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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).


Abstract

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).


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