Longxiang Su1, Bo Tang1, Yaling Liu2, Guanhua Zhou3, Qinghua Guo3, Wei He4, Chunmei Wang5, Haizhou Zhuang6, Li Jiang7, Long Qin8, Qun Deng9, Weizheng Shuai10, Lina Zhang11, Xiaomeng Wang12, Jie Su13, Siqing Ma14, Dawei Liu1, Yun Long15. 1. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. 2. Department of Critical Care Medicine, Beijing Pinggu Hospital, Beijing 101200, China. 3. Department of Critical Care Medicine, People's Hospital of Beijing Daxing District, Beijing 102628, China. 4. Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China. 5. Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China. 6. Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100009, China. 7. Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China. 8. Department of Critical Care Medicine, Beijing Haidian Hospital, Beijing 100036, China. 9. Department of Critical Care Medicine, Chinese PLA General Affiliated First Hospital, Beijing 100000, China. 10. Department of Critical Care Medicine, PLA Navy General Hospital, Beijing 100048, China. 11. Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China. 12. Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou 221009, China. 13. Department of Critical Care Medicine, Hebei Province Medical University Affiliated Fourth Hospital, Shijiazhuang 050000, China. 14. Department of Critical Care Medicine, Qinghai Province People's Hospital, Xining 810007, China. 15. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: ly_icu@aliyun.com.
Abstract
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.
RCT Entities:
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.
Authors: Arnaldo Dubin; Cecilia Inés Loudet; Francisco Javier Hurtado; Mario Omar Pozo; Daniel Comande; Luz Gibbons; Federico Rodriguez Cairoli; Ariel Bardach Journal: Rev Bras Ter Intensiva Date: 2022 Apr-Jun