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Background  To evaluate the ability of the central venous-to-arterial CO 2  content and tension differences to arteriovenous oxygen content difference ratios (∆ContCO 2 /∆ContO 2  and ∆PCO 2 /∆ContO 2 , respectively), blood lactate concentration, and central venous oxygen saturation (ScvO 2 ) to detect the presence of global anaerobic metabolism through the increase in oxygen consumption (VO 2 ) after an acute increase in oxygen supply (DO 2 ) induced by volume expansion (VO 2 /DO 2  dependence).    Methods  We prospectively studied 98 critically ill mechanically ventilated patients in whom a fluid challenge was decided due to acute circulatory failure related to septic shock. Before and after volume expansion (500 mL of colloid solution), we measured cardiac index, VO 2 , DO 2 , ∆ContCO 2 /∆ContO 2  and ∆PCO 2 /∆ContO 2  ratios, lactate, and ScvO 2 . Fluid-responders were defined as a ≥15 % increase in cardiac index. Areas under the receiver operating characteristic curves (AUC) were determined for these variables.    Results  Fifty-one patients were fluid-responders (52 %). DO 2  increased significantly (31 ± 12 %) in these patients. An increase in VO 2  ≥ 15 % (“VO 2 -responders”) concurrently occurred in 57 % of the 51 fluid-responders (45 ± 16 %). Compared with VO 2 -non-responders, VO 2 -responders were characterized by higher lactate levels and higher ∆ContCO 2 /∆ContO 2  and ∆PCO 2 /∆ContO 2  ratios. At baseline, lactate predicted a fluid-induced increase in VO 2  ≥ 15 % with AUC of 0.745. Baseline ∆ContCO 2 /∆ContO 2  and ∆PCO 2 /∆ContO 2  ratios predicted an increase of VO 2  ≥ 15 % with AUCs of 0.965 and 0.962, respectively. Baseline ScvO 2  was not able to predict an increase of VO 2  ≥ 15 % (AUC = 0.624).    Conclusions  ∆ContCO 2 /∆ContO 2  and ∆PCO 2 /∆ContO 2  ratios are more reliable markers of global anaerobic metabolism than lactate. ScvO 2  failed to predict the presence of global tissue hypoxia.    Electronic supplementary material  The online version of this article (doi:10.1186/s13613-016-0110-3) contains supplementary material, which is available to authorized users.

annals of intensive care

Ratios of central venous-to-arterial carbon dioxide content or tension to arteriovenous oxygen content are better markers of global anaerobic metabolism than lactate in septic shock patients