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Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients

par Pierrakos, Charalampos ;De Bels, David ;Nguyen, Thomas ;Velissaris, Dimitrios;Attou, Rachid ;Devriendt, Jacques ;Honoré, Patrick P.M.;Taccone, Fabio ;De Backer, Daniel
Référence PloS one, 16, 9 September, e0257314
Publication Publié, 2021-09

Article révisé par les pairs

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Résumé :

Background In this prospective observational study, we evaluated the effects of fluid bolus (FB) on venous-to-arterial carbon dioxide tension (PvaCO2) in 42 adult critically ill patients with pre-infusion PvaCO2 > 6 mmHg. Results FB caused a decrease in PvaCO2, from 8.7 [7.6−10.9] mmHg to 6.9 [5.8−8.6] mmHg (p < 0.01). PvaCO2 decreased independently of pre-infusion cardiac index and PvaCO2 changes during FB were not correlated with changes in central venous oxygen saturation (ScvO2) whatever pre-infusion CI. Pre-infusion levels of PvaCO2 were inversely correlated with decreases in PvaCO2 during FB and a pre-infusion PvaCO2 value < 7.7 mmHg could exclude a decrease in PvaCO2 during FB (AUC: 0.79, 95%CI 0.64–0.93; Sensitivity, 91%; Specificity, 55%; p < 0.01). Conclusions Fluid bolus decreased abnormal PvaCO2 levels independently of pre-infusion CI. Low baseline PvaCO2 values suggest that a positive response to FB is unlikely.