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Background: Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality. Methods: Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis. Results: Initially, 584 of 787 patients (74%) had mean arterial pressure (MAP) < 65 mm Hg and/or signs of hypoperfusion and received 30 mL/kg of fluids, mostly normal saline (53%) and Ringer lactate (35%). Vasopressors and/or inotropes were administered in 514 (65%) patients, mainly norepinephrine (100%) and dobutamine (9%); in 22%, vasopressors were administered before ending the fluid load. After this, 413 patients (53%) presented persisting or recurrent hypotension and/or hypoperfusion, which prompted administration of additional fluid, based on: lactate levels (66%), urine output (62%), heart rate (54%), central venous O2 saturation (39%), central venous–arterial PCO2 difference (38%), MAP (31%), dynamic tests of fluid responsiveness (30%), capillary-refill time (28%), mottling (26%), central venous pressure (24%), cardiac index (13%) and/or pulmonary wedge pressure (3%). Independent predictors of mortality were SOFA and Charlson scores, lactate, requirement of mechanical ventilation, and utilization of dynamic tests of fluid responsiveness. Conclusions: In this prospective observational study assessing the characteristics of resuscitation of septic patients in Argentina, a LMIC, the prevalent use of initial fluid bolus with normal saline and Ringer lactate and the use of norepinephrine as the most frequent vasopressor, reflect current worldwide practices. After initial resuscitation with 30 mL/kg of fluids and vasopressors, 413 patients developed persistent or recurrent hypoperfusion, which required further volume expansion. In this setting, the assessment of fluid responsiveness with dynamic tests to guide fluid resuscitation was independently associated with decreased mortality. [ABSTRACT FROM AUTHOR]

Objective: Central venous-arterial PCO 2 to arterial-central venous O 2 content ratio (P cv-a CO 2 /C a-cv O 2 ) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although P cv-a CO 2 /C a-cv O 2 might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Our goal was to compare P cv-a CO 2 /C a-cv O 2 and RQ in patients with septic shock., Design: Prospective, observational study., Setting: Two adult ICUs., Patients: Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation., Interventions: None., Main Variables of Interest: We measured arterial and central venous gases, Hb, and O 2 Hb. P cv-a CO 2 /C a-cv O 2 and the ratio of central venous-arterial CO 2 content to arterial-central venous O 2 content (C cv-a CO 2 /C a-cv O 2 ) were calculated. RQ was determined by indirect calorimetry., Results: P cv-a CO 2 /C a-cv O 2 and C cv-a CO 2 /C a-cv O 2 were not correlated with RQ (R 2 = 0.01, P = 0.50 and R 2 = 0.01, P = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10-3.27 and 0.42, -1.53-2.37). A multiple linear regression model showed Hb, and central venous PCO 2 and O 2 Hb, but not RQ, as P cv-a CO 2 /C a-cv O 2 determinants (R 2 = 0.36, P = 0.0007)., Conclusions: In patients with septic shock, P cv-a CO 2 /C a-cv O 2 did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO 2 from Hb. P cv-a CO 2 /C a-cv O 2 seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution., (Copyright © 2024 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)