Central venous-to-arterial carbon dioxide difference in critically ill pediatric patients with septic shock.

Rongxin Chen; Yucai Zhang; Yun Cui; Huijie Miao; Liang XU; Qunfang Rong

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Central venous-to-arterial carbon dioxide difference in critically ill pediatric patients with septic shock.

Author: Rongxin CHEN ¹ ; Yucai ZHANG ² ; Yun CUI ¹ ; Huijie MIAO ¹ ; Liang XU ¹ ; Qunfang RONG ¹
Author Information

1. Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China.
2. Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China. Email: zyucai2018@126.com.
Publication Type:Journal Article
MeSH: Arterial Pressure; Blood Gas Analysis; Carbon Dioxide; blood; Central Venous Pressure; Child, Preschool; China; Critical Illness; Female; Heart Rate; Hemodynamics; Hospital Mortality; Humans; Infant; Lactic Acid; blood; Male; Oximetry; Prognosis; Prospective Studies; Resuscitation; Severity of Illness Index; Shock, Septic; blood; therapy
From: Chinese Journal of Pediatrics 2014;52(12):918-922
CountryChina
Language:Chinese
Abstract:
OBJECTIVETo assess the value of central venous-to-arterial carbon dioxide difference [ P( cv-a) CO₂] in evaluation of disease severity and prognosis in children with septic shock who already had central venous oxygen saturation (ScvO₂) higher than 70% after early resuscitation.
METHODIn this prospective study, 48 septic shock children seen in Shanghai Children's Hospital, Shanghai Jiao Tong University were enrolled from Jun 2012 to May 2014. 36(75.0%) were male, 12 (25.0%) were female, the average age was (31.9 ± 24.5) months. The critically ill patients with septic shock were treated to achieve ScvO₂greater than 70% depending on early goal-directed therapy (EGDT). All patients were divided into two groups, based on P(cv-a)CO₂, low P(cv-a)CO₂group with P(cv-a)CO₂< 6 mmHg (1 mmHg = 0.133 kPa) and high P(cv-a)CO₂group with P(cv-a)CO₂≥ 6 mmHg. The parameters of hemodynamics including mean blood pressure (MAP), heart rate (HR), central venous pressure (CVP), perfusion-related parameters [ScvO₂, P(cv-a)CO₂, serum lactate (Lac), Lac clearance rate], pediatric critical illness score, PRISMIII score, and 28 days in-hospital mortality were recorded for all patients.
RESULTOf the 48 cases with septic shock whose ScvO₂was higher than 70%, 17 patients (35.4%) had high P(cv-a)CO₂( ≥ 6 mmHg) and 31 (65.6%) had lower P(cv-a)CO₂(<6 mmHg). There were no significant differences between the 2 groups of patients in age, PRISMIII score and PCIS (P > 0.05 ), but Lac and P(cv-a)CO₂values were significantly different ( P < 0.05). Low P(cv-a) CO₂group patients had lower 28 days mortality than high P(cv-a) CO₂group[11/17 vs. 32.3% (10/31), P < 0.05]; 24 h after resuscitation, compared with high P(cv-a) CO₂group, low P(cv-a) CO₂group patients had lower Lac values [(2.0 ± 1.3) vs.( 2.7 ± 1.2) mmol/L, P < 0.05]. Low P(cv-a) CO₂group patients had shorter duration of vasoactive drugs use [(16 ± 14) vs. (44 ± 21)h, P < 0.05], 24 h Lac clearance rate was significantly higher for low P(cv-a) CO₂group than for high P(cv-a) CO₂group[ (31 ± 10) % vs. (26 ± 6)%, P < 0.05].
CONCLUSIONWhen ScvO₂> 70% was achieved after early resuscitation in septic shock children, P(cv-a) CO₂is a sensitive biomarker to assess tissue perfusion, and high P(cv-a) CO₂group patients had poor outcome.