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Oxygen Challenge Test in Septic Shock Patients: Prognostic Value and Influence of Respiratory Status

Mari, Arnaud*†; Vallée, Fabrice‡§; Bedel, Jérome†∥; Riu, Béatrice*; Ruiz, Jean*; Sanchez-Verlaan, Pascale*; Geeraerts, Thomas*†; Génestal, Michèle*†; Silva, Stein*†; Fourcade, Olivier*†

doi: 10.1097/SHK.0000000000000156
Clinical Science Aspects

ABSTRACT: Transcutaneous oxygen pressure (PtcO2) value in response to an increase of FiO2 or oxygen challenge test (OCT) in ventilated patients has been reported to be related to peripheral perfusion and outcome during septic shock. However, patients with sepsis-related acute respiratory distress syndrome could demonstrate compromised arterial oxygenation with OCT impairment decoupled to circulatory failure. The aims of this study were to confirm the prognostic value of OCT and to explore the influence of respiratory status on OCT results. This was a prospective study set in an intensive care unit of a tertiary teaching hospital. Fifty-six mechanically ventilated patients with septic shock criteria were studied. Transcutaneous oxygen pressure was measured at baseline and after OCT, at intensive care unit admittance (T0), and 24 h later (T24). Survival at day 28 and hemodynamic and respiratory parameters were analyzed and compared according to outcome and respiratory status. Central hemodynamic parameters or static transcutaneous data did not differ between survivors and nonsurvivors at enrollment. The OCT was statistically different at T24 according to outcome (P < 0.001), but sensitivity was low (53%). Moreover, patients with low OCT results at T24 exhibited more severe respiratory failure (P < 0.01). The OCT at T24 is related to outcome but is influenced by the severity of respiratory failure. Our results suggest considering with caution hemodynamic management based on OCT in septic shock patients with altered pulmonary function.

*Service de Réanimation Hôpital Purpan, Pôle d’Anesthsie-Réanimation, Centre Hospitalier Universitaire de Toulouse, France; Equipe d’accueil Modlisation de l’agression tissulaire et nociceptive, Université Toulouse 3, Toulouse, France; Réanimation chirurgicale, Département d’Anesthésie-Réanimation, Hôpital Lariboisiére, Paris, France; §EA 322, Université Paris 7, Paris, France; and Réanimation médico-chirurgicale, Centre Hospitalier André Mignot, Le Chesnay, France

Received 17 Dec 2013; first review completed 2 Jan 2014; accepted in final form 13 Feb 2014

Address reprint requests to Arnaud Mari, MD, Service de Ranimation Hpital Purpan, Ple d’Anesthsie-Ranimation, CHU Purpan, Place du Dr Baylac, TSA 40031, 31059 Toulouse Cedex 9, France. E-mail: mari.a@chu-toulouse.fr.

The study was conducted in the Service de Ranimation Hpital Purpan, Ple d’Anesthsie-Ranimation, CHU Purpan, Place Dr Baylac, TSA 40031, 31059 Toulouse Cedex 9, France.

The authors receive any financial support for the study, including any institutional department funds.

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© 2014 by the Shock Society