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P(v-a)CO2/C(a-v)O2-directed resuscitation does not improve prognosis compared with SvO2 in severe sepsis and septic
Longxiang Su1, Bo Tang1, Yaling Liu2
1Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Purposes:
The present study examined the value of P(v-a)CO2/C(a-v)O2 compared with ScvO2 as a target for clinical resuscitation of severe sepsis/septic shock.
Materials And Methods:
228 patients were randomly divided into a P(v-a)CO2/C(a-v)O2-targeted and a ScvO2-targeted therapy group. The effects on hemodynamics, interventional intensity, and outcome were recorded and analyzed.
Results:
The mean arterial pressure (MAP) of the P(v-a)CO2/C(a-v)O2-targeted therapy group was significantly higher at 3 h, 12 h, 24 h, and 3 days (P < .05). The P(v-a)CO2/C(a-v)O2 of the ScvO2-targeted therapy group was significantly higher at each time point after resuscitation (P < .05). However, the CVP, lactate, urine output, ScvO2, and P(v-a)CO2 were not significantly improved. The P(v-a)CO2/C(a-v)O2-targeted therapy group used a smaller fluid volume and required fewer red blood cell transfusions and vasoactive drugs, but these results were also not significant. There were no differences between 28-day and 60-day mortality, APACHEII and SOFA scores, ICU length of stay, residence length of stay, number of days free of vasoactive drugs, or number of ventilator-free days. Post hoc tests revealed no significant differences between these two groups in 28-day survival.
Conclusion:
P(v-a)CO2/C(a-v)O2-directed resuscitation did not improve prognosis compared with ScvO2 in severe sepsis and septic shock. ClinicalTrials.gov Identifier NCT01877798.
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