Ríos-Jaimes F, Figueroa-Rivera M, Villarreal-Ríos E, Martínez-González L, Vargas-Daza ER, Galicia-Rodríguez L

Language: Spanish
References: 30
Page: 767-776
PDF size: 200.67 Kb.

ABSTRACT

Objective To identify, based on delta CO₂ (ΔpCO₂), the probability of death within 24 hours of admission to the emergency department in patients with septic shock.
Materials and Methods: Cases and controls nested in a cohort in patients with septic shock in the emergency department. Cases, patients who died within 24 hours of admission to the emergency department; controls, patients who did not die 24 hours after admission. The veno-arterial difference in carbon dioxide or delta CO₂ (ΔpCO₂) was calculated on admission to the emergency department with the formula ΔpCO₂ = PvCO₂-P_aCO₂, it was measured on a discrete scale and subsequently grouped into two categories (reference point 6). Age was measured in years, stratifying in decades and subsequently in two groups (reference point 60).
Results: The sample size was 25 cases and 55 controls. When the discrete scale delta CO₂ value and the patient’s age in decades were used to estimate the probability of death in patients with septic shock seen in the emergency department, the model was significant (χ² = 36.70, p = 0.000). The probability of death was 92.1% when the delta CO₂ value was 9 and age 80 or more years.
Conclusions: The model integrated by ΔpCO₂ and age predicts the probability of dying within 24 hours of admission to the emergency department in patients with septic shock.

REFERENCES

1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M,Ferrer R, et al. Surviving sepsis campaign: International guidelinesfor management of sepsis and septic shock: 2016.Intensive Care Med 2017; 45 (3): 486-552. doi: 10.1097/CCM.0000000000002255.

2. Singer M, Deutschman CS, Warren C, Shankar-Hari M, AnnaneD, Bauer M, et al. The third international consensusdefinition for sepsis and septic shock (SEPSIS-3). JAMA2016; 315 (8): 801-810. doi:10.1001/jama.2016.0287.

3. Seymour C, Rosengart MR. Septic shock advances indiagnosis and treatment. JAMA 2015; 314 (7): 798-7. doi:10.1001/jama.2015.7885.

4. Cecconi M, De Becker D, Antonelli M, Beale R, Bakker J,Hofer C, et al. Consensus on circulatory shock and hemodynamicmonitoring. Task force of the European societyof intensive care medicine. Intensive Care Med 2014; 40:1795-1815. doi: 10.1007/s00134-014-3525-z.

5. Landry DW, Oliver JA. The pathogenesis of vasodilatoryshock. N Engl J Med 2001; 345 (8): 588-595. DOI: 10.1056/NEJMra002709.

6. Vallet B, Pinsky MR, Cecconi M. Resuscitation of patientswith septic shock: please “mind the gap”. Intensive CareMed 2013; 39: 1653-1655. doi: 10.1007/s00134-013-2998-5.

7. Nandhabalan P, Loannou N, Meadows C, Wyncoll D.Refractory septic shock: our pragmatic approach. CriticalCare 2018; 22 (215): 1-5. https://doi.org/10.1186/s13054-018-2144-4.

8. Ocelotl R, Valle J, De Jesus D, Cortes JA, Herrera BE, MendozaM. Delta de CO2 como factor de riesgo de muerte enchoque séptico. Medicina Crítica Terapia Intensiva 2016;30 (1): 30-42.

9. Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR,Osborn TM, et al. Lactate measurements in sepsis-inducedtissue hypoperfusion: results from the surviving sepsiscampaign database. Critical Care 2015; 43 (3): 567-573.doi: 10.1097/CCM.0000000000000742.

10. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H,Opal SM, et al. Surviving sepsis campaign: internationalguidelines for management of severe sepsis and septicshock, 2012. Intensive Care Med. 2013; 41: 580-637. doi:10.1097/CCM.0b013e31827e83af.

11. Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, etal. A randomized trial protocol-based care for early septicshock. N Engl J Med 2014; 370: 1683-1693. DOI: 10.1056/NEJMoa1401602.

12. Mouncey PR, Osborn TM, Power S, Harrison DA, SadiqueMZ, Grieve RD, Jahan R, et al. Trial of early, goal-directedresuscitation for septic shock. N Engl J Med 2015; 372:

13. 1301-1311. DOI: 10.1056/NEJMoa150089613. Pope JV, Jones AE, Gaiseki DF, Arnold RC, Trzeciak S, ShapiroNL. Multi-center study of central of central oxygen saturation(SVCO2) as a predictor of mortality in patients withsepsis. Ann Emerg Med 2010; 55: 40-46. doi: 10.1016/j.annemergmed.2009.08.014.

