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VOLUME 25 , ISSUE 12 ( December, 2021 ) > List of Articles

Original Article

Temporal Evolution of the PcvCO2–PaCO2/CaO2–CcvO2 Ratio vs Serum Lactate during Resuscitation in Septic Shock

Rahul K Anand, Preet M Singh, Vimi Rewari

Keywords : PcvCO2–PaCO2/CaO2–CcvO2 ratio, Resuscitation, Septic shock, Serum lactate

Citation Information : Anand RK, Singh PM, Rewari V. Temporal Evolution of the PcvCO2–PaCO2/CaO2–CcvO2 Ratio vs Serum Lactate during Resuscitation in Septic Shock. Indian J Crit Care Med 2021; 25 (12):1370-1376.

DOI: 10.5005/jp-journals-10071-24044

License: CC BY-NC 4.0

Published Online: 17-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Lactate as a target for resuscitation in patients with septic shock has important limitations. The PcvCO2–PaCO2/CaO2–CcvO2 ratio may be used as an alternative for the same. The primary outcome of the study is to evaluate the correlation between serum lactate and PcvCO2–PaCO2/CaO2–CcvO2 ratio measured at various time points to a maximum of 24 hours in patients with septic shock [mean arterial pressure (MAP) <65 mm Hg]. The secondary outcomes were to study the (1) relationship between the PcvCO2–PaCO2/CaO2–CcvO2 ratio and lactate clearance at 6, 12, and 24 hours as compared to the initial serum lactate, (2) to ascertain whether the PcvCO2–PaCO2/CaO2–CcvO2 ratio and the arterial lactate levels in the first 24 hours are able to predict mortality at day 28 of enrollment, and (3) to determine whether the PcvCO2–PaCO2/CaO2–CcvO2 ratio and arterial lactate are useful in discriminating survivors from nonsurvivors. Materials and methods: Thirty patients with sepsis-induced hypotension who were being actively resuscitated were enrolled. Paired arterial and central venous blood samples were obtained 0.5 hourly till stabilization of MAP and 6 hourly thereafter for the first 24 hours. Patients were followed up to day 28 of enrollment for mortality and organ system failure. Results: A positive correlation was observed between arterial lactate and PcvCO2–PaCO2/CaO2–CcvO2 ratio at 0, 6, 12, and 18 hours (R = 0.413, p = 0.02; R = 0.567, p = 0.001; R = 0.408, p = 0.025; R = 0.521, p = 0.003, respectively). No correlation was seen between PcvCO2–PaCO2/CaO2–CcvO2 ratio and lactate clearance. The subgroup analysis showed that PcvCO2–PaCO2/CaO2–CcvO2 ratio >1.696 at 24 hours of resuscitation predicted 28-day mortality (sensitivity: 80%, specificity 69.2%, area under the receiver operating characteristic curve 0.82). Conclusion: The PcvCO2–PaCO2/CaO2–CcvO2 ratio and lactate are positively correlated during the first 24 hours of active resuscitation from sepsis-induced hypotension, and a threshold of 1.696 mm Hg/mL/dL at 24 hours significantly differentiates survivors from nonsurvivors (CTRI/2017/11/010342).

  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  2. 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. DOI: 10.1007/s00134-017-4683-6.
  3. Cestero RF, Dent DL. Endpoints of resuscitation. Surg Clin North Am 2015;95(2):319–336. DOI: 10.1016/j.suc.2014.10.004.
  4. Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care 2006;12(4):315–321. DOI: 10.1097/01.ccx.0000235208.77450.15.
  5. Mekontso-Dessap A, Castelain V, Anguel N, Bahloul M, Schauvliege F, Richard C, et al. Combination of venoarterial PCO2 difference with arteriovenous O2 content difference to detect anaerobic metabolism in patients. Intensive Care Med 2002;28(3):272–277. DOI: 10.1007/s00134-002-1215-8.
  6. Mesquida J, Saludes P, Gruartmoner G, Espinal C, Torrents E, Baigorri F, et al. A central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock. Crit Care 2015;19(1):126. DOI: 10.1186/s13054-015-0858-0.
  7. Ospina-Tascón GA, Umaña M, Bermúdez WF, Bautista-Rincón DF, Valencia JD, Madriñán HJ, et al. Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock? Intensive Care Med 2016;42(2):211–221. DOI: 10.1007/s00134-015-4133-2.
  8. Ospina-Tascón GA, Umaña M, Bermúdez W, Bautista-Rincón DF, Hernandez G, Bruhn A, et al. Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock. Intensive Care Med 2015;41(5):796–805. DOI: 10.1007/s00134-015-3720-6.
  9. Maheshwari K, Nathanson BH, Munson SH, Khangulov V, Stevens M, Badani H, et al. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med 2018;44(6):857–867. DOI: 10.1007/s00134-018-5218-5.
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