Data were expressed as medians and 25 to 75% interquartile ranges. P ��0.05 (two-tailed) was considered significant.ResultsDuring the 24-month period, 108 patients A Number Of Things You Didn't Realize Regarding H89 older than 18 years with a new episode of septic shock were screened. Patients with advanced cirrhosis (n = 4), patients with severe chronic obstructive pulmonary disease (n = 8) and pregnant women (n = 4) were not included for analysis; additionally, a central catheter could not be placed in four patients, and three refused the procedure. The final sample was therefore 85 patients. The median length of ICU stay for all patients was 6 days (25 to 75% interquartile range, 3 to 11 days), and the 28-day mortality rate was 37.6%. The median time elapsed from sepsis-induced hypotension to catheter insertion was 3.
0 hours (25 to 75% interquartile range, 1.0 to 4.0 hours) and the median volume of fluids received before catheter insertion was 2,079 ml (25 to 75% interquartile range, 1,184 to 3,135 ml) for all patients.Thirty-six patients had Pv-aCO2 <6.0 mmHg at T0 and T6, and 17 patients had a high PvaCO2 at T0 but it fell below 6 mmHg at T6 (a total of 53 patients had Pv-aCO2 <6 mmHg at T6); on the other hand, 24 patients had a persistently high Pv-aCO2 during the first 6 hours and the remaining eight evolved from normal at T0 to high PvaCO2 at T6 (32 patients had Pv-aCO2 ��6 mmHg at T6).We did not find any significant difference with regard to Acute Physiology and Chronic Health Evaluation II score, comorbidities, demographics, or respiratory and hemodynamic variables between groups (Tables?1 and ?and2),2), and neither for the volume of fluids received before inclusion (T0).
Doses of vasopressors or inotropic received were similar for the groups both at T0 and T6 (Table?2). Multiorgan dysfunction at day 3 was significantly higher among patients with persistently high Pv-aCO2 compared with those with persistently normal or decreasing Pv-aCO2 during the first 6 hours of resuscitation (Kruskal�CWallis test, P <0.001) (Figure?1). Likewise, patients with persistently high Pv-aCO2 during the first 6 hours of resuscitation had a significant lower survival at day 28 compared with those who normalized Pv-aCO2 during this period (log-rank, Mantel�CCox: 19.21, P <0.001; Figure?2). These results were maintained after adjusting for the SvO2 achieved at T6 (log-rank test, P <0.001). The time course of SvO2, ScvO2 and cardiac output did not significantly differ between Pv-aCO2 groups (Table?2) nor between survivors and nonsurvivors at day 28 (Figures S1a,b and S2 in Additional file 1). Interestingly, a poor agreement between cardiac output and Pv-aCO2 was observed both at each time of resuscitation and when all data were pooled (r2 = 0.025, P <0.01) (Figure?3; Figure S3 in Additional file 1).