Changes in End-Tidal Carbon Dioxide (ETCO2) vs. Changes in Central Venous Oxygen Saturation (ScvO2) and Lactate Clearance as a Quantitative Goal Parameter in Treatment of Suspected Septic Shock Patients


Introduction: Physiologic indexes for therapeutic assessment of shock were introduced long time ago. Recent studies have evaluated central venous pressure (CVP), central venous oxygen saturation (ScvO2), lactate and end-tidal carbon dioxide (ETCO2) levels in this regard. Objective: To understand the potential diagnostic capability of ETCO2 in comparison with ScvO2, CVP and lactate in patients with suspected septic shock, we aimed to compare these parameters through a quantitative resuscitation treatment approach. Methods: In this cross-sectional study, 84 patients with suspected septic shock were selected randomly. All patients underwent quantitative resuscitation treatment approach. The following parameters were measured and recorded at baseline: ETCO2, CVP, ScvO2, mean arterial pressure (MAP), percentage of arterial oxygen saturation (SatO2), blood lactate levels, heart rate (HR), respiratory rate (RR), and the exact amount of urine output. At the time of treatment, and 3 hours and 6 hours after, all of the tests and measurements were re-implemented and registered by an emergency medicine specialist. Results: There was a significant positive correlation between ETCO2 and ScvO2 at all times (baseline: r=0.566, p<0.001; after 3 hours: r=0.409, p<0.001; after 6 hours: r=0.170, p>0.05). Furthermore, there was a significant inverse correlation between ETCO2 and lactate at all times (baseline: r= -0.538, after 3 hours: r= -0.677, after 6 hours: r= -0.799). There was no significant correlation between ETCO2 and CVP at any time (p>0.05). Conclusions: All parameters significantly changed over time, and the correlation between changes in ETCo2, ScvO2 and lactate clearance was significant.

1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
2. Polat G, Ugan RA, Cadirci E, Halici Z. Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. Eurasian J Med. 2017;49(1):53-8.
3. Guirgis F, Williams D, Kalynych C, Jones A, Wears R. The Relationship of ETCO2 to SCVO2 and Lactate During Early Goal-Directed Therapy for the Treatment of Severe Sepsis and Septic Shock. Ann Emerg Med. 2013;4(62):S140.
4. Zanotti Cavazzoni SL, Dellinger RP. Hemodynamic optimization of sepsis-induced tissue hypoperfusion. Crit Care. 2006;10(Suppl 3):S2.
5. Guirgis FW, Williams DJ, Kalynych CJ, Hardy ME, Jones AE, Dodani S, et al. End-tidal carbon dioxide as a goal of early sepsis therapy. Am J Emerg Med. 2014;32(11):1351-6.
6. Hunter CL, Silvestri S, Dean M, Falk JL, Papa L. End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis. Am J Emerg Med. 2013;31(1):64-71.
7. Yu H, Chi D, Wang S, Liu B. Effect of early goal-directed therapy on mortality in patients with severe sepsis or septic shock: a meta-analysis of randomised controlled trials. BMJ Open. 2016;6(3):e008330.
8. Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock. 2009;32(1):35-9.
9. Hunter CL, Silvestri S, Ralls G, Stone A, Walker A, Papa L. A prehospital screening tool utilizing end-tidal carbon dioxide predicts sepsis and severe sepsis. Am J Emerg Med. 2016;34(5):813-9.
10. Nebout S, Pirracchio R. Should We Monitor ScVO(2) in Critically Ill Patients? Cardiol Res Pract. 2012; 2012:370697.
11. Permpikul C, Noppakaorattanamanee K, Tongyoo S, Ratanarat R, Poompichet A. Dynamics of central venous oxygen saturation and serum lactate during septic shock resuscitation. J Med Assoc Thai. 2013;96 Suppl 2:S232-7.
12. McGillicuddy DC, Tang A, Cataldo L, Gusev J, Shapiro NI. Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis. Intern Emerg Med. 2009;4(1):41-4.
IssueVol 5 No 1 (2021): Winter (February) QRcode
SectionOriginal article
Central Venous Oxygen Saturation Central Venous Pressure End-Tidal Carbon Dioxide Shock, Septic Patient Management

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Khajebashi SH, Cholmaghani T, Nasr-Esfahani M. Changes in End-Tidal Carbon Dioxide (ETCO2) vs. Changes in Central Venous Oxygen Saturation (ScvO2) and Lactate Clearance as a Quantitative Goal Parameter in Treatment of Suspected Septic Shock Patients. Front Emerg Med. 2020;5(1):e3.


Download data is not yet available.