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Medicina crítica (Colegio Mexicano de Medicina Crítica)
Print version ISSN 2448-8909
Abstract
RIVERA SOLIS, Gerardo et al. Clinical classification of tissue perfusion in patients with septic shock based on central venous oxygen saturation (SvcO 2 ) and central venous-to-arterial carbon dioxide difference/arterial-central venous oxygen (ΔP(v-a)CO 2 /C(a-v)O 2 ). Med. crít. (Col. Mex. Med. Crít.) [online]. 2016, vol.30, n.5, pp.283-289. ISSN 2448-8909.
Introduction:
Septic shock is the leading cause of shock in the intensive care unit (62% of all cases), mortality is about 40 to 50%; early recognition of tissue hypoperfusion is vital for management.
Material and methods:
A prospective, longitudinal, descriptive and analytical cohort study, which included patients diagnosed with septic shock according to the guidelines of the Surviving Sepsis Campaign in 2012 admitted to the intensive care unit during the period comprising from June 2015 to June 2016.
Results:
Multivariate analysis of survival at 24 hours showed that SvcO2 >70%, OR 0.23 (CI95% 0.047-1.15) p=0.07 and (ΔP(v-a)CO2/C(a-v)O2) >1.4, OR 5.49 (CI95% 1.07-28.09) p = 0.04. The Group 4 (ScvO2 <70% and (ΔP(v-a)CO2/C(a-v)O2)>1.4), which included seven patients, was associated with poor prognosis and 43% mortality (n = 6).
Discussion:
Different studies have shown poor correlation between macro- and microcirculation, that microcirculatory alterations are present before the drop in blood pressure, cardiac output, and that perfused vessel density is independent of these parameters.
Conclusion:
Patients with septic shock with SvcO2<70% and (ΔP(v-a)CO2/C(a-v)O2) >1.4 measured at 24 hours of admission have increased 30-day mortality.
Keywords : Intensive care unit; septic shock; hypoperfusion; mortality.
