Intensive Care Medicine

, Volume 40, Issue 3, pp 404–411 | Cite as

Time course of central venous-to-arterial carbon dioxide tension difference in septic shock patients receiving incremental doses of dobutamine

  • Jihad Mallat
  • Younes Benzidi
  • Julia Salleron
  • Malcolm Lemyze
  • Gaëlle Gasan
  • Nicolas Vangrunderbeeck
  • Florent Pepy
  • Laurent Tronchon
  • Benoit Vallet
  • Didier Thevenin



To assess the time course of the central venous–arterial carbon dioxide tension difference (∆PCO2)—as an index of the carbon dioxide production (VCO2)/cardiac index (CI) ratio—in stable septic shock patients receiving incremental doses of dobutamine.


Twenty-two hemodynamically stable septic shock patients with no signs of global tissue hypoxia, as testified by normal blood lactate levels, were prospectively included. A dobutamine infusion was administered at a dose of up to 15 μg/kg/min in increments of 5 μg/kg/min every 30 min. Complete hemodynamic and gas measurements were obtained at baseline, and at each dose of dobutamine.


Dobutamine induced a significant dose-dependent increase of CI from 0 to 15 μg/kg/min (P < 0.001). Oxygen consumption (VO2) and VCO2 were progressively increased by dobutamine. These increases were more marked between 10 and 15 μg/kg/min (8.3 and 8.6 %, respectively) than between the lower doses. ∆PCO2 and oxygen extraction (EO2) significantly decreased between 0 (8.0 ± 2.0 mmHg and 43.8 ± 13.4 %, respectively) and 10 μg/kg/min of dobutamine (4.2 ± 1.6 mmHg and 28.9 ± 7.9 %, respectively), but remained unchanged from 10 to 15 μg/kg/min (5.4 ± 2.4 mmHg and 29.5 ± 8.2 %, respectively). The central venous oxygen saturation significantly (ScvO2) increased from 0 to 10 μg/kg/min and remained unchanged from 10 to 15 μg/kg/min. Time courses of ∆PCO2, ScvO2, and EO2 were linked therefore to the biphasic changes of VO2 and VCO2.


∆PCO2 is a good indicator of the change of VCO2 induced by dobutamine. Measurement of ∆PCO2, along with ScvO2 and EO2, may be presented as a useful tool to assess the adequacy of oxygen supply versus metabolic and oxygen demand.


Central venous-to-arterial carbon dioxide tension difference Cardiac index Dobutamine Stable septic shock Oxygen consumption CO2 production 



American College of Chest Physicians


Acute Physiology and Chronic Health Evaluation


Cardiac index


Chronic heart failure


Oxygen delivery


Oxygen extraction


Fractional inspired oxygen level


Mean arterial pressure


Central venous-to-arterial carbon dioxide tension difference


Mixed venous-to-arterial carbon dioxide tension difference


Society of Critical Care Medicine


Central venous oxygen saturation


Sequential Organ Failure Assessment


CO2 production


Oxygen consumption

Supplementary material

134_2013_3170_MOESM1_ESM.doc (37 kb)
Supplementary material 1 (DOC 37 kb)


