P(v-a)CO2/C(a-v)O2-directed resuscitation does not improve prognosis compared with SvO2 in severe sepsis and septic shock: A prospective multicenter randomized controlled clinical study.

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.