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Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock?

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Abstract

Objective

To test the hypothesis that, in resuscitated septic shock patients, central venous-to-arterial carbon dioxide difference [P(cv-a)CO2] may serve as a global index of tissue perfusion when the central venous oxygen saturation (ScvO2) goal value has already been reached.

Design

Prospective observational study.

Setting

A 22-bed intensive care unit (ICU).

Patients

After early resuscitation in the emergency unit, 50 consecutive septic shock patients with ScvO2 > 70% were included immediately after their admission into the ICU (T0). Patients were separated in Low P(cv-a)CO2 group (Low gap; n = 26) and High P(cv-a)CO2 group (High gap; n = 24) according to a threshold of 6 mmHg at T0.

Measurements

Measurements were performed every 6 h over 12 h (T0, T6, T12).

Results

At T0, there was a significant difference between Low gap patients and High gap patients for cardiac index (CI) (4.3 ± 1.6 vs. 2.7 ± 0.8 l/min/m², P < 0.0001) but not for ScvO2 values (78 ± 5 vs. 75 ± 5%, P = 0.07). From T0 to T12, the clearance of lactate was significantly larger for the Low gap group than for the High gap group (P < 0.05) as well as the decrease of SOFA score at T24 (P < 0.01). At T0, T6 and T12, CI and P(cv-a)CO2 values were inversely correlated (P < 0.0001).

Conclusion

In ICU-resuscitated patients, targeting only ScvO2 may not be sufficient to guide therapy. When the 70% ScvO2 goal-value is reached, the presence of a P(cv-a)CO2 larger than 6 mmHg might be a useful tool to identify patients who still remain inadequately resuscitated.

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Authors and Affiliations

  1. Pôle d’Anesthésie et Réanimation, Unité de Réanimation Polyvalente de Purpan, GRCB 48, Université Paul Sabatier, CHU de Toulouse, France

    Fabrice Vallée, Olivier Mathe, Jacqueline Parraguette, Arnaud Mari, Stein Silva, Kamran Samii, Olivier Fourcade & Michèle Genestal

  2. Pôle d’Anesthésie et Réanimation, Hôpital Huriez, Université Lille II, CHU de Lille, France

    Benoit Vallet

  3. Réanimation polyvalente adulte, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059, Toulouse Cedex 9, France

    Fabrice Vallée

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  1. Fabrice Vallée
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Correspondence to Fabrice Vallée.

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134_2008_1199_MOESM1_ESM.doc

ESM Figure 1: Correlation between CI and P(cv-a)CO2 at each time. T0: r = 0.57, p<0.0001; T6: r = 0.58, p<0.0001 and T12 : r = 0.58, p<0.0001 (DOC 40 kb)

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Vallée, F., Vallet, B., Mathe, O. et al. Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock?. Intensive Care Med 34, 2218–2225 (2008). https://doi.org/10.1007/s00134-008-1199-0

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  • DOI: https://doi.org/10.1007/s00134-008-1199-0

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