Abstract PR100

Abstract

Background & Objectives: Severe sepsis and septic shock is associated with high morbidity and mortality. Early goal directed therapy (EGDT) remains the corner stone for severe sepsis and septic shock intervention but EGDT target variables are often misleading. Many patients with severe sepsis and septic shock already achieved high ScVO2 value on arrival but still show signs of hipoperfusion. This research aims to describe the effect of EGDT on PCO2 gap as a marker of end target resuscitation. Materials & Methods: 30 patients with severe sepsis and septic shock was resuscitated using the EGDT algorythm to a achieve targets such as MAP above 65 mmhg, urine output more that 0.5 cc/kgbb/hours, hematocrit more than 30 gram% and ScVO2 more than 70%. PCO2 gap was measured by calculating the difference between central venous and arterial PCO2. Values more than 5 mmHg was considered high or abnormal. Statystical analysis was done using the unpaired t test and p value < 0.05 was considered statystically significant. Results: In general all subjects had a mean PCO2 gap of 6,46 mmHg prior to EGDT and 5,18 mmHg after EGDT. Unpaired t test shows that there is no significant change after EGDT on PCO2 gap with p value 0.093. For further analysis the subjects was divided into two groups based on PCO2 gap value prior to EGDT which was Group N(Normal) with PCO2 gap less then 5 mmhg and group H) with PCO2 gap more then equal 5 mmHg. Both groups shows no significant difference in age, disease severity, MAP, CVP value and SCVO2 values. H group has a higher lactate level (2.61 mmol vs 1.96 mmol/l) compared to N group although it was statisticaly significant. Analysis shows that in the H group PCO2 gap change was statystically very significant with values dropping from 9.14 mmHg to 5.51 mmHg (p = 0.000) with a significant change in lactate from 3.36 mmol/L to 2.61 mmol/liter (p = 0.026) while in the N group both PCO2 gap and lactate did not change significantly with p values > 0.05. Conclusion: PCO2 gap could be used as a marker for under resuscitated patient after EGDT and may be a parameter of EGDT responsiveness. Disclosure of Interest: None declared