Du W, Liu DW, Wang XT, Long Y, Chai WZ, Zhou X, Rui X.; J Crit Care. 2013 Dec;28(6):1110.e1-5.
PURPOSE: Central venous oxygen saturation (Scvo2) is a useful therapeutic target when treating septic shock. We hypothesized that combining Scvo2 and central venous-to-arterial partial pressure of carbon dioxide difference (△Pco2) may provide additional information about survival.
MATERIALS AND METHODS: We performed a retrospective analysis of 172 patients treated for septic shock. All patients were treated using goal-directed therapy to achieve Scvo2 ≥70%. After 6 hours of treatment, we divided patients into 4 groups based on Scvo2 (<70% or ≥70%) and △Pco2 (<6 mm Hg or ≥6 mm Hg).
RESULTS: Overall, 28-day mortality was 35.5%. For patients in whom the Scvo2 target was not achieved at 6 hours, mortality was 50.0%, compared with 29.5% in those in whom Scvo2 exceeded 70% (P = .009). In patients with Scvo2 ≥70%, mortality was lower if △Pco2 was <6 mm Hg than if △Pco2 was ≥6 mm Hg (56.1% vs 16.1%, respectively; P < .001) and 6-hour lactate clearance was superior (0.01 ± 0.61 vs 0.21 ± 0.31, respectively; P = .016).
CONCLUSIONS: The combination of Scvo2 and △Pco2 appears to predict outcome in critically ill patients resuscitated from septic shock better than Scvo2 alone. Patients who meet both targets appear to clear lactate more efficiently.
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