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Background: Tissue hypercarbia is related to hypoperfusion and microcirculatory disturbances in patients with septic shock. Transcutaneous Pco₂ devices using a heated sensor to arterialize the tissue have been used as an alternative method for estimation of Paco₂. This study investigates whether a cutaneous sensor attached to an ear lobe and regulated to 37°C could be used to measure cutaneous Pco₂ (Pcco₂) and evaluate microperfusion in patients with septic shock.
Methods: Fifteen stable patients in an ICU were studied as a control group. Forty-six patients with septic shock who were ventilated were enrolled as the study group. The difference of the gradients between Pcco₂ and Paco₂ (Pc-aco₂) and between Pcco₂ and end-tidal Pco₂(Pc-etco₂) were evaluated for 36 h. Variations of the Pc-aco₂ and Pc-etco₂ during fluid challenge were compared with microcirculatory skin blood flow (mBFskin) assessed by laser Doppler flowmetry.
Results: The baseline levels for Pc-aco₂ and Pc-etco₂ were significantly higher in the patients with septic shock than in the control group (14.8 [12.6] vs 6 [2.7] mm Hg and 25 [16.3] vs 9 [3.8] mm Hg, P < .0001, respectively). During the following 36 h, the Pc-aco₂ and Pc-etco₂ for the surviving patients with septic shock decreased significantly compared with the nonsurvivors (P < .01). The evolution of macrohemodynamic parameters showed no differences between survivors and nonsurvivors. At hour 24, a Pc-aco₂ > 16 mm Hg and a Pc-etco₂ > 26 mm Hg were related to poor outcome. Pc-aco₂ and Pc-etco₂ variations during fluid challenge were inversely correlated with changes in mBFskin (r² = 0.7).
Conclusions: Ear lobe cutaneous Pco₂ at 37°C represents a noninvasive technique to assess tissue Pco₂ measurement. Pc-aco₂ and Pc-etco₂ were related to outcome and provide continuous information on microperfusion in patients with septic shock.
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http://dx.doi.org/10.1378/chest.09-2690 | DOI Listing |
Infect Drug Resist
December 2024
Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Background: Bloodstream infections (BSIs) caused by (AB), especially carbapenem-resistant (CRAB), can lead to a high patient mortality rate.
Methods: This study aimed to analyze the clinical data and prognosis of 191 patients with AB-BSI hospitalized in Southern China from January 2017 to December 2023.
Results: CRAB was diagnosed in 128 (67.
Pan Afr Med J
December 2024
Department of Surgery, Faculty of Medicine, Hasanuddin University, Hasanuddin University Hospital, Makassar, Indonesia.
Acute heart failure is associated with high hospitalization and mortality rates. A strong, independent risk factor for mortality in patients with heart failure is acute kidney injury, and the condition caused by this connection between disturbances in heart function and proper kidney functioning is cardiorenal syndrome (CRS). This case report discusses the role of continuous renal replacement therapy (CRRT) in the management of a CRS case with septic shock due to pneumonia.
View Article and Find Full Text PDFCureus
November 2024
Obstetrics and Gynecology, Private Clinic "Yana Alexandr", Sana'a, YEM.
Septic shock is a serious and life-threatening illness marked by potentially fatal and metabolic abnormalities, leading to high mortality rates in adult patients. Early goal-directed therapy (EGDT) was introduced as a systematic approach to manage septic shock through early, protocol-based hemodynamic optimization to improve outcomes. This systematic review aims to evaluate the efficacy of EGDT in managing adult patients with septic shock.
View Article and Find Full Text PDFCureus
November 2024
Internal Medicine, Robert Wood Johnson (RWJ) Barnabas Health, Long Branch, USA.
Background: Septic shock is defined as sepsis with hypotension requiring vasopressors to maintain a mean arterial pressure above 65 mmHg and having a serum lactate level of more than 2 mmol/L despite adequate volume resuscitation as per the Sepsis-3 criteria. Continuous renal replacement therapy (CRRT) is commonly utilized in septic shock patients for the treatment of acute kidney injury as well as for modulating immune response and maintaining hemodynamic stability.
Methods: We looked at the National Inpatient Sample database in 2019.
Jt Dis Relat Surg
January 2025
Ankara Bilkent Şehir Hastanesi İç Hastalıkları Kliniği, 06800 Çankaya, Ankara, Türkiye.
Objectives: This study aimed to identify predictors of sepsis in earthquake survivors who underwent either amputation or fasciotomy and to compare these two patient groups across many clinical outcomes, including sepsis.
Patients And Methods: In this retrospective study, a total of 1,608 patients who presented to our hospital following the February 6, 2023, Kahramanmaraş earthquakes were evaluated between February 2023 and March 2023. Of these, 138 patients (65 males, 73 females; median age: 35 years; range, 18 to 74 years) who underwent either fasciotomy or amputation were included in the study.
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