Fundación Universitaria de Ciencias de la Salud, Facultad de Medicina, Bogotá, Colombia; Servicio de Medicina Interna, Hospital de San José de Bogotá, Bogotá, Colombia; Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de Colombia Sede Bogotá, Bogotá, Colombia.
Fundación Universitaria de Ciencias de la Salud, Facultad de Medicina, Bogotá, Colombia; Servicio de Medicina Interna, Hospital de San José de Bogotá, Bogotá, Colombia.
Med Intensiva. 2017 Oct;41(7):401-410. doi: 10.1016/j.medin.2017.03.008. Epub 2017 May 16.
The way to assess tissue perfusion during the resuscitation of patients with severe sepsis and septic shock is a current subject of research and debate. Venous oxygen saturation and lactate concentration have been the most frequently used criteria, though they involve known limitations. The venous-to-arterial difference of carbon dioxide (pCO delta) is a parameter than can be used to indicate tissue perfusion, and its determination therefore may be useful in these patients.
A qualitative systematic review of the literature was made, comprising studies that assessed pCO delta in adult patients with severe sepsis or septic shock, and published between January 1966 and November 2016 in the Medline-PubMed, Embase-Elsevier, Cochrane Library, and LILACS databases. There was no language restriction. The PRISMA statement was followed, and methodological quality was evaluated.
Twelve articles were included, all of an observational nature, and including 10 prospective studies (9 published since 2010). Five documented greater mortality among patients with high pCO delta values, in 3 cases even when achieving venous oxygen saturation targets. In 4 studies, a high pCO delta was related to lower venous oxygen saturation and higher lactate levels, and another 3 documented lesser percentage lactate reductions.
The parameter pCO delta has been more frequently assessed in the management of patients with severe sepsis during the last few years. The studies demonstrate its correlation to mortality and other clinical outcomes, defining pCO delta as a useful tool in the management of these patients.
在严重脓毒症和感染性休克患者的复苏过程中评估组织灌注的方法是目前研究和争论的主题。静脉血氧饱和度和乳酸浓度是最常使用的标准，但它们存在已知的局限性。二氧化碳静脉-动脉差值（pCO delta）是一个可以用于指示组织灌注的参数，因此其测定在这些患者中可能是有用的。
对文献进行了定性系统评价，包括评估严重脓毒症或感染性休克成年患者 pCO delta 的研究，并于 1966 年 1 月至 2016 年 11 月期间在 Medline-PubMed、Embase-Elsevier、Cochrane 图书馆和 LILACS 数据库中发表，没有语言限制。遵循 PRISMA 声明，并评估了方法学质量。
共纳入 12 篇文章，均为观察性研究，包括 10 项前瞻性研究（其中 9 项发表于 2010 年之后）。有 5 项研究记录了高 pCO delta 值患者的死亡率更高，在 3 项研究中，即使达到了静脉血氧饱和度目标也是如此。在 4 项研究中，高 pCO delta 与较低的静脉血氧饱和度和较高的乳酸水平相关，另外 3 项研究记录了乳酸减少百分比较低。
在过去几年中，在严重脓毒症患者的管理中更频繁地评估了 pCO delta 参数。这些研究表明它与死亡率和其他临床结果相关，将 pCO delta 定义为这些患者管理的有用工具。
