부산대학교 도서관

Byline: Guillermo Gutierrez (1), Pablo Comignani (2), Luis Huespe (3), F. Javier Hurtado (4), Arnaldo Dubin (5), Vinayak Jha (1), Yanina Arzani (2), Silvio Lazzeri (3), Lombardo Sosa (3), Juan Riva (6), Wolf Kohn (6), Daniela Suarez (4), Gonzalo Lacuesta (4), Daniela Olmos (5), Carlos Mizdraji (3), Alejandra Ojeda (3) Keywords: Mixed venous; Central venous; Sepsis; Myocardial metabolism; Tissue oxygenation Abstract: Objective Blood O.sub.2 saturation and lactate concentration gradients from superior vena cava (SVC) to pulmonary artery (PA) occur in critically ill patients. These gradients (ISO.sub.2 and I[Lac]) may be positive or negative. We tested the hypothesis that positive ISO.sub.2 and I[Lac] are associated with improved survival in critically ill patients. Design and setting Multinational, prospective observational study conducted in six medical and surgical ICUs. Patients Consecutive sample of 106 adults requiring insertion of a pulmonary artery catheter (PAC). Average age was 59.5 +- 15.5 years, APACHE II score was 15.5 +- 6.7 (mean +- SD). Main outcome measure was 28-day mortality. Interventions None. Measurements and results We drew blood samples from the proximal and distal ports of PACs every 6 h from the time of PAC insertion (Initial measurement) until its removal (Final measurement). Samples were analyzed for SO.sub.2, [Lac], glucose concentration and blood gases. Hemodynamic measurements were obtained after blood samples. We monitored patients for 30.9 +- 11.0 h. Overall mortality rate was 25.5%. More survivors had mean and final ISO.sub.2 aY= 0 and I[Lac] aY= 0 than decedents (p < 0.01 p < 0.05 respectively). On the average, ISO.sub.2 and I[Lac] were positive in survivors and negative in decedents. Survival odds ratios for final measurements of ISO.sub.2 aY= 0 and I[Lac] aY= 0 were 19.22 and 7.70, respectively (p < 0.05). Conclusions A strong association exists between positive ISO.sub.2 and I[Lac] and survival in critically ill patients. Whether therapy aimed at increasing ISO.sub.2 and I[Lac] results in improved ICU survival remains to be determined. Author Affiliation: (1) Pulmonary and Critical Care Medicine Division, The George Washington University Medical Center, 2150 Pennsylvania Ave., N.W, Washington, DC, 20037, USA (2) Fundacion Favaloro, Buenos Aires, Argentina (3) Hospital Escuela Corrientes, Corrientes, Argentina (4) Centro de Tratamiento Intensivo, Hospital de Clinicas, Montevideo, Uruguay (5) Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina (6) Centro Cardiologico del Sanatorio Americano, Montevideo, Uruguay Article History: Registration Date: 11/04/2008 Received Date: 21/12/2007 Accepted Date: 01/04/2008 Online Date: 30/04/2008 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1128-2) contains supplementary material, which is available to authorized users.