Department of Emergency and Critical Care Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Crit Care. 2021 Dec 4;25(1):416. doi: 10.1186/s13054-021-03830-z.
Several clinical guidelines recommend monitoring blood lactate levels and central venous oxygen saturation for hemodynamic management of patients with sepsis. We hypothesized that carbon dioxide production (VCO) and oxygen extraction (VO) evaluated using indirect calorimetry (IC) might provide additional information to understand the dynamic metabolic changes in sepsis.
Adult patients with sepsis who required mechanical ventilation in the intensive care unit (ICU) of our hospital between September 2019 and March 2020 were prospectively enrolled. Sepsis was diagnosed according to Sepsis-3. Continuous measurement of VCO and VO using IC for 2 h was conducted within 24 h after tracheal intubation, and the changes in VCO and VO over 2 h were calculated as the slopes by linear regression analysis. Furthermore, temporal lactate changes were evaluated. The primary outcome was 28-day survival.
Thirty-four patients with sepsis were enrolled, 26 of whom survived 76%. Significant differences in the slope of VCO (- 1.412 vs. - 0.446) (p = 0.012) and VO (- 2.098 vs. - 0.851) (p = 0.023) changes were observed between non-survivors and survivors. Of note, all eight non-survivors and 17 of the 26 survivors showed negative slopes of VCO and VO changes. For these patients, 17 survivors had a median lactate of - 2.4% changes per hour (%/h), whereas non-survivors had a median lactate of 2.6%/hr (p = 0.023).
The non-survivors in this study showed temporal decreases in both VCO and VO along with lactate elevation. Monitoring the temporal changes in VCO and VO along with blood lactate levels may be useful in predicting the prognosis of sepsis.
几项临床指南建议监测血乳酸水平和中心静脉血氧饱和度，以进行脓毒症患者的血流动力学管理。我们假设使用间接热量测定法（IC）评估二氧化碳产生（VCO）和氧摄取（VO）可能会提供额外的信息，以了解脓毒症的动态代谢变化。
2019 年 9 月至 2020 年 3 月期间，我院重症监护病房（ICU）中需要机械通气的成年脓毒症患者被前瞻性纳入研究。根据 Sepsis-3 诊断脓毒症。在气管插管后 24 小时内，通过 IC 连续测量 2 小时的 VCO 和 VO，并通过线性回归分析计算 VCO 和 VO 在 2 小时内的变化斜率。此外，评估了时间上的乳酸变化。主要结局为 28 天生存率。
共纳入 34 例脓毒症患者，其中 26 例存活。非幸存者和幸存者的 VCO 斜率（-1.412 比-0.446）（p=0.012）和 VO 斜率（-2.098 比-0.851）（p=0.023）存在显著差异。值得注意的是，所有 8 例非幸存者和 26 例幸存者中的 17 例均显示 VCO 和 VO 变化的斜率为负。对于这些患者，17 例幸存者的乳酸水平每小时变化中位数为-2.4%（%/h），而非幸存者为 2.6%/hr（p=0.023）。
本研究中的非幸存者表现出 VCO 和 VO 随时间下降，同时乳酸升高。监测 VCO 和 VO 随时间的变化以及血乳酸水平可能有助于预测脓毒症的预后。
