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Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O 2 content difference ratio as markers of resuscitation in patients with septic shock.
Intensive Care Med. 2015 May; 41(5):796-805.IC

Abstract

PURPOSE

To evaluate the prognostic value of the Cv-aCO2/Da-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock.

METHODS

Prospective observational study in a 60-bed mixed ICU. One hundred and thirty-five patients with septic shock were included. The resuscitation protocol targeted mean arterial pressure, pulse pressure variations or central venous pressure, mixed venous oxygen saturation, and lactate levels. Patients were classified into four groups according to lactate levels and Cv-aCO2/Da-vO2 ratio at 6 h of resuscitation (T6): group 1, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 >1.0; group 2, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 ≤1.0; group 3, lactate <2.0 mmol/L and Cv-aCO2/Da-vO2 >1.0; and group 4, lactate <2.0 mmol/L and Cv-aCO2/Da-vO2 ≤1.0.

RESULTS

Combination of hyperlactatemia and high Cv-aCO2/Da-vO2 ratio was associated with the worst SOFA scores and lower survival rates at day 28 [log rank (Mantel-Cox) = 31.39, p < 0.0001]. Normalization of both variables was associated with the best outcomes. Patients with a high Cv-aCO2/Da-vO2 ratio and lactate <2.0 mmol/L had similar outcomes to hyperlactatemic patients with low Cv-aCO2/Da-vO2 ratio. The multivariate analysis revealed that Cv-aCO2/Da-vO2 ratio at both T0 (RR 3.85; 95 % CI 1.60-9.27) and T6 (RR 3.97; 95 % CI 1.54-10.24) was an independent predictor for mortality at day 28, as well as lactate levels at T6 (RR 1.58; 95 % CI 1.13-2.22).

CONCLUSION

Complementing lactate assessment with Cv-aCO2/Da-vO2 ratio during early stages of resuscitation of septic shock can better identify patients at high risk of adverse outcomes. The Cv-aCO2/Da-vO2 ratio may become a potential resuscitation goal in patients with septic shock.

Authors+Show Affiliations

Intensive Care Unit, Fundación Valle Del Lili - Universidad ICESI, Av. Simón Bolívar Cra. 98, Cali, Colombia, gusospin@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25792204

Citation

Ospina-Tascón, Gustavo A., et al. "Combination of Arterial Lactate Levels and Venous-arterial CO2 to Arterial-venous O 2 Content Difference Ratio as Markers of Resuscitation in Patients With Septic Shock." Intensive Care Medicine, vol. 41, no. 5, 2015, pp. 796-805.
Ospina-Tascón GA, Umaña M, Bermúdez W, et al. Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O 2 content difference ratio as markers of resuscitation in patients with septic shock. Intensive Care Med. 2015;41(5):796-805.
Ospina-Tascón, G. A., Umaña, M., Bermúdez, W., Bautista-Rincón, D. F., Hernandez, G., Bruhn, A., Granados, M., Salazar, B., Arango-Dávila, C., & De Backer, D. (2015). Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O 2 content difference ratio as markers of resuscitation in patients with septic shock. Intensive Care Medicine, 41(5), 796-805. https://doi.org/10.1007/s00134-015-3720-6
Ospina-Tascón GA, et al. Combination of Arterial Lactate Levels and Venous-arterial CO2 to Arterial-venous O 2 Content Difference Ratio as Markers of Resuscitation in Patients With Septic Shock. Intensive Care Med. 2015;41(5):796-805. PubMed PMID: 25792204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O 2 content difference ratio as markers of resuscitation in patients with septic shock. AU - Ospina-Tascón,Gustavo A, AU - Umaña,Mauricio, AU - Bermúdez,William, AU - Bautista-Rincón,Diego F, AU - Hernandez,Glenn, AU - Bruhn,Alejandro, AU - Granados,Marcela, AU - Salazar,Blanca, AU - Arango-Dávila,César, AU - De Backer,Daniel, Y1 - 2015/03/20/ PY - 2014/12/08/received PY - 2015/02/25/accepted PY - 2015/3/21/entrez PY - 2015/3/21/pubmed PY - 2016/2/13/medline SP - 796 EP - 805 JF - Intensive care medicine JO - Intensive Care Med VL - 41 IS - 5 N2 - PURPOSE: To evaluate the prognostic value of the Cv-aCO2/Da-vO2 ratio combined with lactate levels during the early phases of resuscitation in septic shock. METHODS: Prospective observational study in a 60-bed mixed ICU. One hundred and thirty-five patients with septic shock were included. The resuscitation protocol targeted mean arterial pressure, pulse pressure variations or central venous pressure, mixed venous oxygen saturation, and lactate levels. Patients were classified into four groups according to lactate levels and Cv-aCO2/Da-vO2 ratio at 6 h of resuscitation (T6): group 1, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 >1.0; group 2, lactate ≥2.0 mmol/L and Cv-aCO2/Da-vO2 ≤1.0; group 3, lactate <2.0 mmol/L and Cv-aCO2/Da-vO2 >1.0; and group 4, lactate <2.0 mmol/L and Cv-aCO2/Da-vO2 ≤1.0. RESULTS: Combination of hyperlactatemia and high Cv-aCO2/Da-vO2 ratio was associated with the worst SOFA scores and lower survival rates at day 28 [log rank (Mantel-Cox) = 31.39, p < 0.0001]. Normalization of both variables was associated with the best outcomes. Patients with a high Cv-aCO2/Da-vO2 ratio and lactate <2.0 mmol/L had similar outcomes to hyperlactatemic patients with low Cv-aCO2/Da-vO2 ratio. The multivariate analysis revealed that Cv-aCO2/Da-vO2 ratio at both T0 (RR 3.85; 95 % CI 1.60-9.27) and T6 (RR 3.97; 95 % CI 1.54-10.24) was an independent predictor for mortality at day 28, as well as lactate levels at T6 (RR 1.58; 95 % CI 1.13-2.22). CONCLUSION: Complementing lactate assessment with Cv-aCO2/Da-vO2 ratio during early stages of resuscitation of septic shock can better identify patients at high risk of adverse outcomes. The Cv-aCO2/Da-vO2 ratio may become a potential resuscitation goal in patients with septic shock. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/25792204/Combination_of_arterial_lactate_levels_and_venous_arterial_CO2_to_arterial_venous_O_2_content_difference_ratio_as_markers_of_resuscitation_in_patients_with_septic_shock_ DB - PRIME DP - Unbound Medicine ER -