{"title":"Combination of C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> and P<sub>v-a</sub>CO<sub>2</sub> as markers of resuscitation or microcirculation in patients with septic shock: a pilot study.","authors":"Luping Cheng, Wenxin Wang, Xia Hu, Chuanliang Pan","doi":"10.1186/s40560-025-00801-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The ratio of central venous-to-arterial carbon dioxide content difference to arterial-to-venous oxygen content difference (C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub>) and central venous-to-arterial carbon dioxide tension difference (P<sub>v-a</sub>CO<sub>2</sub>) are indicators for monitoring anaerobic metabolism and tissue perfusion in shock. We hypothesized that significant differences in patient outcomes exist across different C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> and P<sub>v-a</sub>CO<sub>2</sub> groups during the early stages of shock resuscitation and that these two indicators reflect microcirculatory perfusion in septic shock patients.</p><p><strong>Methods: </strong>This single-center, prospective, observational, cohort, exploratory, pilot study involved newly diagnosed patients with septic shock admitted to intensive care unit (ICU) between May 2023 and August 2024. We classified patients into four groups based on their C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> and P<sub>v-a</sub>CO<sub>2</sub> levels at 6 h post-ICU admission (T6), monitored sublingual microcirculation, and followed them for 28 days. The grouping is as follows: Group A is C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> ≤ 1 and P<sub>v-a</sub>CO<sub>2</sub> < 6 mmHg; Group B is C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> ≤ 1 and P<sub>v-a</sub>CO<sub>2</sub> ≥ 6 mmHg; Group C is C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> > 1 and P<sub>v-a</sub>CO<sub>2</sub> < 6 mmHg; and Group D is C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> > 1 and P<sub>v-a</sub>CO<sub>2</sub> ≥ 6 mmHg.</p><p><strong>Results: </strong>105 patients were included in the study. The 28-day mortality differed significantly among the four groups of patients (A:8.3%, B:19%, C:30%, and D:46.7%, p < 0.05). The Kaplan-Meier curves for the four groups revealed significant differences in the 28-day survival probabilities. (p = 0.014). Multivariate Cox regression revealed that the independent risk factors for 28-day mortality were age [hazard ratio (HR) = 1.05, 95% confidence interval (95% CI) = 1.02-1.09, p = 0.001], C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> (HR = 1.67, 95% CI = 1.03-2.69, p = 0.036), and P<sub>v-a</sub>CO<sub>2</sub> (HR = 1.13, 95% CI = 1.00-1.27, p = 0.043). There were significant differences among the four groups in terms of the proportion of perfused vessels for all (PPV), proportion of perfused vessels for d < 20 μm (sPPV), microvascular flow index (MFI), and heterogeneity index (HI) values (p < 0.001); correlations were observed for C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub>, P<sub>v-a</sub>CO<sub>2</sub>, and sPPV (r = -0.49, p < 0.001, R<sup>2</sup> = 0.19; r = -0.22, p = 0.028, R<sup>2</sup> = 0.08).</p><p><strong>Conclusions: </strong>The combined assessment of C<sub>v-a</sub>CO<sub>2</sub>/C<sub>a-v</sub>O<sub>2</sub> and P<sub>v-a</sub>CO<sub>2</sub> during the early stages of resuscitation demonstrates a significant association with mortality in septic shock patients. This combination could potentially serve as a resuscitation target and reflect microcirculatory perfusion in septic shock patients.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"35"},"PeriodicalIF":3.8000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12172353/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40560-025-00801-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The ratio of central venous-to-arterial carbon dioxide content difference to arterial-to-venous oxygen content difference (Cv-aCO2/Ca-vO2) and central venous-to-arterial carbon dioxide tension difference (Pv-aCO2) are indicators for monitoring anaerobic metabolism and tissue perfusion in shock. We hypothesized that significant differences in patient outcomes exist across different Cv-aCO2/Ca-vO2 and Pv-aCO2 groups during the early stages of shock resuscitation and that these two indicators reflect microcirculatory perfusion in septic shock patients.
Methods: This single-center, prospective, observational, cohort, exploratory, pilot study involved newly diagnosed patients with septic shock admitted to intensive care unit (ICU) between May 2023 and August 2024. We classified patients into four groups based on their Cv-aCO2/Ca-vO2 and Pv-aCO2 levels at 6 h post-ICU admission (T6), monitored sublingual microcirculation, and followed them for 28 days. The grouping is as follows: Group A is Cv-aCO2/Ca-vO2 ≤ 1 and Pv-aCO2 < 6 mmHg; Group B is Cv-aCO2/Ca-vO2 ≤ 1 and Pv-aCO2 ≥ 6 mmHg; Group C is Cv-aCO2/Ca-vO2 > 1 and Pv-aCO2 < 6 mmHg; and Group D is Cv-aCO2/Ca-vO2 > 1 and Pv-aCO2 ≥ 6 mmHg.
Results: 105 patients were included in the study. The 28-day mortality differed significantly among the four groups of patients (A:8.3%, B:19%, C:30%, and D:46.7%, p < 0.05). The Kaplan-Meier curves for the four groups revealed significant differences in the 28-day survival probabilities. (p = 0.014). Multivariate Cox regression revealed that the independent risk factors for 28-day mortality were age [hazard ratio (HR) = 1.05, 95% confidence interval (95% CI) = 1.02-1.09, p = 0.001], Cv-aCO2/Ca-vO2 (HR = 1.67, 95% CI = 1.03-2.69, p = 0.036), and Pv-aCO2 (HR = 1.13, 95% CI = 1.00-1.27, p = 0.043). There were significant differences among the four groups in terms of the proportion of perfused vessels for all (PPV), proportion of perfused vessels for d < 20 μm (sPPV), microvascular flow index (MFI), and heterogeneity index (HI) values (p < 0.001); correlations were observed for Cv-aCO2/Ca-vO2, Pv-aCO2, and sPPV (r = -0.49, p < 0.001, R2 = 0.19; r = -0.22, p = 0.028, R2 = 0.08).
Conclusions: The combined assessment of Cv-aCO2/Ca-vO2 and Pv-aCO2 during the early stages of resuscitation demonstrates a significant association with mortality in septic shock patients. This combination could potentially serve as a resuscitation target and reflect microcirculatory perfusion in septic shock patients.
期刊介绍：
"Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction.
Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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