Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock?

Intensive Care Medicine

Volumn 42, Issue 2, 2016, Pages 211-221

  Ospina Tascón, Gustavo A ^a,b   Umaña, Mauricio ^a   Bermúdez, William F ^b   Bautista Rincón, Diego F ^a   Valencia, Juan D ^a   Madriñán, Humberto J ^a   Hernandez, Glenn ^c   Bruhn, Alejandro ^c   Arango Dávila, César ^a,b   De Backer, Daniel ^d  

^a UNIVERSIDAD ICESI   (Colombia)

^b UNIVERSIDAD DEL VALLE   (Colombia)

^c PONTIFICIA UNIVERSIDAD CATÓLICA DE CHILE   (Chile)

^d UNIVERSITÉ LIBRE DE BRUXELLES   (Belgium)

Author keywords

Microcirculation; Microcirculatory blood flow; Septic shock; Venous to arterial carbon dioxide difference

Indexed keywords

CARBON DIOXIDE;

ADULT; AGED; ARTICLE; BLOOD FLOW; BLOOD GAS ANALYZER; CAPILLARY DENSITY; CARBON DIOXIDE TENSION; FEMALE; HEMODYNAMICS; HUMAN; IMAGING SYSTEM; MAJOR CLINICAL STUDY; MALE; MICROCIRCULATION; OBSERVATIONAL STUDY; PROSPECTIVE STUDY; SEPTIC SHOCK; VENOUS TO ARTERIAL CARBON DIOXIDE DIFFERENCE; ARTERY; BLOOD; BLOOD GAS ANALYSIS; COLOMBIA; COMPARATIVE STUDY; MIDDLE AGED; PATHOPHYSIOLOGY; PHYSIOLOGY; VEIN; VERY ELDERLY;

ADULT; AGED; AGED, 80 AND OVER; ARTERIES; BLOOD GAS ANALYSIS; CARBON DIOXIDE; COLOMBIA; FEMALE; HUMANS; MALE; MICROCIRCULATION; MIDDLE AGED; PROSPECTIVE STUDIES; SHOCK, SEPTIC; VEINS;

EID: 84955723689     PISSN: 03424642     EISSN: 14321238     Source Type: Journal    
DOI: 10.1007/s00134-015-4133-2     Document Type: Article

References (46)

