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Venous-to-arterial carbon dioxide difference in the resuscitation of patients with severe sepsis and septic shock: A systematic review
La diferencia venoarterial de dióxido de carbono en la reanimación de pacientes con sepsis grave y shock séptico: una revisión sistemática
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"apellidos" => "Sprockel Díaz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Fundación Universitaria de Ciencias de la Salud, Facultad de Medicina, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de San José de Bogotá, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de Colombia Sede Bogotá, Bogotá, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La diferencia venoarterial de dióxido de carbono en la reanimación de pacientes con sepsis grave y shock séptico: una revisión sistemática" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1693 "Ancho" => 1626 "Tamanyo" => 141422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Summary of the literature search.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sepsis is one of the main causes of admission to Intensive Care Units (ICUs). This heterogeneous and complex syndrome can result in a 20–50% mortality rate, depending on the severity of the clinical condition,<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">1,2</span></a> which in turn is conditioned to the presence of organ dysfunction mediated by different mechanisms of cell damage. The way in which the different individual mechanisms interact is not fully understood, though sepsis is known to involve microvascular anomalies, and a decrease in oxygen supply and/or deficient utilization of the available oxygen constitute a central element of such organ dysfunction.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">3</span></a> The early identification of tissue damage is therefore crucial in the management of these patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The measurement of certain physiological variables of use in assessing tissue perfusion status has been proposed in the initial care of such patients. In its early versions, the Surviving Sepsis Campaign recommended the measurement of venous oxygen saturation (SvO<span class="elsevierStyleInf">2</span>), evaluated as mixed venous saturation or central venous oxygen saturation (SvcO<span class="elsevierStyleInf">2</span>), and lactate concentration in this respect, with the definition of a series of target values intended to secure adequate patient resuscitation.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">4</span></a> This proposal was essentially based on the early intervention protocol published by Rivers et al., advocating the “normalization” of SvcO<span class="elsevierStyleInf">2</span>, central venous pressure (CVP) and mean arterial pressure, with the purpose of improving tissue perfusion.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">5</span></a> Other investigators, fundamentally Jones et al., reinforced the idea that lactate can also be used in protocols of this kind.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although the usefulness of the protocol was evaluated in the context of randomized clinical trials, each of the mentioned variables has known limitations, and the use of a single variable does not seem to be the best way to assess tissue perfusion.<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">8,9</span></a> More recently, multicenter clinical trials have been unable to confirm the usefulness of the protocol developed by Rivers et al., and the measurement of SvcO<span class="elsevierStyleInf">2</span> as a guide in patient resuscitation has been questioned.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">10–12</span></a> As a result of the above, the latest version of the Surviving Sepsis Campaign does not recommend the use of this variable as an initial resuscitation goal or target in the management of such patients.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Other parameters for the assessment of tissue perfusion are therefore needed to guide therapy. One such parameter is the venous-to-arterial pressure difference of CO<span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta or Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>), which serves as a surrogate marker of the venous-to-arterial difference in CO<span class="elsevierStyleInf">2</span> content. Under physiological conditions, the venous CO<span class="elsevierStyleInf">2</span> concentration is higher than in arterial blood, due to CO<span class="elsevierStyleInf">2</span> production at peripheral level, coupled to oxygen consumption and metabolism in general. The measurement of these pressure values has been proposed since within normal ranges, the CO<span class="elsevierStyleInf">2</span> concentration is linearly correlated to pressure. In theory, low flow conditions and non-anaerobic sources of CO<span class="elsevierStyleInf">2</span> production can increase the venous concentration and thus increment the normal difference.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">14,15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta value has been proposed as a parameter capable of indicating altered tissue perfusion in different clinical contexts,<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">16,17</span></a> including sepsis.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">14,18</span></a> However, the evaluation of this parameter has not yet been recommended by the international Surviving Sepsis Campaign guide, and its usefulness during the initial resuscitation of these patients or as a resuscitation goal is not clear.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">4,14</span></a> The present study conducts a systematic literature review with the aim of identifying studies and outcomes referred to the use of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta as a measure of prognostic or therapeutic value in patients with severe sepsis or septic shock.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A systematic search was made of the literature, including full-test original articles in which the primary objective was the evaluation of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta during the initial management of patients specifically diagnosed with septic shock and/or severe sepsis. We excluded studies that evaluated patients under 18 years of age or pregnant women. There were no restrictions regarding the type of study or language of the publication.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The search covered the period between January 1966 and October 2015, with updating to November 2016, and was carried out in the Medline-PubMed, Embase-Elsevier, Cochrane Library and LILACS databases, using the terms of the strategy established in the research protocol (Annex A). Two authors reviewed the titles and abstracts, identifying those studies that met the screening criteria. Disagreements between the investigators were resolved by consensus with a third author. The references of the selected articles were in turn used to identify additional studies.