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Since normal or high central venous oxygen saturation (ScvO 2 ) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (P cva CO 2  gap) has been proposed. In the present study, we aimed to evaluate the ability of the P cva CO 2  gap and the P cva CO 2 /arterial-venous oxygen content difference ratio (P cva CO 2 /C av O 2 ) to predict lactate evolution in septic shock.    Methods  Observational study. Septic shock patients within the first 24 hours of ICU admission. After restoration of mean arterial pressure, and central venous oxygen saturation, the P cva CO 2  gap and the P cva CO 2 /C av O 2  ratio were calculated. Consecutive arterial and central venous blood samples were obtained for each patient within 24 hours. Lactate improvement was defined as the decrease ≥ 10% of the previous lactate value.    Results  Thirty-five septic shock patients were studied. At inclusion, the P cva CO 2  gap was 5.6 ± 2.1 mmHg, and the P cva CO 2 /C av O 2  ratio was 1.6 ± 0.7 mmHg · dL/mL O 2 . Those patients whose lactate values did not decrease had higher P cva CO 2 /C av O 2  ratio values at inclusion (1.8 ± 0.8vs. 1.4 ± 0.5,  p  0.02). During the follow-up, 97 paired blood samples were obtained. No-improvement in lactate values was associated to higher P cva CO 2 /C av O 2  ratio values in the previous control. The ROC analysis showed an AUC 0.82 ( p  < 0.001), and a P cva CO 2 /C av O 2  ratio cut-off value of 1.4 mmHg · dL/mL O 2  showed sensitivity 0.80 and specificity 0.75 for lactate improvement prediction. The odds ratio of an adequate lactate clearance was 0.10 ( p  < 0.001) in those patients with an elevated P cva CO 2 /C av O 2  ratio (≥1.4).    Conclusion  In a population of septic shock patients with normalized MAP and S cv O 2 , the presence of elevated P cva CO 2 /C av O 2  ratio significantly reduced the odds of adequate lactate clearance during the following hours.

critical care

Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock