Abstrakt

Central Venous-to-Arterial Carbon Dioxide Difference (Pcv-aCO2 gap) Guided Resuscitation in Patients with Septic Shock: A Pilot Randomized Controlled Trial

Jing Wang, Peng Lei Yang, Xiang-Hui Li, Rui Qiang Zheng, Jiang Quan Yu*

Objective: The treatment approach for septic shock patients with elevated Pcv-aCO₂ and no volume response is controversial. This study aimed to explore the use of inotropes to reduce Pcv-aCO₂ and improve tissue perfusion.

Method: Single-center, open-label, randomized clinical trial. Pcv-aCO₂ was measured 3 hours after ICU admission, and eligible patients were randomly assigned to the milrinone or conventional therapy group. Milrinone patients without volume responsiveness received milrinone intervention, while the conventional therapy group received treatment per 2016 SSC guidelines, using other inotropes if necessary.

Results: 51 Patients were analyzed. At 6h post-ICU admission, 46.15% (12/26) of milrinone patients had Pcv-aCO₂ ≥ 6 mm Hg, compared to 80% (20/25) in the conventional therapy group. There was a significant difference between the groups (p=0.012). The Pcv-aCO₂ levels were 6.07 ± 2.11 mm Hg and 7.25 ± 1.80 mm Hg in the milrinone and conventional therapy groups, respectively, with a significant difference (p=0.037). Milrinone patients exhibited higher cardiac output (4.38 L/min (3.98-5.28) vs. 3.98 L/min (3.46-4.72), p=0.043) and a higher lactate clearance rate compared to the conventional therapy group.

Conclusion: Early intervention with milrinone in septic shock patients with no fluid responsiveness after adequate fluid resuscitation can increase cardiac output and lactate clearance rate, and reduce levels of inflammatory factors.