The Value of Central Venous-arterial Carbon Dioxide Difference
Condition: Jugular Veins; Radial Artery; Carbon Dioxide
Study type: Interventional

Summary: 
      By observing the changes of Central venous-arterial partial pressure difference of carbon
      dioxide [P (v-a) CO2] in liquid resuscitation during early escharectomy in patients with
      large-scale burns, We investigate the effect of P (v-a) CO2 on postoperative tissue perfusion
      and oxygenation in order to seek a more effective intergrated target plan of liquid
      resuscitation for burn patients.
    

Detailed description: 
      Objective: By observing the changes of Central venous-arterial partial pressure difference of
      carbon dioxide [P (v-a) CO2] in liquid resuscitation during early escharectomy in patients
      with large-scale burns, We investigate the effect of P (v-a) CO2 on postoperative tissue
      perfusion and oxygenation in order to seek a more effective intergrated target plan of liquid
      resuscitation for burn patients.

      Methods: a prospective observational study was conducted on 145 patients with extensive burns
      admitted to surgical intensive care unit（SICU）of Guangzhou Red Cross hospital from January
      2016 to December 2019. All patients received hemodynamic monitoring and goal-directed fluid
      therapy, patients with central venous oxygen saturation (ScvO2)< 70% were excluded. Patients
      were divided into the following groups according to the changing trend of Pcv-aCO2 between T
      base (before induction) and T 0h (after surgery) : group 1 (H-H) : Pcv-aCO2≥6mmHg between T
      base and T 0h. Group 2 (L-H) : Pcv-aco2< 6mmHg at T base and≥6mmHg at T 0h; Group 3 (H-L) :
      Pcv-aCO2≥6mmHg at T base and < 6mmHg at T 0h. Group 4( L-L) : Pcv-aCO2 < 6mmHg between T base
      and T0h.Postoperative basic physiological indicators such as heart rate（HR）, blood pressure,
      central venous pressure (CVP), cardiac output index (CI), Pcv-aCO2 and lactic acid were
      recorded at 0 and 18 hours after surgery. Oxygen dynamic indicators such as oxygen delivery
      index (DO2I), oxygen consumption index (VO2I), oxygen uptake rate (O2ER) and so on were
      calculated. Pearson correlation analysis was used to evaluate the correlation between
      Pcv-aCO2 and CI. The change of tissue perfusion and oxygenation with different levels of
      Pcv-aCO2 after fluid resuscitation were analyzed.
    

Intervention name(s): Goal-directed fluid therapy (GDET)
Intervention type(s): Drug
Intervention description(s): Compensatory dilatation was performed firstly and 5ml/kg crystal solution was added within 30min before induction of anesthesia.When SVV≥13%, infusion of colloidal solution 2ml/kg was performed 15-20 minutes.If the increase of SV was≥10% after the liquid impact and the SVV was still≥13%, the colloidal solution was used again for 2mL/kg and the infusion was maintained until the SVV < 13%.The infusion was stopped when the SVV < 10%.If the increase of SV was less than 10% or CI < 2.0L/min/m2 after infusion, dobutamine was given intravenously to observe the change of SV. If the increase of SV was greater than 10%, dobutamine could be maintained and the above fluid regimen continued.If the increase of SV was less than 10% and MAP≥65mmHg, the infusion of liquid was stopped and replaced with 4ml/kg/h infusion for maintenance.If the increase of SV was less than 10% and MAP was less than 65mmHg, the infusion was suspended.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: central venous-arterial carbon dioxide difference; liquid resuscitation; tissue perfusion and oxygenation