Hypoxia-related parameters during septic shock resuscitation: Pathophysiological determinants and potential clinical implications

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dc.contributor.authorPavez, Nicolas
dc.contributor.authorKattan, Eduardo
dc.contributor.authorVera, Magdalena
dc.contributor.authorFerri, Giorgio
dc.contributor.authorDaniel Valenzuela, Emilio
dc.contributor.authorAlegria, Leyla
dc.contributor.authorBravo, Sebastian
dc.contributor.authorPairumani, Ronald
dc.contributor.authorSantis, Cesar
dc.contributor.authorOviedo, Vanessa
dc.contributor.authorSoto, Dagoberto
dc.contributor.authorOspina Tascon, Gustavo
dc.contributor.authorBakker, Jan
dc.contributor.authorHernandez, Glenn
dc.contributor.authorCastro, Ricardo
dc.date.accessioned2024-01-10T13:10:02Z
dc.date.available2024-01-10T13:10:02Z
dc.date.issued2020
dc.description.abstractBackground: Assessment of tissue hypoxia at the bedside has yet to be translated into daily clinical practice in septic shock patients. Perfusion markers are surrogates of deeper physiological phenomena. Lactate-to-pyruvate ratio ( LPR) and the ratio between veno-arterial PCO2 difference and Ca-vO(2) (Delta PCO2/Ca-vO(2)) have been proposed as markers of tissue hypoxia, but they have not been compared in the clinical scenario. We studied acute septic shock patients under resuscitation. We wanted to evaluate the relationship of these hypoxia markers with clinical and biochemical markers of hypoperfusion during septic shock resuscitation.
dc.description.abstractMethods: Secondary analysis of a randomized controlled trial. Septic shock patients were randomized to fluid resuscitation directed to normalization of capillary refill time (CRT) versus normalization or significant lowering of lactate. Multimodal assessment of perfusion was performed at 0, 2, 6 and 24 hours, and included macrohemodynamic and metabolic perfusion variables, CRT, regional flow and hypoxia markers. Patients who attained their pre-specified endpoint at 2-hours were compared to those who did not.
dc.description.abstractResults: Forty-two patients were recruited, median APACHE-II score was 23 [15-31] and 28-day mortality 23%. LPR and Delta PCO2/Ca-vO(2) ratio did not correlate during early resuscitation (0-2 h) and the whole study period (24-hours). Delta PCO2/Ca-vO(2) ratio derangements were more prevalent than LPR ones, either in the whole cohort (52% vs. 23%), and in association with other perfusion abnormalities. In patients who reached their resuscitation endpoints, the proportion of patients with altered Delta PCO2/Ca-vO(2) ratio decreased significantly (66% to 33%, P=0.045), while LPR did not (14% vs. 25%, P=0.34).
dc.description.abstractConclusions: Hypoxia markers did not exhibit correlation during resuscitation in septic shock patients. They probably interrogate different pathophysiological processes and mechanisms of dysoxia during early septic shock. Future studies should better elucidate the interaction and clinical role of hypoxia markers during septic shock resuscitation.
dc.description.funderGrant FONDECYT Chile
dc.format.extent10 páginas
dc.fuente.origenWOS
dc.identifier.doi10.21037/atm-20-2048
dc.identifier.eissn2305-5847
dc.identifier.issn2305-5839
dc.identifier.pubmedidMEDLINE:32647709
dc.identifier.urihttps://doi.org/10.21037/atm-20-2048
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/77749
dc.identifier.wosidWOS:000547552700054
dc.information.autorucFacultad de Medicina; Vera Alarcon, Maria Magdale; S/I; 226652
dc.issue.numero12
dc.language.isoen
dc.nota.accesoSin adjunto
dc.publisherAME PUBL CO
dc.revistaANNALS OF TRANSLATIONAL MEDICINE
dc.rightsregistro bibliográfico
dc.subjectHypoxia
dc.subjectseptic shock
dc.subjectcapillary refill time
dc.subjectlactate
dc.subjectO-2 CONTENT DIFFERENCE
dc.subjectVENOUS-ARTERIAL CO2
dc.subjectTISSUE HYPOXIA
dc.subjectPERFUSION PARAMETERS
dc.subjectOXYGEN-CONSUMPTION
dc.subjectLACTATE
dc.subjectRATIO
dc.subjectLACTATE/PYRUVATE
dc.subjectCOMBINATION
dc.subjectEVOLUTION
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleHypoxia-related parameters during septic shock resuscitation: Pathophysiological determinants and potential clinical implications
dc.typeartículo
dc.volumen8
sipa.codpersvinculados226652
sipa.indexWOS
sipa.indexPubmed
sipa.trazabilidadCarga SIPA;09-01-2024
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