14. Andersen LW, MackenhauerJ, Roberts JC, Berg KM, CocchiMN, Donnino MW. Etiology and therapeutic approach toelevate lactate. Mayo Clin Proc 2013; 88: 1127-1140. doi:10.1016/j.mayocp.2013.06.012.

15. Lamsfus-Prieto JA, Castro-Fernandez R, Hernandez-GarciaAM, Marcano-Rodriguez G. Prognostic value of gasometricparameters of carbon dioxide in resuscitation of septicpatients. A bibliographic review. Rev Esp Anestesiol Reanim2016; 63: 220-230. doi: 10.1016/j.redar.2015.11.005.

16. Lavandenz LA, Pérez Chacón ME, Corrales V, Aguilar RW.Diferencia veno-arterial de dióxido de carbón como predictorde mortalidad en pacientes en estado de shock, enterapia intensiva del Hospital Viedma junio 2013-enero2014. Rev Cient Cienc Med 2014; 17 (2): 14-18.

17. López-Pérez HR, Sandoval J, Salina C, Poblano M, SánchezC, Aguirre J, Franco J. Delta arterial-venoso de la presión deCO2 (ΔPCO2) como indicador de reanimación y mortalidaden cuidados postquirúrgicos cardiovasculares. Revista AsocMex Medicina Crítica Terapia Intensiva 2010; 25 (1): 13-17.

18. Lima-Rocha, Pessoa CM, Correa TD, Pereira AJ, De AssuncaoMS, Silva E. Current concepts on hemodynamic support andtherapy in septic shock. Braz Rev Anestesiol 2015; 65 (5):395-402. doi: 10.1016/j.bjane.2014.11.006.

19. Etulain JE. Delta de dióxido de carbono para valorar perfusióntisular como predictor de mortalidad en choqueséptico. Rev Mex Med Crít 2011; 25 (2): 66-70.

20. Hernández L, López PH, Etulain GJ, Olvera GC, Aguirre SJ,Aguirre SJ, Franco GJ. Delta de dióxido de carbono paravalorar perfusión tisular como predictor de mortalidaden choque séptico. Rev Asoc Mex Med Crit y Ter Int 2011;25 (2): 66-70.

21. Van-Beest PA, Spronk PE. Early hemodynamic resuscitationin septic shock: understanding and modifying oxygendelivery. Critical Care 2014; 18: 111-112. https://doi.org/10.1186/cc13732.

22. Cuschieri J, Rivers EP, Donnino MW, Katilius M, JacobsenG, Nguyen N, Horst HM. Central venous-arterial carbondioxide difference as an indicator of cardiac index. IntensiveCare Med 2005; 31 (6): 818-22. doi: 10.1007/s00134-005-2602-8.

23. Mesquida J, Saludes P, Gruartmoner G, Espinal C, Torrents E,Baigorri F, Artigas A. Central venous-to-arterial carbon dioxidedifference combined with arterial-to-venous oxygen contentdifference is associated with lactate evolution in the hemodynamicresuscitation process in early septic shock. CriticalCare 2015; 28 (19): 126. doi: 10.1186/s13054-015-0858-0.

24. Simpson SQ, Gaines M, Hussein Y, Badgett RG. Early goaldirectedtherapy for severe sepsis and septic shock: Aliving systematic review. J Crit Care 2016; 36: 43-48. doi:10.1016/j.jcrc.2016.06.017.

25. Sharawy N, Lehman C. New directions for sepsis and septicshock. J Surg Res 2015; 194: 520-527. doi: 10.1016/j.jss.2014.12.014.

26. Vallé F, Vellet B, Mathe O, Parraquette J, Mari A, Silva S, etal. Central venous-to-arterial carbon dioxide difference; anadditional target for goal-directed therapy in septic shock?Intensive Care Med 2008; 34: 2218-2225. doi: 10.1007/s00134-008-1199-0.

27. Howell MD, Donnino M, Clardy P, Talmor D, et al. Occulthypoperfusion and mortality in patients with suspectedinfection. Intensive Care Med 2007; 33: 1892-1899. doi:10.1007/s00134-007-0680-5.

28. Martin GS, Mannino DM, Moss M. The effect of age on thedevelopment and outcome of adult sepsis. Crit Care Med2006; 34: 15. doi: 10.1097/01.ccm.0000194535.82812.ba.

29. Loiacono LA, Shapiro DS. Detection of hypoxia at the cellularlevel. Crit Care Clin 2010; 26: 409-421. doi: 10.1016/j.ccc.2009.12.001.

30. Gu WJ, Zhang Z, Bakker J. Early lactate clearance-guidedtherapy in patients with sepsis: a meta-analysis withtrial sequential analysis of randomized controlled trials.Intensive Care Med 2015; 41: 1862-2863. doi: 10.1007/s00134-015-3955-2.