Centralvenous-to-arterial Carbon Dioxide Difference In Guiding Fluid Resuscitation Of Septic Shock

Objective: The study searched the effect of centralvenous-to-arterial carbon dioxide difference in guiding fluid resuscitation of septic shock to explore the safety and feasibility. At the same time we investigated the comprehensive therapy to prevent overload of fluid resuscitation. Then we can improve the treatment effect of septic shock.Methods: The patients with septic shock were diagnosed and treated in the Intensive Care Unit of the General Hospital of North China Petroleum Bureau from December, 2013 to December, 2014. All the patients accepted the treatment of fluid resuscitation. Inclusion criteria:(1)The septic shock were confirmed by the standard. Reference standard was made by ACCP and SCCM in 1992.(2)There were complete data of the patients.(3)The patients of septic shock were diagnosed within 6 hours.(4) Suitable for treatment.(5)18-85 years old. Exclusion criteria:(1) pregnancy.(2) Aged<18 years or >85years of age.(3) Patients in the terminal stage. The patients were predicted to death within 24 h.(4) Patients refused the treatment.(5) The data of the patients were not complete.(6) Patients suffered from severe heart disease,acute myocardial infarction or cardiac shock. Fifty-seven patients were randomly divided into the test group and the control group. These patients include 36 cases of male and 21 cases of female. The patients of two groups received different fluid resuscitation. Then we observed the changes of CVP,Pa O2/Fi O2, APACHE Ⅱscore, SOFA score, ICU stay, mechanical ventilation,28 d mortality and 6 hours fluid balance. The SPSS17.0 software collected data entry, numeric variable application of T-test, categorical variables using chi-square test was used for statistical analysis. The level of statistical significance was set at P<0.05.Results: With the method of the statistical analysis, we can observed thatthere is no significant difference between the two groups in sex, age, average sites of infection and underlying diseases(P>0.05). Before treatment, the CVP, Pa O2/Fi O2, APACHE Ⅱ score and SOFA score of two groups showed no significant difference(P>0.05). Two groups of patients have comparable.CVP and Pa O2/Fi O2 after treatment were higher than those before treatment. The difference was significant(P<0.05). APACHE Ⅱ score and SOFA score were significantly decreased(P<0.05). CVP and Pa O2/Fi O2 after treatment in test group were significantly higher than those in the control group(P<0.05). APACHE Ⅱ score and SOFA score in the two groups were significant difference(P<0.05). The score in test group was lower than that in control group. ICU stay, mechanical ventilation and 6 hours fluid balance were significantly lower than those in the control group. The difference had statistical significance(P<0.05). 28 day mortality of two groups were 33.3%(10/30)and 40.7%(11/27). There were no significant difference between them(P>0.05).Conclusion:1 Central venous-to-arterial carbon dioxide difference is a feasible monitoring index in fluid resuscitation of septic shock. The treatment of fluid resuscitation by monitoring ΔPCO2 can effectively reduce the amount of fluid balance and avoid the fluid overload.2 The fluid resuscitation of septic shock by monitoring ΔPCO2 can effectively shorten the duration of mechanical ventilation and ICU stay.Then it can improves the effect of treatment.