Time Course of Central Venous-to-arterial Carbon Dioxide Tension Difference in Septic Shock Patients Receiving Incremental Doses of Dobutamine

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2013 Dec 6

PMID 24306082

Citations 10

Authors

Jihad Mallat

Younes Benzidi

Julia Salleron

Malcolm Lemyze

Gaelle Gasan

Nicolas Vangrunderbeeck

Florent Pepy

Laurent Tronchon

Benoit Vallet

Didier Thevenin

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess the time course of the central venous-arterial carbon dioxide tension difference (∆PCO2)-as an index of the carbon dioxide production (VCO2)/cardiac index (CI) ratio-in stable septic shock patients receiving incremental doses of dobutamine.

Methods: Twenty-two hemodynamically stable septic shock patients with no signs of global tissue hypoxia, as testified by normal blood lactate levels, were prospectively included. A dobutamine infusion was administered at a dose of up to 15 μg/kg/min in increments of 5 μg/kg/min every 30 min. Complete hemodynamic and gas measurements were obtained at baseline, and at each dose of dobutamine.

Results: Dobutamine induced a significant dose-dependent increase of CI from 0 to 15 μg/kg/min (P < 0.001). Oxygen consumption (VO2) and VCO2 were progressively increased by dobutamine. These increases were more marked between 10 and 15 μg/kg/min (8.3 and 8.6 %, respectively) than between the lower doses. ∆PCO2 and oxygen extraction (EO2) significantly decreased between 0 (8.0 ± 2.0 mmHg and 43.8 ± 13.4 %, respectively) and 10 μg/kg/min of dobutamine (4.2 ± 1.6 mmHg and 28.9 ± 7.9 %, respectively), but remained unchanged from 10 to 15 μg/kg/min (5.4 ± 2.4 mmHg and 29.5 ± 8.2 %, respectively). The central venous oxygen saturation significantly (ScvO2) increased from 0 to 10 μg/kg/min and remained unchanged from 10 to 15 μg/kg/min. Time courses of ∆PCO2, ScvO2, and EO2 were linked therefore to the biphasic changes of VO2 and VCO2.

Conclusion: ∆PCO2 is a good indicator of the change of VCO2 induced by dobutamine. Measurement of ∆PCO2, along with ScvO2 and EO2, may be presented as a useful tool to assess the adequacy of oxygen supply versus metabolic and oxygen demand.

Citing Articles

Changes in central venous-to-arterial PCO difference and central venous oxygen saturation as markers to define fluid responsiveness in critically ill patients: a pot-hoc analysis of a multi-center prospective study.

Mallat J, Abou-Arab O, Lemyze M, Saleh D, Guinot P, Fischer M Crit Care. 2024; 28(1):360.

PMID: 39516883 PMC: 11549741. DOI: 10.1186/s13054-024-05156-y.

Central venous oxygen saturation changes as a reliable predictor of the change of CI in septic shock: To explore potential influencing factors.

An R, Wan X, Chen Y, Dong R, Wang C, Jiang W Chin J Traumatol. 2024; 28(1):43-49.

PMID: 38789315 PMC: 11840319. DOI: 10.1016/j.cjtee.2024.05.001.

Use of CO-Derived Variables in Cardiac Intensive Care Unit: Pathophysiology and Clinical Implications.

Cousin V, Joye R, Wacker J, Beghetti M, Polito A J Cardiovasc Dev Dis. 2023; 10(5).

PMID: 37233175 PMC: 10219326. DOI: 10.3390/jcdd10050208.

Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients.

Pierrakos C, De Bels D, Nguyen T, Velissaris D, Attou R, Devriendt J PLoS One. 2021; 16(9):e0257314.

PMID: 34506589 PMC: 8432848. DOI: 10.1371/journal.pone.0257314.

High central venous oxygen saturation is associated with mitochondrial dysfunction in septic shock: A prospective observational study.

Wittayachamnankul B, Apaijai N, Sutham K, Chenthanakij B, Liwsrisakun C, Jaiwongkam T J Cell Mol Med. 2020; 24(11):6485-6494.

PMID: 32352229 PMC: 7294163. DOI: 10.1111/jcmm.15299.

