[Evaluation of the hemodynamic state of critically ill cancer patients with central venous to arterial carbon dioxide difference].

OBJECTIVE:To evaluate the hemodynamic state of critically ill cancer patients using central venous-to-arterial carbon dioxide difference (Pcv-aCO(2)) and to direct the treatment. METHODS:Clinical data of 47 cancer critically ill patients with acute physiology and chronic health evaluation II (APACHE II) score> 15 and unstable hemodynamic state were enrolled from intensive care unit of Tianjin Medical University Cancer Hospital from October 1st 2010 to May 31th 2011, were analyzed retrospectively. The patients were receiving the standard treatment according to the guidelines for 24 hours, the end-point of therapy was the standard of early goal direct therapy (EGDT). According to difference of sequential organ failure scores (ΔSOFA) of that after treatment and before treatment, the patients were divided into two groups: ΔSOFA≤ 1 (n = 27) and ΔSOFA> 1 (n = 20). The mean arterial pressure (MAP), urine output per hour, central venous pressure (CVP), oxygen saturation of central venous blood (ScvO(2)), the clearance of lactic acid, and Pcv-aCO(2) before treatment were compared with those after treatment, and their correlation with ΔSOFA was analysed. RESULTS:There were no significant differences in MAP (mm Hg, 1 mm Hg = 0.133 kPa: 54.48 ± 4.95 vs. 54.45 ± 4.30), urine output per hour (ml:19.33 ± 4.53 vs. 20.55 ± 5.54), CVP(mm Hg: 3.48 ± 1.81 vs. 3.25 ± 1.16), ScvO(2) (0.571 ± 0.042 vs. 0.578 ± 0.047) of two groups before treatment (all P > 0.05), but in the group ΔSOFA≤1, the Pcv-aCO(2) (mm Hg: 7.80 ± 2.20 vs. 9.39 ± 0.97) and SOFA scores (6.33 ± 2.11 vs. 9.50 ± 1.24) were significantly lower than those of the group ΔSOFA>1 (all P < 0.01). There were no significant differences in MAP (mm Hg: 73.48 ± 6.12 vs. 71.30 ± 7.30), CVP (mm Hg: 6.85 ± 1.26 vs. 6.50 ± 1.28), ScvO(2) (0.693 ± 0.032 vs. 0.684 ± 0.039) between two groups after treatment (all P > 0.05), though their RESULTS:data were improved compared with that of before treatment. However, there were significant differences in Pcv-aCO(2) (mm Hg: 3.02 ± 1.59 vs. 8.21 ± 2.23), urine output per hour (ml: 71.41 ± 6.74 vs. 51.70 ± 7.50), SOFA score (6.03 ± 2.56 vs. 10.05 ± 1.61), the clearance of lactic acid [(27.71 ± 11.46)% vs. -(0.78 ± 13.29)%, all P < 0.01]. There was significant correlation between urine output per hour, Pcv-aCO(2), clearance of lactic acid and ΔSOFA (r values were -0.712, 0.745, -0.631, all P < 0.05). CONCLUSION:Pcv-aCO(2) could be used as an index of evaluating the cardiac index and the hemodynamic state, and it could be considered to be one of the indices of evaluating the therapeutic effect and prognosis.