In this prospective study, 48 septic shock children seen in Shanghai Children's Hospital, Shanghai Jiao Tong University were enrolled from Jun 2012 to May 2014. 36(75.0%) were male, 12 (25.0%) were female, the average age was (31.9 ± 24.5) months. The critically ill patients with septic shock were treated to achieve ScvO₂greater than 70% depending on early goal-directed therapy (EGDT). All patients were divided into two groups, based on P(cv-a)CO₂, low P(cv-a)CO₂group with P(cv-a)CO₂< 6 mmHg (1 mmHg = 0.133 kPa) and high P(cv-a)CO₂group with P(cv-a)CO₂≥ 6 mmHg. The parameters of hemodynamics including mean blood pressure (MAP), heart rate (HR), central venous pressure (CVP), perfusion-related parameters [ScvO₂, P(cv-a)CO₂, serum lactate (Lac), Lac clearance rate], pediatric critical illness score, PRISMIII score, and 28 days in-hospital mortality were recorded for all patients. RESULT: Of the 48 cases with septic shock whose ScvO₂was higher than 70%, 17 patients (35.4%) had high P(cv-a)CO₂(≥ 6 mmHg) and 31 (65.6%) had lower P(cv-a)CO₂(<6 mmHg). There were no significant differences between the 2 groups of patients in age, PRISMIII score and PCIS (P > 0.05), but Lac and P(cv-a)CO₂values were significantly different (P < 0.05). Low P(cv-a) CO₂group patients had lower 28 days mortality than high P(cv-a) CO₂group[11/17 vs. 32.3% (10/31), P < 0.05]; 24 h after resuscitation, compared with high P(cv-a) CO₂group, low P(cv-a) CO₂group patients had lower Lac values [(2.0 ± 1.3) vs.(2.7 ± 1.2) mmol/L, P < 0.05]. Low P(cv-a) CO₂group patients had shorter duration of vasoactive drugs use [(16 ± 14) vs. (44 ± 21)h, P < 0.05], 24 h Lac clearance rate was significantly higher for low P(cv-a) CO₂group than for high P(cv-a) CO₂group[ (31 ± 10) % vs. (26 ± 6)%, P < 0.05]. CONCLUSION: When ScvO₂> 70% was achieved after early resuscitation in septic shock children, P(cv-a) CO₂is a sensitive biomarker to assess tissue perfusion, and high P(cv-a) CO₂group patients had poor outcome. SN - 0578-1310 UR - https://www.unboundmedicine.com/medline/citation/25619349/[Central_venous_to_arterial_carbon_dioxide_difference_in_critically_ill_pediatric_patients_with_septic_shock]_ DB - PRIME DP - Unbound Medicine ER -