二氧化碳静脉-动脉差值与氧动脉-静脉差值之比与高乳酸血症危重症患者液体冲击后乳酸降低无关：一项前瞻性观察研究的结果。

Ratio of carbon dioxide veno-arterial difference to oxygen arterial-venous difference is not associated with lactate decrease after fluid bolus in critically ill patients with hyperlactatemia: results from a prospective observational study.

机构信息

Intensive Care Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium.

Internal Medicine Department, University Hospital of Patras, Patras, Greece.

出版信息

BMC Anesthesiol. 2023 Jan 31;23(1):37. doi: 10.1186/s12871-023-01993-6.

DOI:10.1186/s12871-023-01993-6

PMID:36721083

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9887917/

Abstract

BACKGROUND

High ratio of the carbon dioxide veno-arterial difference to the oxygen arterial-venous difference (PCO/CO) is associated with fluid bolus (FB) induced increase in oxygen consumption (VO). This study investigated whether PCO/CO was associated with decreases in blood-lactate levels FB in critically ill patients with hyperlactatemia.

METHODS

This prospective observational study examined adult patients in the intensive care unit (ICU) with lactate levels > 1.5 mmol/L who received FBs. Blood-lactate levels were measured before and after FB under unchanged metabolic, respiratory, and hemodynamic conditions. The primary outcome was blood-lactate levels after FB. Significant decreases in blood-lactate levels were considered as blood-lactate levels < 1.5 mmol/L or a decrease of more than 10% compared to baseline.

RESULTS

The study enrolled 40 critically ill patients, and their median concentration of blood lactate was 2.6 [IQR:1.9 - 3.8] mmol/L. There were 27 (68%) patients with PCO/CO ≥ 1.4 mmHg/ml, and 10 of them had an increase in oxygen consumption (dVO) ≥ 15% after FB, while 13 (32%) patients had PCO/CO < 1.4 mmHg/ml before FB, and none of them had dVO ≥ 15% after FB. FB increased the cardiac index in patients with high and low preinfusion PCO/CO (13.4% [IQR: 8.3 - 20.2] vs. 8.8% [IQR: 2.9 - 17.4], p = 0.34). Baseline PCO/CO was not found to be associated with a decrease in blood lactate after FB (OR: 0.88 [95% CI: 0.39 - 1.98], p = 0.76). A positive correlation was observed between changes in blood lactate and baseline PCO/CO (r = 0.35, p = 0.02).

CONCLUSIONS

In critically ill patients with hyperlactatemia, PCO/CO before FB cannot be used to predict decreases in blood-lactate levels after FB. Increased PCO/CO is associated with less decrease in blood-lactate levels.

摘要

背景

二氧化碳静脉-动脉差值与氧动脉-静脉差值的比值高（PCO/CO）与液体冲击（FB）引起的氧耗增加（VO）有关。本研究旨在探讨在伴有高乳酸血症的危重病患者中，PCO/CO 是否与 FB 引起的血乳酸水平降低有关。

方法

本前瞻性观察研究纳入了 ICU 中乳酸水平＞1.5mmol/L 的成年患者，并对其进行 FB。在代谢、呼吸和血流动力学条件不变的情况下，分别在 FB 前后测量血乳酸水平。主要结局是 FB 后血乳酸水平。血乳酸水平明显降低定义为血乳酸水平＜1.5mmol/L 或与基线相比降低超过 10%。

结果

该研究共纳入 40 名危重病患者，其血乳酸中位数浓度为 2.6 [IQR：1.9-3.8]mmol/L。有 27 名（68%）患者的 PCO/CO≥1.4mmHg/ml，其中 10 名患者在 FB 后 VO 增加≥15%，而 13 名（32%）患者在 FB 前 PCO/CO＜1.4mmHg/ml，且他们在 FB 后均无 VO 增加≥15%。在高和低预输注 PCO/CO 的患者中，FB 增加了心指数（13.4%[IQR：8.3-20.2]比 8.8%[IQR：2.9-17.4]，p=0.34）。未发现基线 PCO/CO 与 FB 后血乳酸降低有关（OR：0.88 [95%CI：0.39-1.98]，p=0.76）。血乳酸的变化与基线 PCO/CO 呈正相关（r=0.35，p=0.02）。