Accéder directement au contenu Accéder directement à la navigation
Article dans une revue

Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock

Abstract : The mixed venous-to-arterial carbon dioxide (CO2) tension difference [P (v-a) CO2] is the difference between carbon dioxide tension (PCO2) in mixed venous blood (sampled from a pulmonary artery catheter) and the PCO2 in arterial blood. P (v-a) CO2 depends on the cardiac output and the global CO2 production, and on the complex relationship between PCO2 and CO2 content. Experimental and clinical studies support the evidence that P (v-a) CO2 cannot serve as an indicator of tissue hypoxia, and should be regarded as an indicator of the adequacy of venous blood to wash out the total CO2 generated by the peripheral tissues. P (v-a) CO2 can be replaced by the central venous-to-arterial CO2 difference (ΔPCO2), which is calculated from simultaneous sampling of central venous blood from a central vein catheter and arterial blood and, therefore, more easy to obtain at the bedside. Determining the ΔPCO2 during the resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a central venous oxygen saturation (ScvO2) > 70% associated with elevated blood lactate levels. Because high blood lactate levels is not a discriminatory factor in determining the source of that stress, an increased ΔPCO2 (> 6 mmHg) could be used to identify patients who still remain inadequately resuscitated. Monitoring the ΔPCO2 from the beginning of the reanimation of septic shock patients might be a valuable means to evaluate the adequacy of cardiac output in tissue perfusion and, thus, guiding the therapy. In this respect, it can aid to titrate inotropes to adjust oxygen delivery to CO2 production, or to choose between hemoglobin correction or fluid/inotrope infusion in patients with a too low ScvO2 related to metabolic demand. The combination of P (v-a) CO2 or ΔPCO2 with oxygen-derived parameters through the calculation of the P (v-a) CO2 or ΔPCO2/arteriovenous oxygen content difference ratio can detect the presence of global anaerobic metabolism.
Type de document :
Article dans une revue
Liste complète des métadonnées

Littérature citée [67 références]  Voir  Masquer  Télécharger

https://hal.univ-lille.fr/hal-02613556
Contributeur : Lilloa Université de Lille <>
Soumis le : mercredi 20 mai 2020 - 11:18:10
Dernière modification le : mercredi 20 mai 2020 - 13:30:59

Fichier

WJCCM-5-47.pdf
Fichiers éditeurs autorisés sur une archive ouverte

Licence


Distributed under a Creative Commons Paternité - Pas d'utilisation commerciale 4.0 International License

Identifiants

Collections

Citation

Jihad Mallat, Malcolm Lemyze, Laurent Tronchon, Benoit Vallet, Didier Thevenin. Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock. World journal of critical care medicine, 2016, World journal of critical care medicine, 5 (1), pp.47-56. ⟨10.5492/wjccm.v5.i1.47⟩. ⟨hal-02613556⟩

Partager

Métriques

Consultations de la notice

11

Téléchargements de fichiers

33