Central blood gases versus lactate level for assessment of initial resuscitation success in patients with sepsis in critical care

Abstract

ABSTRACT Background Central blood gas and lactate levels serve as goals for fluid resuscitation. Objective To evaluate the role of blood gases [the ratio of P(v-a)CO2/C(a-v)O2 and P(v-a)CO2)] and lactate clearance as indicators of initial fluid resuscitation in patients diagnosed with sepsis. Study design This study included three groups of patients according to the resuscitation effective predictors. Patients A total of 120 patients were divided into 3 groups, 40 patients in each. Group (A): ratio P(v-a)CO2/C(a-v)O2, group (B):: of Lactate clearance (LC), and group (C): P(v-a)co2. Interventions Variables were measured at the start of ICU arrival (T0) and after 8 hours of resuscitation (T8). Main outcome measures The ratio P(v-a)CO2/C(a-v)O2, difference of P(v-a)co2 and Lactate level and clearance (LC) recorded and calculated, a dose of dobutamine required, packed RBCs, length of stay, mortality, and any recorded complication. Measured at T0 and T8 time points Results In group A, the ratio of P(v-a)CO2/C(a-v)O2 was improved significantly at T8 when compared with values at baseline. Lactate (group B) showed a significantly lower level at T8 than at T0. In group C, the gradient of P(v-a)CO2 did not differ significantly at T8. After 28 days, group C had a higher mortality rate (55% in group C vs 25% in group A and 30% in group B). Conclusion The ratio of P(v-a)CO2/C(a-v)O2 calculation may be as good as, if not better than, lactate as an indicator of initial resuscitation success of patients with sepsis, this can improve the outcome and reduce mortality. Unfortunately, the P(v-a)CO2 gradient alone is not