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2020, Number 3

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Med Crit 2020; 34 (3)

Efficiency of blood gas analysis as mortality predictor on septic shock patients: prolective cohort study

Palacios-Calderón ÓE, Monter-Vigueras JE, Aguirre-Sánchez JS, Franco-Granillo J, Camarena-Alejo G, Aisa-Álvarez A

Language: Spanish
References: 19
Page: 194-199
PDF size: 256.21 Kb.


ABSTRACT

Introduction: Blood gas analysis is probably the most common diagnostic tool used in intensive care. A proper understanding and use of arterial and pulmonary/central venous blood gas analysis makes it possible to correctly interpret most of the respiratory, circulatory and metabolic derangements which may occur in septic shock patients.
Objective: To assess the effectiveness of arterial and venous blood analysis in predicting mortality of patients with septic shock.
Material and methods: Prolective cohort study conducted in two adult intensive care units, period January 2018-July 2019. Adult patients +18 years who entered the intensive therapy unit of ABC Medical Center, both campuses, with septic shock diagnosis were included according to SEPSIS-3 criteria. For every patient admitted with a diagnosis of septic shock, arterial and venous blood analysis was performed at the same time for the following calculations: PaO2/FiO2, ScvO2, Qs/Qt, Dv-aCO2, Da-vO2, Dv-aCO2/Da-vO2, IEO2.
Results: 136 patients were included. Average age was 66 years. Average BMI 25.17 kg/m2, 74 (54%) were men, most common comorbilities were smoking, hypertension, cancer and diabetes. 75% of income was non-surgical, with respiratory causes (30%) as the most frequent medical conditions. 30% of patients died. Past history of chronic kidney disease was statistically significant with mortality OR 3.73 (95% CI 1.28-10.8); p = 0.01. The blood gas analysis showed that Da-vO2 with an average of 2.91 mL/dL (hyperdynamics) was directly related to mortality OR 0.58 (95% CI 0.39-0.87); p = 0.008; also, the Dv-aCO2/Da-vO2 p = 0.023 index.
Conclusion: Blood gas analysis is a useful, non-invasive tool for the analysis of the different pathophysiological changes in the patient in septic shock. An isolated parameter does not indicate an adequate or inadequate tissue oxygen supply (DO2). Considering the effects of overstimulation generated by sympathetic activity and the finding of a hyperdynamic profile mostly associated with mortality, therapeutic management with beta blockers may be an attractive treatment in selected septic shock patients.


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