危重症患者液体冲击引起的中心静脉至动脉二氧化碳分压变化。
Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients.
机构信息
Intensive Care Department, Brugmann University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium.
Internal Medicine Department, University Hospital of Patras, Patras, Greece.
出版信息
PLoS One. 2021 Sep 10;16(9):e0257314. doi: 10.1371/journal.pone.0257314. eCollection 2021.
BACKGROUND
In this prospective observational study, we evaluated the effects of fluid bolus (FB) on venous-to-arterial carbon dioxide tension (PvaCO2) in 42 adult critically ill patients with pre-infusion PvaCO2 > 6 mmHg.
RESULTS
FB caused a decrease in PvaCO2, from 8.7 [7.6-10.9] mmHg to 6.9 [5.8-8.6] mmHg (p < 0.01). PvaCO2 decreased independently of pre-infusion cardiac index and PvaCO2 changes during FB were not correlated with changes in central venous oxygen saturation (ScvO2) whatever pre-infusion CI. Pre-infusion levels of PvaCO2 were inversely correlated with decreases in PvaCO2 during FB and a pre-infusion PvaCO2 value < 7.7 mmHg could exclude a decrease in PvaCO2 during FB (AUC: 0.79, 95%CI 0.64-0.93; Sensitivity, 91%; Specificity, 55%; p < 0.01).
CONCLUSIONS
Fluid bolus decreased abnormal PvaCO2 levels independently of pre-infusion CI. Low baseline PvaCO2 values suggest that a positive response to FB is unlikely.
背景
在这项前瞻性观察研究中，我们评估了在 42 名预输注 PvaCO2 > 6mmHg 的成年危重症患者中，液体冲击（FB）对静脉-动脉二氧化碳分压（PvaCO2）的影响。
结果
FB 导致 PvaCO2 从 8.7[7.6-10.9]mmHg 下降至 6.9[5.8-8.6]mmHg（p<0.01）。PvaCO2 的降低与预输注心指数无关，并且在任何预输注 CI 下，FB 期间 PvaCO2 的变化与中心静脉血氧饱和度（ScvO2）的变化均不相关。预输注 PvaCO2 水平与 FB 期间 PvaCO2 的降低呈负相关，预输注 PvaCO2 值<7.7mmHg 可排除 FB 期间 PvaCO2 的降低（AUC：0.79，95%CI 0.64-0.93；敏感性，91%；特异性，55%；p<0.01）。
结论
液体冲击可独立于预输注 CI 降低异常 PvaCO2 水平。低基线 PvaCO2 值提示对 FB 的反应不太可能为阳性。
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