Venous-arterial CO2 to arterial-venous O2 content ratio in different shock types and correlation with hypoxia indicators

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GÜVEN G., Van Steekelenburg A., Akin S.

TUBERKULOZ VE TORAKS-TUBERCULOSIS AND THORAX, cilt.70, sa.3, ss.221-230, 2022 (ESCI) identifier identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 70 Sayı: 3
  • Basım Tarihi: 2022
  • Doi Numarası: 10.5578/tt.20229701
  • Dergi Adı: TUBERKULOZ VE TORAKS-TUBERCULOSIS AND THORAX
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, CAB Abstracts, EMBASE, MEDLINE, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.221-230
  • Anahtar Kelimeler: Septic shock, cardiogenic shock, Pcv-aCO2, Ca-cvO2, ScvO2, PARTIAL-PRESSURE DIFFERENCE, O-2 CONTENT DIFFERENCE, OXYGEN-SATURATION, VENOARTERIAL PCO2, SEVERE SEPSIS, LACTATE, RESUSCITATION, COMBINATION, METABOLISM, CONSENSUS
  • Hacettepe Üniversitesi Adresli: Evet

Özet

Introduction: Shock is a generalized form of acute circulatory failure charac-terized by low tissue perfusion. If not recognized early, it highly increases patient morbidity and mortality. Central venous-arterial CO2 (Carbon dioxide) to arterial-central venous O2 (Oxygen) content ratio (Pcv-aCO2/Ca-cvO2) has been used for the early prediction of anaerobic metabolism in septic shock patients. However, knowledge about the usability of this ratio in cardiogenic shock is scarce.Materials and Methods: We retrospectively collected the data of patients admitted to our 18-bed intensive care unit (Haga Hospital, Department of Intensive Care, The Hague, The Netherlands) with a diagnosis of septic shock or cardiogenic shock in 2018. All patients who had undergone Swan-Ganz or Pulse index Continuous Cardiac Output device insertion were included in the study. The hemodynamic variables were recorded both at ICU admission and during catheterization.Results: Forty-six (n= 46) patients with a mean age of 62 +/- 13 years and 52% female gender were enrolled in the study. The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score was 96 +/- 39. Twenty-four patients had septic shock, and twenty-two were diagnosed with cardiogenic shock. Although Pcv-aCO2 (Central venous-arterial CO2) and ScvO2 (Central venous oxygen) were not found different between the cardiogenic and septic shock groups, the Pcv-aCO2/Ca-cvO2 ratio was significantly lower in patients with cardiogenic shock (p= 0.035). The Pcv-aCO2/Ca-cvO2 ratio had a weak cor-relation with ScvO2 (r= 0.21, p= 0.040). Pcv-aCO2 and ScvO2 showed nega-tive lower moderate correlation (r=-0.40, p= 0.030). Twenty patients [nine (19%) with cardiogenic shock, and eleven (23%) with septic shock] died during their ICU or hospital stay. Although Ca-cvO2, Pcv-aCO2, and ScvO2 were not associated with mortality, a higher Pcv-aCO2/Ca-cvO2 ratio was associated with increased mortality (p= 0.035).Conclusion: The Pcv-aCO2/Ca-cvO2 ratio is a valuable hypoxia indicator in states of shock. However, cutoff levels should be identified for different shock types.