Introduction:
Abnormal levels of end-tidal carbon dioxide (ETCO
2
) may reflect a derangement in perfusion, metabolism, or gas exchange. It is unclear if ETCO
2
can be used for fluid resuscitation (FR) compared with traditional mean arterial pressure (MAP) as an outcome predictor in sepsis.
Hypothesis:
Use of ETCO2 is better than MAP in guiding fluid resuscitation to improve lactate levels and microcirculatory blood flow in sepsis.
Methods:
Thirty-five male Sprague-Dawley rats weighing 350-400g were randomized to: 1) SHAM, n=5; 2) cecal ligation and puncture (CLP) Control group (with CLP, without FR, n=10); 3) ETCO
2
group (with CLP, FR began when ETCO
2
≤25 mmHg, n=10) and 4) MAP group (with CLP, FR began when MAP≤100 mmHg, n=10). Lactate level, cardiac output (CO), perfused small vessel density (PSVD) and sublingual microvascular flow index (MFI) was assessed at baseline, 2 h, 4 h, 8 h, 10 h and 12 h post-CLP. Survival duration was recorded.
Results:
After FR,CO in the ETCO
2
group increased compared with the MAP group 12h after CLP while lactate levels decreased compared with the Control and MAP groups (p<0.05) (Figure-1). Both sublingual PSVD and MFI decreased after CLP in the control group and MAP group but significantly improved in the ETCO
2
group 8h post-CLP. The average survival time in the ETCO
2
group was significantly greater than MAP group (Figure-2).
Conclusions:
ETCO
2
guided FR was associated with improved CO, lactate, microcirculatory flow, and survival time compared to MAP guided FR in a CLP-induced rat model of sepsis.
Autonomic control in a rat model of sepsis induced by cecal ligation and puncture
