Anesthésie et recherche clinique
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Abstrait

The Impact of Early Goal Directed Therapy and PCO₂ Gap Protocol on Outcomes of High-Risk Surgical Patients Admitted to ICU: A Prospective Study

Gad. Sayed*

Objectives: High risk surgical patients are prone to experience complicated outcomes that directly lead to longer days on ventilators and consequently longer ICU and hospital stay. PCO₂ gap has elicited an increasing interest in directing resuscitation towards optimizing CO₂ gap. Thus, we aimed to compare the impact of PCO₂ gap targeting protocol to a classical Goal Directed Therapy Protocol (GDT) on ICU stay Ventilator day and length of hospital stay, in high-risk surgical patients admitted to ICU.

Design: Blinded prospective randomized clinical trial.

Settings: Qena University Hospital.

Patients: 80 patients who have high risk surgical criteria adopted from Shoemacker et al score and were admitted to ICU postoperatively, were divided into two groups: in group (A) PCO₂ gap algorithm was applied 12 h postoperative with end point PCO₂ gap 2-6 mm Hg ,and in group (B) goal directed therapy protocolwas applied 12 postoperative targeting endpoints: MAP >65mmHg, CVP between 8-12 cmH₂O, Haematocrite value more than 30, SvO₂ >75% and urine output more than >0.5 ml/kg/hr.

Measurements and results: Regarding duration of ventilator dependency, ICU stay and hospital stay, all values were lower in group a compared to group B although it was statistically insignificant.

Conclusion: In high risk surgical patients in ICU, targeting PCO₂ values has no significant difference to early goal directed therapy regarding the decrease in ventilation days, ICU stay or hospital stay.