الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The present systematic review found most of the articles that studied potential usefulness of delta pCO2 in patients with sepsis and septic shock the more recent interest in the investigation of this parameter is related to the limitations identified in the variables most commonly recommended in the management of these patients as serum lactate and SvO2.
Evaluation of the microcirculation using novel techniques and the evidence of microcirculatory alterations despite apparent normality of the macrodynamic variables including SvO2 and cardiac index. The studies generally showed high delta pCO2 values to be associated with poorer clinical outcomes including worsened hemodynamic parameters, poorer tissue perfusion, greater in-hospital mortality and mortality after 28 days.
Although different studies had shown that both ScvO2 and serum lactate to be of prognostic value for tissue perfusion in septic shock patients, the recording of delta pCO2 appears to offer additional information. This was seen in three studies that analyzed patients that were able to reach adequate ScvO2 goals after 6 hours of resuscitation, in which the presence of a normal delta pCO2 was seen to imply a better prognosis .This may indicate the usefulness of serial measurements of delta pCO2 during the initial resuscitation of septic shock patients ,where first the ScvO2 goal is reached ,followed by the achievement an additional target based on delta pCO2. The cutoff point of 6 mmHg for stratifying the two groups (normal and high delta pCO2) was quite consistent in all the studies However, it must be noted that the importance of serial measurements has been best established in lactate concentration. In this regard, the importance of percentage lactate clearance, even as a resuscitation goal, has been documented both in sepsis and in the general critical patient population.