Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis

Abstract Background Several clinical guidelines recommend monitoring blood lactate levels and central venous oxygen saturation for hemodynamic management of patients with sepsis. We hypothesized that carbon dioxide production (VCO2) and oxygen extraction (VO2) evaluated using indirect calorimetry (I...

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Autores principales:	Ichiro Hirayama, Toshifumi Asada, Miyuki Yamamoto, Naoki Hayase, Takahiro Hiruma, Kent Doi
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Carbon dioxide production Oxygen extraction Indirect calorimetry Sepsis Lactate Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/65a5bcb1e3114cd2a0c1483e4d863507
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spelling	oai:doaj.org-article:65a5bcb1e3114cd2a0c1483e4d8635072021-12-05T12:03:50ZChanges in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis10.1186/s13054-021-03830-z1364-8535https://doaj.org/article/65a5bcb1e3114cd2a0c1483e4d8635072021-12-01T00:00:00Zhttps://doi.org/10.1186/s13054-021-03830-zhttps://doaj.org/toc/1364-8535Abstract Background Several clinical guidelines recommend monitoring blood lactate levels and central venous oxygen saturation for hemodynamic management of patients with sepsis. We hypothesized that carbon dioxide production (VCO2) and oxygen extraction (VO2) evaluated using indirect calorimetry (IC) might provide additional information to understand the dynamic metabolic changes in sepsis. Methods Adult patients with sepsis who required mechanical ventilation in the intensive care unit (ICU) of our hospital between September 2019 and March 2020 were prospectively enrolled. Sepsis was diagnosed according to Sepsis-3. Continuous measurement of VCO2 and VO2 using IC for 2 h was conducted within 24 h after tracheal intubation, and the changes in VCO2 and VO2 over 2 h were calculated as the slopes by linear regression analysis. Furthermore, temporal lactate changes were evaluated. The primary outcome was 28-day survival. Results Thirty-four patients with sepsis were enrolled, 26 of whom survived 76%. Significant differences in the slope of VCO2 (− 1.412 vs. − 0.446) (p = 0.012) and VO2 (− 2.098 vs. − 0.851) (p = 0.023) changes were observed between non-survivors and survivors. Of note, all eight non-survivors and 17 of the 26 survivors showed negative slopes of VCO2 and VO2 changes. For these patients, 17 survivors had a median lactate of − 2.4% changes per hour (%/h), whereas non-survivors had a median lactate of 2.6%/hr (p = 0.023). Conclusions The non-survivors in this study showed temporal decreases in both VCO2 and VO2 along with lactate elevation. Monitoring the temporal changes in VCO2 and VO2 along with blood lactate levels may be useful in predicting the prognosis of sepsis.Ichiro HirayamaToshifumi AsadaMiyuki YamamotoNaoki HayaseTakahiro HirumaKent DoiBMCarticleCarbon dioxide productionOxygen extractionIndirect calorimetrySepsisLactateMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care, Vol 25, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Carbon dioxide production Oxygen extraction Indirect calorimetry Sepsis Lactate Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Carbon dioxide production Oxygen extraction Indirect calorimetry Sepsis Lactate Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Ichiro Hirayama Toshifumi Asada Miyuki Yamamoto Naoki Hayase Takahiro Hiruma Kent Doi Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis
description	Abstract Background Several clinical guidelines recommend monitoring blood lactate levels and central venous oxygen saturation for hemodynamic management of patients with sepsis. We hypothesized that carbon dioxide production (VCO2) and oxygen extraction (VO2) evaluated using indirect calorimetry (IC) might provide additional information to understand the dynamic metabolic changes in sepsis. Methods Adult patients with sepsis who required mechanical ventilation in the intensive care unit (ICU) of our hospital between September 2019 and March 2020 were prospectively enrolled. Sepsis was diagnosed according to Sepsis-3. Continuous measurement of VCO2 and VO2 using IC for 2 h was conducted within 24 h after tracheal intubation, and the changes in VCO2 and VO2 over 2 h were calculated as the slopes by linear regression analysis. Furthermore, temporal lactate changes were evaluated. The primary outcome was 28-day survival. Results Thirty-four patients with sepsis were enrolled, 26 of whom survived 76%. Significant differences in the slope of VCO2 (− 1.412 vs. − 0.446) (p = 0.012) and VO2 (− 2.098 vs. − 0.851) (p = 0.023) changes were observed between non-survivors and survivors. Of note, all eight non-survivors and 17 of the 26 survivors showed negative slopes of VCO2 and VO2 changes. For these patients, 17 survivors had a median lactate of − 2.4% changes per hour (%/h), whereas non-survivors had a median lactate of 2.6%/hr (p = 0.023). Conclusions The non-survivors in this study showed temporal decreases in both VCO2 and VO2 along with lactate elevation. Monitoring the temporal changes in VCO2 and VO2 along with blood lactate levels may be useful in predicting the prognosis of sepsis.
format	article
author	Ichiro Hirayama Toshifumi Asada Miyuki Yamamoto Naoki Hayase Takahiro Hiruma Kent Doi
author_facet	Ichiro Hirayama Toshifumi Asada Miyuki Yamamoto Naoki Hayase Takahiro Hiruma Kent Doi
author_sort	Ichiro Hirayama
title	Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis
title_short	Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis
title_full	Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis
title_fullStr	Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis
title_full_unstemmed	Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis
title_sort	changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/65a5bcb1e3114cd2a0c1483e4d863507
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Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis

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