  1. 1.
    Ruffolo RR Jr (1987) The pharmacology of dobutamine. Am J Med Sci 294:244–248PubMedCrossRefGoogle Scholar
  2. 2.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Intensive Care Med 39:165–228PubMedCrossRefGoogle Scholar
  3. 3.
    Bhatt SB, Hutchinson RC, Tomlinson B, Oh TE, Mak M (1992) Effect of dobutamine on oxygen supply and uptake in healthy volunteers. Br J Anaesth 69:298–303PubMedCrossRefGoogle Scholar
  4. 4.
    Green CJ, Frazer RS, Underhill S, Maycock P, Fairhurst JA, Campbell IT (1992) Metabolic effects of dobutamine in normal man. Clin Sci 82:77–83PubMedGoogle Scholar
  5. 5.
    McHardy GJ (1967) The relationship between the differences in pressure and content of carbon dioxide in arterial and venous blood. Clin Sci 32:299–309PubMedGoogle Scholar
  6. 6.
    Dres M, Monnet X, Teboul JL (2012) Hemodynamic management of cardiovascular failure by using PCO(2) venous-arterial difference. J Clin Monit Comput 26:367–374PubMedCrossRefGoogle Scholar
  7. 7.
    Teboul JL, Mercat A, Lenique F, Berton C, Richard C (1998) Value of the venous-arterial PCO2 gradient to reflect the oxygen supply to demand in humans: effects of dobutamine. Crit Care Med 26:1007–1010PubMedCrossRefGoogle Scholar
  8. 8.
    Cuschieri J, Rivers EP, Donnino MW, Katilius M, Jacobsen G, Nguyen HB, Pamukov N, Horst HM (2005) Central venous-arterial carbon dioxide difference as an indicator of cardiac index. Intensive Care Med 31:818–822PubMedCrossRefGoogle Scholar
  9. 9.
    van Beest PA, Lont MC, Holman ND, Loef B, Kuiper MA, Boerma EC (2013) Central venous-arterial PCO2 difference as a tool in resuscitation of septic patients. Intensive Care Med 39:1034–1039PubMedCrossRefGoogle Scholar
  10. 10.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definition conference. Crit Care Med 31:1250–1256PubMedCrossRefGoogle Scholar
  11. 11.
    Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, Joffre J, Margetis D, Guidet B, Maury E, Offenstadt G (2011) Mottling score predicts survival in septic shock. Intensive Care Med 37:801–807PubMedCrossRefGoogle Scholar
  12. 12.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  13. 13.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG, On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  14. 14.
    Vincent JL, Van der Linden P, Domb M, Blecic S, Azimi G, Bernard A (1987) Dopamine compared with dobutamine in experimental septic shock: relevance to fluid administration. Anaesth Analg 66:565–571CrossRefGoogle Scholar
  15. 15.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463PubMedCrossRefGoogle Scholar
  16. 16.
    McLellan S, Walsh T, Burdess A, Lee A (2002) Comparison between the Datex-Ohmeda M-COVX metabolic monitor and the Deltatrac II in mechanically ventilated patients. Intensive Care Med 28:870–876PubMedCrossRefGoogle Scholar
  17. 17.
    Mallat J, Pepy F, Lemyze M, Barrailler S, Gasan G, Tronchon L, Thevenin D (2012) Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients. J Crit Care 27:376–383PubMedCrossRefGoogle Scholar
  18. 18.
    Roy A (2006) Estimating correlation coefficient between two variables with repeated observations using mixed effects model. Biom J 48:286–301PubMedCrossRefGoogle Scholar
  19. 19.
    Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F (2008) Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med 36:1701–1706PubMedCrossRefGoogle Scholar
  20. 20.
    Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722PubMedCrossRefGoogle Scholar
  21. 21.
    Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R, SvO2 Collaborative Group (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032PubMedCrossRefGoogle Scholar
  22. 22.
    De Backer D, Moraine JJ, Berre J, Kahn RJ, Vincent JL (1994) Effects of dobutamine on oxygen consumption in septic patients. Direct versus indirect determinations. Am J Respir Crit Care Med 150:95–100PubMedCrossRefGoogle Scholar
  23. 23.
    Vincent JL, Roman A, De Backer D, Kahn RJ (1990) Oxygen uptake/supply dependency. Effects of short-term dobutamine infusion. Am Rev Respir Dis 142:2–7PubMedCrossRefGoogle Scholar
  24. 24.
    Schaffartzik W, Sanft C, Schaefer JH, Spies C (2000) Different dosages of dobutamine in septic shock patients: determining oxygen consumption with a metabolic monitor integrated in a ventilator. Intensive Care Med 26:1740–1746PubMedCrossRefGoogle Scholar
  25. 25.
    De Backer D (2000) VO2/DO2 relationship: how to get rid of methodological pitfalls? Intensive Care Med 26:1719–1722PubMedCrossRefGoogle Scholar
  26. 26.
    Teboul JL, Graini L, Boujdaria R, Berton C, Richard C (1993) Cardiac index versus oxygen-derived parameters for rational use of dobutamine in patients with congestive heart failure. Chest 103:81–85PubMedCrossRefGoogle Scholar
  27. 27.
    Levy MN (1959) Influence of variations in blood flow and of dinitrophenol on renal oxygen consumption. Am J Physiol 196:937–942PubMedGoogle Scholar
  28. 28.
    Chioléro R, Flatt JP, Revelly JP, Jéquier E (1991) Effects of catecholamines on oxygen consumption and oxygen delivery in critically ill patients. Chest 100:1676–1684PubMedCrossRefGoogle Scholar
  29. 29.
    Cohn JN, Levine TB, Olivari MT, Garberg V, Lura D, Francis GS, Simon AB, Rector T (1984) Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:819–823PubMedCrossRefGoogle Scholar
  30. 30.
    Uusaro A, Hartikainen J, Parviainen M, Takala J (1995) Metabolic stress modifies the thermogenic effect of dobutamine in man. Crit Care Med 23:674–680PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Jihad Mallat
    • 1
  • Younes Benzidi
    • 1
  • Julia Salleron
    • 2
  • Malcolm Lemyze
    • 1
  • Gaëlle Gasan
    • 1
  • Nicolas Vangrunderbeeck
    • 1
  • Florent Pepy
    • 1
  • Laurent Tronchon
    • 1
  • Benoit Vallet
    • 3
  • Didier Thevenin
    • 1
  1. 1.Intensive Care Unit, Centre Hospitalier du Dr. Schaffner de Lens, Service de Réanimation PolyvalenteLens cedexFrance
  2. 2.Department of Biostatistics, EA2694, UDSLLille UniversityLilleFrance
  3. 3.Department of Anaesthesiology and Critical Care MedicineUniversity Hospital of Lille, Univ Nord de FranceLilleFrance

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