References

Ruffolo Jr R . The pharmacology of dobutamine. Am J Med Sci. 1987; 294(4):244-8. DOI: 10.1097/00000441-198710000-00005. View

Cuschieri J, Rivers E, Donnino M, Katilius M, Jacobsen G, Nguyen H . Central venous-arterial carbon dioxide difference as an indicator of cardiac index. Intensive Care Med. 2005; 31(6):818-22. DOI: 10.1007/s00134-005-2602-8. View

Levy M, Fink M, Marshall J, Abraham E, Angus D, Cook D . 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003; 31(4):1250-6. DOI: 10.1097/01.CCM.0000050454.01978.3B. View

Ait-Oufella H, Lemoinne S, Boelle P, Galbois A, Baudel J, Lemant J . Mottling score predicts survival in septic shock. Intensive Care Med. 2011; 37(5):801-7. DOI: 10.1007/s00134-011-2163-y. View

Cohn J, Levine T, Olivari M, Garberg V, Lura D, Francis G . Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984; 311(13):819-23. DOI: 10.1056/NEJM198409273111303. View

Knaus W, Draper E, Wagner D, Zimmerman J . APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10):818-29. View

LEVY M . Influence of variations in blood flow and of dinitrophenol on renal oxygen consumption. Am J Physiol. 1959; 196(4):937-42. DOI: 10.1152/ajplegacy.1959.196.4.937. View

McLellan S, Walsh T, Burdess A, Lee A . Comparison between the Datex-Ohmeda M-COVX metabolic monitor and the Deltatrac II in mechanically ventilated patients. Intensive Care Med. 2002; 28(7):870-6. DOI: 10.1007/s00134-002-1323-5. View

Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F . Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med. 2008; 36(6):1701-6. DOI: 10.1097/CCM.0b013e318174db05. View

10.

Dres M, Monnet X, Teboul J . Hemodynamic management of cardiovascular failure by using PCO(2) venous-arterial difference. J Clin Monit Comput. 2012; 26(5):367-74. DOI: 10.1007/s10877-012-9381-x. View

11.

Schaffartzik W, Sanft C, Schaefer J, Spies C . Different dosages of dobutamine in septic shock patients: determining oxygen consumption with a metabolic monitor integrated in a ventilator. Intensive Care Med. 2001; 26(12):1740-6. DOI: 10.1007/s001340000635. View

12.

Teboul J, Graini L, Boujdaria R, Berton C, Richard C . Cardiac index vs oxygen-derived parameters for rational use of dobutamine in patients with congestive heart failure. Chest. 1993; 103(1):81-5. DOI: 10.1378/chest.103.1.81. View

13.

McHARDY G . The relationship between the differences in pressure and content of carbon dioxide in arterial and venous blood. Clin Sci. 1967; 32(2):299-309. View

14.

Vincent J, Roman A, De Backer D, KAHN R . Oxygen uptake/supply dependency. Effects of short-term dobutamine infusion. Am Rev Respir Dis. 1990; 142(1):2-7. DOI: 10.1164/ajrccm/142.6_Pt_2.S2. View

15.

Roy A . Estimating correlation coefficient between two variables with repeated observations using mixed effects model. Biom J. 2006; 48(2):286-301. DOI: 10.1002/bimj.200510192. View

16.

Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A . A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med. 1995; 333(16):1025-32. DOI: 10.1056/NEJM199510193331601. View

17.

Bhatt S, Hutchinson R, Tomlinson B, Oh T, Mak M . Effect of dobutamine on oxygen supply and uptake in healthy volunteers. Br J Anaesth. 1992; 69(3):298-303. DOI: 10.1093/bja/69.3.298. View

18.

Vincent J, Van Der Linden P, Domb M, Blecic S, Azimi G, Bernard A . Dopamine compared with dobutamine in experimental septic shock: relevance to fluid administration. Anesth Analg. 1987; 66(6):565-71. View

19.

Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of.... J Am Soc Echocardiogr. 2005; 18(12):1440-63. DOI: 10.1016/j.echo.2005.10.005. View

20.

De Backer D, Moraine J, Berre J, KAHN R, Vincent J . Effects of dobutamine on oxygen consumption in septic patients. Direct versus indirect determinations. Am J Respir Crit Care Med. 1994; 150(1):95-100. DOI: 10.1164/ajrccm.150.1.8025780. View