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2 results on '"central venous-arterial CO2 difference"'

1. Prognostic significance of central venous-to-arterial carbon dioxide difference during the first 24 hours of septic shock in patients with and without impaired cardiac function.

Author

Muller, G., Mercier, E., Vignon, P., Henry-Lagarrigue, M., Kamel, T., Desachy, A., Botoc, V., Plantefève, G., Frat, J. P., Bellec, F., Quenot, J. P., Dequin, P. F., Boulain, T., and Clinical Research in Intensive Care and Sepsis (CRICS) Group

Subjects
*SEPTIC shock, *PHYSIOLOGICAL effects of carbon dioxide, *HEART physiology, *INTENSIVE care units, *LONGITUDINAL method, *PROGNOSIS, *ARTERIES, *BLOOD pressure, *CARBON dioxide, *CENTRAL venous pressure, *LEFT heart ventricle
Abstract

Objective: To investigate the prognostic significance of central venous-to-arterial carbon dioxide difference (cv-art CO 2 gap) during septic shock in patients with and without impaired cardiac function.Methods: We performed a prospective cohort study in 10 French intensive care units. Patients suffering from septic shock were assigned to the impaired cardiac function group ('cardiac group', n =123) if they had atrial fibrillation (AF) and/or left ventricular ejection fraction (LVEF) <50% at study entry and to the non-cardiac group ( n =240) otherwise.Results: Central venous and arterial blood gases were sampled every 6 h during the first 24 h to calculate cv-art CO 2 gap. Patients in the cardiac group had a higher cv-art CO 2 gap [at study entry and 6 and 12 h (all P <0.02)] than the non-cardiac group. Patients in the cardiac group with a cv-art CO 2 gap >0.9 kPa at 12 h had a higher risk of day 28 mortality (hazard ratio=3.18; P =0.0049). Among the 59 patients in the cardiac group with mean arterial pressure (MAP) ≥65 mm Hg, central venous pressure (CVP) ≥8 mm Hg and central venous oxygen saturation (ScvO 2 ) ≥70% at 12 h, those with a high cv-art CO 2 gap (>0.9 kPa; n =19) had a higher day 28 mortality (37% vs. 13%; P =0.042). In the non-cardiac group, a high cv-art CO 2 gap was not linked to a higher risk of day 28 death, whatever the threshold value of the cv-art CO 2 gap.Conclusion: Patients with septic shock and with AF and/or low LVEF were more prone to a persistent high cv-art CO 2 gap, even when initial resuscitation succeeded in normalizing MAP, CVP, and ScvO 2 . In these patients, a persistent high cv-art CO 2 gap at 12 h was significantly associated with higher day 28 mortality. [ABSTRACT FROM AUTHOR]

Published
2017
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2. Prognostic significance of central venous-to-arterial carbon dioxide difference during the first 24 hours of septic shock in patients with and without impaired cardiac function

Author

Philippe Vignon, Gaëtan Plantefève, Jean-Pierre Quenot, V. Botoc, T. Kamel, A. Desachy, G. Muller, F. Bellec, Emmanuelle Mercier, Thierry Boulain, Pierre-François Dequin, M. Henry-Lagarrigue, J.P. Frat, Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), Service de réanimation (CHRU Tours), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Centre d'Investigation Clinique de Limoges (CIC1435), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques (RESINFIT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Service de réanimation (CH La Roche-sur-Yon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Service de réanimation (CH d'Angoulême), Centre Hospitalier d'Angoulême (CH Angoulême), Service de réanimation (CH Saint-Malo), Centre hospitalier de Saint-Malo, Service de réanimation (CH d'Argenteuil), Centre Hospitalier Victor Dupouy, Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France, Service de Réanimation Médicale [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Hôpital Jean Bernard, Equipe LIPNESS (LNC - U1231) (LIPNESS), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de Réanimation ( ORLEANS - Réa ), Centre Hospitalier Régional d'Orléans ( CHR ), Centre Hospitalier Régional Universitaire de Tours ( CHRU TOURS ), Centre d'Investigation Clinique de Limoges ( CIC1435 ), CHU Limoges-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques ( RESINFIT ), CHU Limoges-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ), Centre Hospitalier d'Angoulême, Centre Hospitalier d'Argenteuil, CHU de Poitiers-Hôpital Jean Bernard, Equipe LIPNESS (LNC - U1231) ( LIPNESS ), Lipides - Nutrition - Cancer [Dijon - U1231] ( LNC ), Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), CHRU Tours, Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Limoges, and Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement

Subjects
Cardiac function curve, Adult, Male, medicine.medical_specialty, Mean arterial pressure, Adolescent, Central Venous Pressure, central venous-arterial CO2 difference, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, Young Adult, 0302 clinical medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Internal medicine, Intensive care, medicine, Humans, Arterial Pressure, Prospective Studies, Aged, Ejection fraction, business.industry, Septic shock, Central venous pressure, 030208 emergency & critical care medicine, Carbon Dioxide, Middle Aged, medicine.disease, Prognosis, Shock, Septic, 3. Good health, Surgery, Anesthesiology and Pain Medicine, Blood pressure, blood gas analysis, Cardiology, Arterial blood, septic shock, Female, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

IF 6.238; International audience; Objective: To investigate the prognostic significance of central venous-to-arterial carbon dioxide difference (cv-art CO2 gap) during septic shock in patients with and without impaired cardiac function.Methods: We performed a prospective cohort study in 10 French intensive care units. Patients suffering from septic shock were assigned to the impaired cardiac function group (‘cardiac group’, n=123) if they had atrial fibrillation (AF) and/or left ventricular ejection fraction (LVEF) 0.9 kPa at 12 h had a higher risk of day 28 mortality (hazard ratio=3.18; P=0.0049). Among the 59 patients in the cardiac group with mean arterial pressure (MAP) ≥65 mm Hg, central venous pressure (CVP) ≥8 mm Hg and central venous oxygen saturation (ScvO2) ≥70% at 12 h, those with a high cv-art CO2 gap (>0.9 kPa; n=19) had a higher day 28 mortality (37% vs. 13%; P=0.042). In the non-cardiac group, a high cv-art CO2 gap was not linked to a higher risk of day 28 death, whatever the threshold value of the cv-art CO2 gap.Conclusion: Patients with septic shock and with AF and/or low LVEF were more prone to a persistent high cv-art CO2 gap, even when initial resuscitation succeeded in normalizing MAP, CVP, and ScvO2. In these patients, a persistent high cv-art CO2 gap at 12 h was significantly associated with higher day 28 mortality.

Published
2017
Full Text
View/download PDF

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