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

Abstract : 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) <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 CO2 gap. Patients in the cardiac group had a higher cv-art CO2 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 CO2 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 (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.
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British Journal of Anaesthesia, Oxford University Press (OUP), 2017, 119 (2), pp.239-248. 〈10.1093/bja/aex131〉
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https://hal-univ-bourgogne.archives-ouvertes.fr/hal-01626152
Contributeur : Lnc - Université de Bourgogne <>
Soumis le : lundi 30 octobre 2017 - 13:21:29
Dernière modification le : vendredi 8 juin 2018 - 14:50:25

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G. Muller, E. Mercier, P. Vignon, M. Henry-Lagarrigue, T. Kamel, et al.. 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. British Journal of Anaesthesia, Oxford University Press (OUP), 2017, 119 (2), pp.239-248. 〈10.1093/bja/aex131〉. 〈hal-01626152〉

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