The Effect Of Central Venous-to-arterial Carbon Dioxide Difference In The Patients With Septic Shock

Objective:To evauate the Central vein-artery carbon dioxide points differential pressure (P(cv-a)CO2)as indieators of outcome of fluid resuseitation in septic shock.Metheds:We randomly assigned patiens who arrived at ICU with severe sepsis or septic shock in control group,central venous oxygen saturation(ScvO2) group and ScvO2+P(cv-a)CO2group.All patients were treated with fluid resuseitation.The goal of fluid resuseitation included the following:①CAP targeting8-12mmHg;②MAP targeting>65mmHg;③urine volume targeting>0.5ml,④ScvO2≥70%.For control group, the goalof fluid resuscitaion was obtained for6hours.For centralvenous oxygen saturaion(ScvO2)group, after reached the goalof fluid.Resuseitation,if ScvO2was<70%,we treated patients with vasoactive drug,and erythroeyte suspension in order to make ScvO2targeting≥70%and remain the level for6hours. For ScvO2+P(cv-a)CO2group,after reached the goal of fluid resuseitation, we treated patients with vasoactive drug, and erythrocyte suspension in order to make P(cv-a)CO2<6mmHg and remain the level for6hours. End points included the following: heartrate, breathing, BP, SpO2,breakrate,CVP,urine volume,ScvO2,lactate clearanee,pulmonary edema,acute cardiae insufficiency,acute renal inadequacy,MODS, mortality rate at6hours,vasoactive drug at6hours, mortality rate at28days.End points were obtained and compared among the three group.Results:Two groups of patients in the fluid resuscitation, heart rate, MAP, CVP, lactic acid, ScvO2APACHE Ⅱ score, SOFA scores are no statistically significant differences were found. ScvO2+P(cv-a)CO2 group and ScvO2group fluid resuscitation fluid resuscitation before and after6hours more:six hours after the heart rate and lactic acid before a decline, CVP, MAP, oxygen and index and ScvO2relatively before rising (P<0.05). ScvO2+P (cv-a) CO2group and ScvO2group compared:6hours, heart rate, EVLWI, pulmonary edema MAP incidence and oxygen and index is not statistically significant difference (P>0.05).6hours ScvO2+P (cv-a) CO2group lactic acid, CI, ScvO2clearance and CVP and liquid balance higher than ScvO2group (P<0.05). But the group ScvO2vascular active drug a dobutamine and norepinephrine dosage is ScvO2+P(cv-a)CO2group more obvious (P<0.05). Although ScvO2group of mechanical ventilation time and live longer than ScvO2ICU+P (cv-a) significantly increased CO2group (P<0.05), but two sets of patients28days there were no statistical difference contrast mortality.Conclusion:P(cv-a)CO2used to guide patients with septic shock fluid resuscitation a valuable indicators, can better evaluation effective blood flow and circulation organization perfusion status, and as a judge septic shock severity, the treatment effect and prognosis of the sensitive index.