Original scientific paper
Prognostic Value of Venoarterial Carbon Dioxide Gradient in Patients with Severe Sepsis and Septic Shock
Rosana Troskot
; Department of Internal Medicine Holy Spirit General Hospital Zagreb, Croatia
Tatjana Šimurina
; Department of Anesthesiology and Intensive Care Unit, General Hospital Zadar, Zadar, Croatia
Mirza Žižak
; Department of Physiology University of Zagreb School of Medicine, Zagreb, Croatia
Karolina Majstorović
; Department of Internal Medicine Holy Spirit General Hospital Zagreb, Croatia
Ivana Marinac
; Ministry of Health and Social Welfare, Zagreb, Croatia
Ines Mrakovčić-Šutić
; Physiology and Immunology Department. University of Rijeka School of Medicine, Rijeka, Croatia
Abstract
Aim To investigate the changes in the venoarterial carbondioxide
gradient (V-a Pco2) and its prognostic value for survival
of patients with severe sepsis and septic shock.
Methods The study was conducted in General Hospital
Holy Spirit from January 2004 to December 2007 and included
71 conveniently sampled adult patients (25 women
and 46 men), who fulfilled the severe sepsis and septic
shock criteria and were followed for a median of 8 days
(interquartile range, 12 days). The patients were divided in
two groups depending on whether or not they had been
mechanically ventilated. Both groups of patients underwent
interventions with an aim to achieve hemodynamic
stability. Mechanical ventilation was applied in respiratory
failure. Venoarterial carbon dioxide gradient was calculated
from the difference between the partial pressure of arterial
CO2 and the partial pressure of mixed venous CO2, which
was measured with a pulmonary arterial Swan-Ganz catheter.
The data were analyzed using Kaplan-Meier survival
analysis, along with a calculation of the hazard ratios.
Results There was a significant difference between nonventilated
and ventilated patients, with almost 4-fold
greater hazard ratio for lethal outcome in ventilated patients
(3.85; 95% confidence interval, 1.64-9.03). Furthermore,
the pattern of changes of many other variables was
also different in these two groups (carbon dioxide-related
variables, variables related to acid-base status, mean arterial
pressure, systemic vascular resistance, lactate, body mass
index, Acute Physiology and Chronic Health Evaluation II,
Simplified Acute Physiology II Score, and Sepsis-related Organ
Failure Assessment score). Pco2 values (with a cut-off
of 0.8 kPa) were a significant predictor of lethal outcome
in non-ventilated patients (P = 0.015) but not in ventilated
ones (P = 0.270).
Conclusion V-a Pco2 was a significant predictor of fatal
outcome only in the non-ventilated group of patients. Ventilated
patients are more likely to be admitted with a less
favorable clinical status, and other variables seem to have a
more important role in their outcome.
Keywords
severe sepsis; septic shock; venoarterial carbon dioxide gradient; haemodynamic monitoring; pulmonary artery catheter
Hrčak ID:
66869
URI
Publication date:
15.12.2010.
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