ArticleMedicine2026
Central venous-arterial CO2 gap to arterial-central venous O2 content difference ratio in guiding of fluid resuscitation of patients with septic shock.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTissue hypoperfusion can persist despite meeting early goal-directed therapy targets, while excessive resuscitation poses risks. The study focuses on the utility of central venous-arterial CO2 gap to arterial-central venous O2 content difference ratio (Pv-aCO2/Ca-vO2) can serve as a valuable tool for guiding fluid resuscitation in patients with septic shock.
methodsA prospective study was conducted in a Chinese intensive care unit from July 1, 2020 to March 31, 2025. The study cohort comprised individuals who have been diagnosed with septic shock. The patients were allocated into 2 groups: control group: after receiving early goal directed therapy target fluid resuscitation for 6h, no additional fluid replacement was required; experimental group: fluid resuscitation should be continued until Pv-aCO2/Ca-vO2 ≤ 1.8 mm Hg/mL. The fundamental data, clinical characteristics, prognostic factors, and complications were comprehensively collected and analyzed. Finally, the reliability of Pv-aCO2/Ca-vO2 as parameter for determining fluid resuscitation targets in septic shock patients was evaluated.
resultsA total of 321 patients were enrolled in the study. There were no significant differences in fundamental data and clinical characteristics among the 2 groups. At baseline, no significant differences were observed between the control and experimental groups regarding the total decannulation rate, duration of mechanical ventilation, and length of stay in the intensive care unit (P >.05). However, the experimental group exhibited a significantly lower 28-day mortality rate compared to the control group (P <.05). Furthermore, the length of hospital stay was significantly reduced in the experimental group relative to the control group (P <.05). The incidence of heart failure or pulmonary edema, hepatic insufficiency, gastrointestinal bleeding, cerebrovascular accidents, and coronary heart disease or myocardial ischemia did not differ significantly between the 2 groups (P >.05). Nonetheless, the incidence of renal insufficiency or the requirement for renal replacement therapy was significantly lower in the experimental group than in the control group (P <.05). In terms of the total fluid replacement volume at time point T6, no statistically significant differences were identified between the control and experimental groups (P >.05). However, at time points T12 and T24, the total fluid replacement volume was significantly higher in the experimental group compared to the control group (P <.05).
conclusionsPv-aCO2/Ca-vO2 may serve as a reliable parameter for determining the fluid resuscitation target in patients with septic shock.
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