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The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis

BACKGROUND: Central venous-arterial carbon dioxide difference (PCO2 gap) can be a marker of cardiac output adequacy in global metabolic conditions that are less affected by the impairment of oxygen extraction capacity. We investigated the relation between the PCO2 gap, serum lactate, and cardiac ind...

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Autores principales: Bitar, Zouheir Ibrahim, Maadarani, Ossama Sajeh, El-Shably, AlAsmar Mohammed, Elshabasy, Ragab Desouky, Zaalouk, Tamer Mohamed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199542/
https://www.ncbi.nlm.nih.gov/pubmed/32377433
http://dx.doi.org/10.1155/2020/9281623
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author Bitar, Zouheir Ibrahim
Maadarani, Ossama Sajeh
El-Shably, AlAsmar Mohammed
Elshabasy, Ragab Desouky
Zaalouk, Tamer Mohamed
author_facet Bitar, Zouheir Ibrahim
Maadarani, Ossama Sajeh
El-Shably, AlAsmar Mohammed
Elshabasy, Ragab Desouky
Zaalouk, Tamer Mohamed
author_sort Bitar, Zouheir Ibrahim
collection PubMed
description BACKGROUND: Central venous-arterial carbon dioxide difference (PCO2 gap) can be a marker of cardiac output adequacy in global metabolic conditions that are less affected by the impairment of oxygen extraction capacity. We investigated the relation between the PCO2 gap, serum lactate, and cardiac index (CI) and prognostic value on admission in relation to fluid administration in the early phases of resuscitation in sepsis. We also investigated the chest ultrasound pattern A or B. METHOD: We performed a prospective observational study and recruited 28 patients with severe sepsis and septic shock in a mixed ICU. We determined central venous PO2, PCO2, PCO2 gap, lactate, and CI at 0 and 6 hours after critical care unit (CCU) admission. The population was divided into two groups based on the PCO2 gap (cutoff value 0.8 kPa). RESULTS: The CI was significantly lower in the high PCO2 gap group (P=0.001). The high PCO2 gap group, on admission, required more administered fluid and vasopressors (P=0.01 and P=0.009, respectively). There was also a significant difference between the two groups for low mean pressure (P=0.01), central venous O2 (P=0.01), and lactate level (P=0.003). The mean arterial pressure was lower in the high PCO2 gap group, and the lactate level was higher, indicating global hypoperfusion. The hospital mortality rate for all patients was 24.5% (7/28). The in-hospital mortality rate was 20% (2/12) for the low gap group and 30% (5/16) for the high gap group; the odds ratio was 1.6 (95% CI 0.5–5.5; P=0.53). Patients with a persistent or rising PCO2 gap larger than 0.8 kPa at T = 6 and 12 hours had a higher mortality change (n = 6; in-hospital mortality was 21.4%) than patients with a PCO2 gap of less than 0.8 kPa at T = 6 (n = 1; in-hospital mortality was 3%); this odds ratio was 5.3 (95% CI 0.9–30.7; P=0.08). The PCO2 gap had no relation with the chest ultrasound pattern. CONCLUSION: The PCO2 gap is an important hemodynamic variable in the management of sepsis-induced circulatory failure. The PCO2 gap can be a marker of the adequacy of the cardiac output status in severe sepsis. A high PCO2 gap value (>0.8 kPa) can identify situations in which increasing CO can be attempted with fluid resuscitation in severe sepsis. The PCO2 gap carries an important prognostic value in severe sepsis.
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spelling pubmed-71995422020-05-06 The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis Bitar, Zouheir Ibrahim Maadarani, Ossama Sajeh El-Shably, AlAsmar Mohammed Elshabasy, Ragab Desouky Zaalouk, Tamer Mohamed Crit Care Res Pract Research Article BACKGROUND: Central venous-arterial carbon dioxide difference (PCO2 gap) can be a marker of cardiac output adequacy in global metabolic conditions that are less affected by the impairment of oxygen extraction capacity. We investigated the relation between the PCO2 gap, serum lactate, and cardiac index (CI) and prognostic value on admission in relation to fluid administration in the early phases of resuscitation in sepsis. We also investigated the chest ultrasound pattern A or B. METHOD: We performed a prospective observational study and recruited 28 patients with severe sepsis and septic shock in a mixed ICU. We determined central venous PO2, PCO2, PCO2 gap, lactate, and CI at 0 and 6 hours after critical care unit (CCU) admission. The population was divided into two groups based on the PCO2 gap (cutoff value 0.8 kPa). RESULTS: The CI was significantly lower in the high PCO2 gap group (P=0.001). The high PCO2 gap group, on admission, required more administered fluid and vasopressors (P=0.01 and P=0.009, respectively). There was also a significant difference between the two groups for low mean pressure (P=0.01), central venous O2 (P=0.01), and lactate level (P=0.003). The mean arterial pressure was lower in the high PCO2 gap group, and the lactate level was higher, indicating global hypoperfusion. The hospital mortality rate for all patients was 24.5% (7/28). The in-hospital mortality rate was 20% (2/12) for the low gap group and 30% (5/16) for the high gap group; the odds ratio was 1.6 (95% CI 0.5–5.5; P=0.53). Patients with a persistent or rising PCO2 gap larger than 0.8 kPa at T = 6 and 12 hours had a higher mortality change (n = 6; in-hospital mortality was 21.4%) than patients with a PCO2 gap of less than 0.8 kPa at T = 6 (n = 1; in-hospital mortality was 3%); this odds ratio was 5.3 (95% CI 0.9–30.7; P=0.08). The PCO2 gap had no relation with the chest ultrasound pattern. CONCLUSION: The PCO2 gap is an important hemodynamic variable in the management of sepsis-induced circulatory failure. The PCO2 gap can be a marker of the adequacy of the cardiac output status in severe sepsis. A high PCO2 gap value (>0.8 kPa) can identify situations in which increasing CO can be attempted with fluid resuscitation in severe sepsis. The PCO2 gap carries an important prognostic value in severe sepsis. Hindawi 2020-01-07 /pmc/articles/PMC7199542/ /pubmed/32377433 http://dx.doi.org/10.1155/2020/9281623 Text en Copyright © 2020 Zouheir Ibrahim Bitar et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Bitar, Zouheir Ibrahim
Maadarani, Ossama Sajeh
El-Shably, AlAsmar Mohammed
Elshabasy, Ragab Desouky
Zaalouk, Tamer Mohamed
The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis
title The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis
title_full The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis
title_fullStr The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis
title_full_unstemmed The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis
title_short The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis
title_sort forgotten hemodynamic (pco2 gap) in severe sepsis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199542/
https://www.ncbi.nlm.nih.gov/pubmed/32377433
http://dx.doi.org/10.1155/2020/9281623
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