medigraphic.com
SPANISH

Medicina Crítica

  • Contents
  • View Archive
  • Information
    • General Information        
    • Directory
  • Publish
    • Instructions for authors        
  • Policies
  • medigraphic.com
    • Home
    • Journals index            
    • Register / Login
  • Mi perfil

2023, Number 1

<< Back Next >>

Med Crit 2023; 37 (1)

CO2 delta as a strategy for the comprehensive management of patients with septic shock in the ICU

León MIE, Mendoza RM, Cortes MJA, López GA
Full text How to cite this article 10.35366/109956

DOI

DOI: 10.35366/109956
URL: https://dx.doi.org/10.35366/109956

Language: Spanish
References: 17
Page: 9-16
PDF size: 275.11 Kb.


Key words:

arterial blood gases, morbidity, mortality, intensive care unit, septic shock, pCO2 delta.

ABSTRACT

Introduction: septic shock is a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are profound enough to substantially increase mortality. These patients can be identified in a clinical setting of septic shock with persistent hypotension. The importance of monitoring delta pCO2 values of 6 mmHg serves as a complementary tool to assess adequate blood flow towards global metabolic demand. Objective: to demonstrate that the pCO2 delta is useful in the comprehensive management of patients with septic shock in the Intensive Care Unit to direct the treatment according to this biomarker (pCO2 delta) that was recorded at admission and at 24 hours, were related to prognosis and mortality in septic shock. Material and methods: descriptive, ambispective, longitudinal and analytical study. The universe was made up of patients admitted to the ICU of the La Villa and Rubén Leñero General Hospitals. Maneuver design: arterial and venous blood gases were taken from the patients admitted to the ICU, the pCO2 delta was calculated to see if the values of this biomarker were above or below 6 mmHg, since a pCO2 delta is related to with mortality; however, delta pCO2 was compared against Lactate to correlate lactate levels greater than two with mortality and finally see which of the two biomarkers is more useful. Descriptive statistics were used for the results. Conclusion: according to the results found in this study, it can be said that delta pCO2 and lactate predicted the death of 15%, which has a weak positive significance (p = 0.245).


REFERENCES

  1. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, Rubenfeld G, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):762-774. Available in: https://doi.org/10.1001/jama.2016.0288

  2. Adeva-Andany M, López-Ojén M, Funcasta-Calderón R, Ameneiros-Rodríguez E, Donapetry-García C, Vila-Altesor M, et al. Comprehensive review on lactate metabolism in human health. Mitochondrion. 2014; 17: 76-100. Available in: https://doi.org/10.1016/j.mito.2014.05.007

  3. Ocelotl PR, Valle RJ, De Jesús BD, Cortés MJA, Herrera MBE, Mendoza RM. Delta de CO2 como factor de riesgo de muerte en choque séptico. Rev Asoc Mex Med Crit. 2016;30(1):30-42.

  4. Van Beest P, Wietasch G, Scheeren T, Spronk P, Kuiper M. Clinical review: use of venous oxygen saturations as a goal - a yet unfinished puzzle. Crit Care. 2011;15(5):232.

  5. Vincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care. 2021;27(3):298-302. Available in: https://doi.org/10.1097/mcc.0000000000000824

  6. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304-377.

  7. Adeva-Andany M, López-Ojén M, Funcasta-Calderón R, Ameneiros-Rodríguez E, Donapetry-García C, Vila-Altesor M, Rodríguez-Seijas J. Comprehensive review on lactate metabolism in human health. Mitochondrion. 2014;17:76-100. Available in: https://doi.org/10.1016/j.mito.2014.05.007

  8. Patiño RMI, Mendoza RM, Huerta VRM, López GA. Biomarcadores de la microcirculación versus escala SOFA como predictores de mortalidad en choque séptico. Med Crit. 2018;32(2):66-75.

  9. Vincent JL, Ince C, Bakker J. Clinical review: Circulatory shock —an update: a tribute to Professor Max Harry Weil. Crit Care. 2012;16(6):239. doi:10.1186/cc11510.

  10. Aya HD, Rhodes A, Chis Ster I, Fletcher N, Grounds RM, Cecconi M. Hemodynamic effect of different doses of fluids for a fluid challenge: a quasi-randomized controlled study. Crit Care Med. 2017;45(2):e161-e168. Available in: https://doi.org/10.1097/ccm.0000000000002067

  11. Ferguson BS, Rogatzki MJ, Goodwin ML, Kane DA, Rightmire Z, Gladden LB. Lactate metabolism: historical context, prior misinterpretations, and current understanding. Eur J Appl Physiol. 2018;118(4):691-728.

  12. Gorordo-Delsol LA. Sepsis: el enemigo oculto entre líneas. Rev Med Inst Mex Seg Soc. 2017;55(4):423.

  13. Mallat J, Pepy F, Lemyze M, Gasan G, Vangrunderbeeck N, Tronchon L, Vallet B, Thevenin D. Central venous-to-arterial carbon dioxide partial pressure difference in early resuscitation from septic shock: a prospective observational study. Eur J Anaesthesiol. 2014;31(7):371-380. doi: 10.1097/EJA.0000000000000064.

  14. Mendoza PE, Lozano NJJ, Mendoza RM. Índice de Briones y delta de CO2 como pronóstico en choque hipovolémico-traumático. Med Crit. 2017;31(1):16-19.

  15. López PHR, Sandoval AJ, Salinas MC, Poblano MM, Sánchez CC, Aguirre SJ, et al. Tercer Lugar: Premio "Dr. Mario Shapiro" Delta arterial-venoso de la presión de CO2 (ΔPCO2) como indicador de reanimación y mortalidad en cuidados postquirúrgicos cardiovasculares. Med Crit. 2010;24(1):13-17.

  16. Ltaief Z, Schneider AG, Liaudet L. Pathophysiology and clinical implications of the veno-arterial PCO2 gap. Crit Care. 2021;25(1):318. Available in: https://doi.org/10.1186/s13054-021-03671-w

  17. Gavelli F, Teboul JL, Monnet X. How can CO2-derived indices guide resuscitation in critically ill patients? J Thorac Dis. 2019;11(Suppl 11):S1528-S1537.




Table 1
Table 2
Table 3

2020     |     www.medigraphic.com

Mi perfil

C?MO CITAR (Vancouver)

Med Crit. 2023;37