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
Original

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

∆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.

Keywords

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

Abbreviations

ACCP

American College of Chest Physicians

APACHE

Acute Physiology and Chronic Health Evaluation

CI

Cardiac index

CHF

Chronic heart failure

DO2

Oxygen delivery

EO2

Oxygen extraction

FiO2

Fractional inspired oxygen level

MAP

Mean arterial pressure

∆PCO2

Central venous-to-arterial carbon dioxide tension difference

P[v–a]CO2

Mixed venous-to-arterial carbon dioxide tension difference

SCCM

Society of Critical Care Medicine

ScvO2

Central venous oxygen saturation

SOFA

Sequential Organ Failure Assessment

VCO2

CO2 production

VO2

Oxygen consumption

Supplementary material

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

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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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