1. Vincent JL, De Backer D (2013) Circulatory shock. N Engl J Med 369:1726–1734
2. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL, Vincent JL, Rhodes A (2014) Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795–1815
3. Bellomo R, Reade MC, Warrillow SJ (2008) The pursuit of a high central venous oxygen saturation in sepsis: growing concerns. Crit Care 12:130
4. Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC, Investigators P (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693
5. Peake SL, Bailey M, Bellomo R, Cameron PA, Cross A, Delaney A, Finfer S, Higgins A, Jones DA, Myburgh JA, Syres GA, Webb SA, Williams P, ARISE Investigators, for the Australian and New Zealand Intensive Care Society Clinical Trials Group (2009) Australasian resuscitation of sepsis evaluation (ARISE): a multi-centre, prospective, inception cohort study. Resuscitation 80:811–818
6. Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM, Investigators PT (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311
7. van Beest PA, Hofstra JJ, Schultz MJ, Boerma EC, Spronk PE, Kuiper MA (2008) The incidence of low venous oxygen saturation on admission to the intensive care unit: a multi-center observational study in the Netherlands. Crit Care 12:R33
8. Ospina-Tascón GA, Bautista-Rincón DF, Umaña M, Tafur JD, Gutiérrez A, García AF, Bermúdez W, Granados M, Arango-Dávila C, Hernández G (2013) Persistently high venous-to-arterial carbon dioxide differences during early resuscitation are associated with poor outcomes in septic shock. Crit Care 17:R294
9. 2 difference as a tool in resuscitation of septic patients. Intensive Care Med 39:1034–1039
10. Vallée F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, Samii K, Fourcade O, Genestal M (2008) Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock? Intensive Care Med 34:2218–2225
11. Grundler W, Weil MH, Rackow EC (1986) Arteriovenous carbon dioxide and pH gradients during cardiac arrest. Circulation 74:1071–1074
12. Weil MH, Rackow EC, Trevino R, Grundler W, Falk JL, Griffel MI (1986) Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med 315:153–156
13. Zhang H, Vincent JL (1993) Arteriovenous differences in PCO2 and pH are good indicators of critical hypoperfusion. Am Rev Respir Dis 148:867–871
14. Van der Linden P, Rausin I, Deltell A, Bekrar Y, Gilbart E, Bakker J, Vincent JL (1995) Detection of tissue hypoxia by arteriovenous gradient for PCO2 and pH in anesthetized dogs during progressive hemorrhage. Anesth Analg 80:269–275
15. Groeneveld AB, Vermeij CG, Thijs LG (1991) Arterial and mixed venous blood acid-base balance during hypoperfusion with incremental positive end-expiratory pressure in the pig. Anesth Analg 73:576–582
16. Teboul JL, Mercat A, Lenique F, Berton C, Richard C (1998) Value of the venous-arterial PCO2 gradient to reflect the oxygen supply to demand in humans: effects of dobutamine. Crit Care Med 26:1007–1010
17. Bakker J, Vincent JL, Gris P, Leon M, Coffernils M, Kahn RJ (1992) Veno-arterial carbon dioxide gradient in human septic shock. Chest 101:509–515
18. Mecher CE, Rackow EC, Astiz ME, Weil MH (1990) Venous hypercarbia associated with severe sepsis and systemic hypoperfusion. Crit Care Med 18:585–589
19. Vallet B, Teboul JL, Cain S, Curtis S (2000) Venoarterial CO(2) difference during regional ischemic or hypoxic hypoxia. J Appl Physiol 89:1317–1321
20. 2 gradient does not reflect intestinal dysoxia in anemic hypoxia. J Trauma 57:1211–1217
21. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104
22. De Backer D, Ospina-Tascon G, Salgado D, Favory R, Creteur J, Vincent JL (2010) Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med 36:1813–1825
23. Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32:1825–1831
24. Creteur J, De Backer D, Sakr Y, Koch M, Vincent JL (2006) Sublingual capnometry tracks microcirculatory changes in septic patients. Intensive Care Med 32:516–523
25. Dubin A, Edul VS, Pozo MO, Murias G, Canullan CM, Martins EF, Ferrara G, Canales HS, Laporte M, Estenssoro E, Ince C (2008) Persistent villi hypoperfusion explains intramucosal acidosis in sheep endotoxemia. Crit Care Med 36:535–542
26. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332
27. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256
28. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med 41:580–637
29. De Backer D, Hollenberg S, Boerma C, Goedhart P, Büchele G, Ospina-Tascon G, Dobbe I, Ince C (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101
30. Wu L, Tiwari MM, Messer KJ, Holthoff JH, Gokden N, Brock RW, Mayeux PR (2007) Peritubular capillary dysfunction and renal tubular epithelial cell stress following lipopolysaccharide administration in mice. Am J Physiol Renal Physiol 292:F261–F268
31. Fink T, Heymann P, Taha-Melitz S, Taha A, Wolf B, Rensing H, Volk T, Mathes AM (2013) Dobutamine pretreatment improves survival, liver function, and hepatic microcirculation after polymicrobial sepsis in rat. Shock 40:129–135
32. Bateman RM, Tokunaga C, Kareco T, Dorscheid DR, Walley KR (2007) Myocardial hypoxia-inducible HIF-1alpha, VEGF, and GLUT1 gene expression is associated with microvascular and ICAM-1 heterogeneity during endotoxemia. Am J Physiol Heart Circ Physiol 293:H448–H456
33. De Backer D, Donadello K, Sakr Y, Ospina-Tascon G, Salgado D, Scolletta S, Vincent JL (2013) Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med 41:791–799
34. Moore JP, Dyson A, Singer M, Fraser J (2015) Microcirculatory dysfunction and resuscitation: why, when, and how. Br J Anaesth 115:366–375
35. Ince C (2014) The rationale for microcirculatory guided fluid therapy. Curr Opin Crit Care 20:301–308
36. Zuurbier CJ, van Iterson M, Ince C (1999) Functional heterogeneity of oxygen supply-consumption ratio in the heart. Cardiovasc Res 44:488–497
37. Stein JC, Ellis CG, Ellsworth ML (1993) Relationship between capillary and systemic venous PO2 during nonhypoxic and hypoxic ventilation. Am J Physiol 265:H537–H542
38. 2 consumption during sepsis: role of heterogeneous capillary spacing and blood flow. Am J Physiol Heart Circ Physiol 290:H2277–H2285
39. Walley KR (1996) Heterogeneity of oxygen delivery impairs oxygen extraction by peripheral tissues: theory. J Appl Physiol 81:885–894
40. De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, Vincent JL (2006) The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 34:403–408
41. Edul VS, Enrico C, Laviolle B, Vazquez AR, Ince C, Dubin A (2012) Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med 40:1443–1448
42. 2 content difference ratio as markers of resuscitation in patients with septic shock. Intensive Care Med 41:796–805
43. 2 difference ratio as a resuscitation target in shock states? Intensive Care Med 41:936–938
44. Cuschieri J, Rivers EP, Donnino MW, Katilius M, Jacobsen G, Nguyen HB, Pamukov N, Horst HM (2005) Central venous-arterial carbon dioxide difference as an indicator of cardiac index. Intensive Care Med 31:818–822
45. Vandenbroucke JP (2008) Observational research, randomised trials, and two views of medical science. PLoS Med 5:e67
46. Pearce N (2011) Registration of protocols for observational research is unnecessary and would do more harm than good. Occup Environ Med 68:86–88