Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3 PT, Parc Taulí, 1, Sabadell, 08208, Spain.
Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
BMC Anesthesiol. 2024 Aug 5;24(1):273. doi: 10.1186/s12871-024-02662-y.
The selection of adequate indicators of tissue hypoxia for guiding the resuscitation process of septic patients is a highly relevant issue. Current guidelines advocate for the use of lactate as sole metabolic marker, which may be markedly limited, and the integration of different variables seems more adequate. In this study, we explored the metabolic profile and its implications in the response to the administration of a fluid challenge in early septic shock patients.
Observational study including septic shock patients within 24 h of ICU admission, monitored with a cardiac output estimation system, with ongoing resuscitation. Hemodynamic and metabolic variables were measured before and after a fluid challenge (FC). A two-step cluster analysis was used to define the baseline metabolic profile, including lactate, central venous oxygen saturation (ScvO), central venous-to-arterial carbon dioxide difference (PcvaCO), and PcvaCO corrected by the difference in arterial-to-venous oxygen content (PcvaCO/CavO).
Seventy-seven fluid challenges were analyzed. Cluster analysis revealed two distinct metabolic profiles at baseline. Cluster A exhibited lower ScvO, higher PcvaCO, and lower PcvaCO/CavO. Increases in cardiac output (CO) were associated with increases in VO exclusively in cluster A. Baseline isolated metabolic variables did not correlate with VO response, and changes in ScvO and PcvaCO were associated to VO increase only in cluster A.
In a population of early septic shock patients, two distinct metabolic profiles were identified, suggesting tissue hypoxia or dysoxia. Integrating metabolic variables enhances the ability to detect those patients whose VO might increase as results of fluid administration.
选择适当的组织缺氧指标来指导脓毒症患者的复苏过程是一个非常重要的问题。目前的指南主张使用乳酸作为唯一的代谢标志物，但这可能存在明显的局限性，而整合不同的变量似乎更为合适。在这项研究中，我们探讨了代谢特征及其在早期脓毒性休克患者液体冲击反应中的意义。
这是一项观察性研究，纳入了 ICU 入院 24 小时内的脓毒性休克患者，使用心输出量估计系统进行监测，并进行持续复苏。在进行液体冲击（FC）前后测量血流动力学和代谢变量。采用两步聚类分析定义基线代谢特征，包括乳酸、中心静脉血氧饱和度（ScvO）、中心静脉-动脉二氧化碳差值（PcvaCO）和经动静脉氧含量差校正的 PcvaCO（PcvaCO/CavO）。
分析了 77 次液体冲击。聚类分析显示基线时有两种不同的代谢特征。簇 A 表现为较低的 ScvO、较高的 PcvaCO 和较低的 PcvaCO/CavO。心输出量（CO）的增加与簇 A 中 VO 的增加相关。基线时孤立的代谢变量与 VO 反应无相关性，而 ScvO 和 PcvaCO 的变化仅与簇 A 中 VO 的增加相关。
在早期脓毒性休克患者人群中，发现了两种不同的代谢特征，提示存在组织缺氧或氧合不足。整合代谢变量可以提高检测那些通过液体输注可能增加 VO 的患者的能力。
