背景:选择适当的组织缺氧指标来指导败血症患者的复苏过程是一个高度相关的问题。目前的指南提倡使用乳酸作为唯一的代谢标志物,这可能是明显有限的,不同变量的整合似乎更充分。在这项研究中,我们探讨了早期脓毒性休克患者的代谢谱及其对液体挑战给药反应的影响.
方法:观察性研究包括ICU入住24小时内的感染性休克患者,用心输出量估计系统监测,正在进行复苏。在液体激发(FC)之前和之后测量血液动力学和代谢变量。使用两步聚类分析来定义基线代谢谱,包括乳酸,中心静脉血氧饱和度(ScvO2),中心静脉-动脉二氧化碳差(PcvaCO2),和PcvaCO2通过动脉到静脉氧含量的差异(PcvaCO2/CavO2)校正。
结果:分析了77次液体挑战。聚类分析显示基线时两种不同的代谢谱。簇A表现出较低的ScvO2,较高的PcvaCO2和较低的PcvaCO2/CavO2。心输出量(CO)的增加仅与群A中VO2的增加相关。基线孤立的代谢变量与VO2反应无关。ScvO2和PcvaCO2的变化仅与A组的VO2升高相关。
结论:在早期脓毒性休克患者人群中,确定了两个不同的代谢谱,提示组织缺氧或缺氧。整合代谢变量可增强检测VO2可能因液体管理而增加的患者的能力。
BACKGROUND: The selection of adequate indicators of tissue hypoxia for guiding the resuscitation process of septic patients is a highly relevant issue. Current guidelines advocate for the use of lactate as sole metabolic marker, which may be markedly limited, and the integration of different variables seems more adequate. In this study, we explored the metabolic profile and its implications in the response to the administration of a fluid challenge in early septic shock patients.
METHODS: Observational study including septic shock patients within 24 h of ICU admission, monitored with a cardiac output estimation system, with ongoing resuscitation. Hemodynamic and metabolic variables were measured before and after a fluid challenge (FC). A two-step cluster analysis was used to define the baseline metabolic profile, including lactate, central venous oxygen saturation (ScvO2), central venous-to-arterial carbon dioxide difference (PcvaCO2), and PcvaCO2 corrected by the difference in arterial-to-venous oxygen content (PcvaCO2/CavO2).
RESULTS: Seventy-seven fluid challenges were analyzed. Cluster analysis revealed two distinct metabolic profiles at baseline. Cluster A exhibited lower ScvO2, higher PcvaCO2, and lower PcvaCO2/CavO2. Increases in cardiac output (CO) were associated with increases in VO2 exclusively in cluster A. Baseline isolated metabolic variables did not correlate with VO2 response, and changes in ScvO2 and PcvaCO2 were associated to VO2 increase only in cluster A.
CONCLUSIONS: In a population of early septic shock patients, two distinct metabolic profiles were identified, suggesting tissue hypoxia or dysoxia. Integrating metabolic variables enhances the ability to detect those patients whose VO2 might increase as results of fluid administration.