Abstract
BackgroundSeveral 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 (VCO2) and oxygen extraction (VO2) evaluated using indirect calorimetry (IC) might provide additional information to understand the dynamic metabolic changes in sepsis.MethodsAdult 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 VCO2 and VO2 using IC for 2 h was conducted within 24 h after tracheal intubation, and the changes in VCO2 and VO2 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.ResultsThirty-four patients with sepsis were enrolled, 26 of whom survived 76%. Significant differences in the slope of VCO2 (− 1.412 vs. − 0.446) (p = 0.012) and VO2 (− 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 VCO2 and VO2 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).ConclusionsThe non-survivors in this study showed temporal decreases in both VCO2 and VO2 along with lactate elevation. Monitoring the temporal changes in VCO2 and VO2 along with blood lactate levels may be useful in predicting the prognosis of sepsis.
Highlights
Sepsis is a leading cause of death in intensive care units (ICUs) [1, 2]
We further evaluated the additional information provided by Carbon dioxide production (VCO2) and V O2 slopes along with lactate temporal changes
A significant difference in lactate temporal changes was observed between non-survivors and survivors
Summary
Sepsis is a leading cause of death in intensive care units (ICUs) [1, 2]. Hemodynamic management in patients with sepsis is important for providing a sufficient amount of oxygen to the organs and preventing the developmentHirayama et al Critical Care (2021) 25:416 outcomes [9]. Hemodynamic management in patients with sepsis is important for providing a sufficient amount of oxygen to the organs and preventing the development. Monitoring carbon dioxide production (VCO2) and oxygen extraction (VO2) is expected to help detect the progression of sepsis exacerbation, especially impaired oxygen usage in the mitochondria. Indirect calorimetry (IC) can simultaneously and noninvasively measure V CO2 and VO2 It has already been used in ICUs for measuring energy expenditure and oxygen consumption [14, 15]. 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 (VCO2) and oxygen extraction (VO2) evaluated using indirect calorimetry (IC) might provide additional information to understand the dynamic metabolic changes in sepsis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