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The information was entered in a datasheet including the study objective, sample size, characteristics of the study population, main outcomes and conclusions of each article. We specifically collected data referred to in-hospital mortality, mortality after 28 days, cardiac output (CO), cardiac index (CI) and other tissue perfusion variables such as lactate and SvO<span class="elsevierStyleInf">2</span>, as well as therapeutic interventions defined in the methodology section of the studies. The PRISMA statement was followed in this systematic review.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">19</span></a> The risk of bias was assessed using the Altman proposal for the evaluation of prognostic variables, which uses a traffic light system with the application of 6 factors: patient sample, patient follow-up, evaluated outcome, prognostic factor, analysis of the data and treatment following inclusion in the cohort.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">20</span></a> The study was approved by the Institutional Review Boards of the Medical School of the <span class="elsevierStyleItalic">Fundación Universitaria de Ciencias de la Salud</span> and <span class="elsevierStyleItalic">Hospital de San José de Bogotá</span> (Colombia).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The search yielded a total of 1375 articles, of which 1304 were discarded after evaluating the title and abstract. Of the 71 articles analyzed in full text format, 12 met the inclusion criteria.<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">21–32</span></a> There were no disagreements between the reviewers. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the screening process of the included articles.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">All the studies were of an observational nature, 10 were prospective, 10 were published in English, and two in Chinese. Convenience sampling was used in all the studies. The main potential sources of bias were a short duration of follow-up and the lack of statistical adjustment for other important prognostic factors (Annex A).</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the included studies. The main results are described below, according to specific aspects evaluated in relation to pCO<span class="elsevierStyleInf">2</span> delta.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080"><span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta and mortality</span><p id="par0065" class="elsevierStylePara elsevierViewall">Three articles evaluated in-hospital mortality in relation to <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta,<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">22,24,25</span></a> while 5 assessed mortality after 28 days.<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">23,26–28,30</span></a> Five studies compared mortality between groups of patients with high versus normal <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values upon admission. These publications recorded greater percentage mortality among the patients with high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values, though the differences in the percentages were variable, and in two studies they failed to reach statistical significance (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Six studies conducted other analyses related to mortality. Troskot et al.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a> showed pCO<span class="elsevierStyleInf">2</span> delta to be a mortality risk factor in non-ventilated patients, while Bakker et al.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a> found <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta to be greater among non-survivors than among survivors (5.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.4 vs 4.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.3, respectively; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05)—though the result was influenced by increased pulmonary impairment in the former group, and the authors concluded that the prognostic value of the parameter is modest.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a> Van Beest et al.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a> in turn showed that <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta >6<span class="elsevierStyleHsp" style=""></span>mmHg 4<span class="elsevierStyleHsp" style=""></span>h after admission exhibited an odds ratio (OR) of 5.3 (95% confidence interval [95%CI] 0.9–30.7; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.08) for in-hospital mortality, while Ospina-Tascon et al.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a> found patients with persistently elevated <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta during the first 6<span class="elsevierStyleHsp" style=""></span>h to have poorer survival after 28 days than those individuals that normalized this variable (log-rank, Mantel–Cox: 19.21; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The study of Du et al.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a> showed that among the patients that reached therapeutic targets referred to SvO<span class="elsevierStyleInf">2</span> during initial resuscitation, those presenting high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta suffered greater mortality compared with those who normalized this variable. Similar results were reported by Ospina-Tascon et al.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a> and Mallat et al.,<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> though statistical significance was not reached in the latter case (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085"><span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta and tissue perfusion variables</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nine studies evaluated <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in relation to other tissue perfusion variables.<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">22,23,25–30,32</span></a> Vallée et al.,<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> Van Beest et al.,<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a> Mallat et al.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> and Zhao et al.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a> recorded higher serum lactate levels and lower SvcO<span class="elsevierStyleInf">2</span> values when the patients presented <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta >6<span class="elsevierStyleHsp" style=""></span>mmHg, compared with those showing <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta <6<span class="elsevierStyleHsp" style=""></span>mmHg, while Bakker et al.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a> reported no statistically significant differences for lactate – though mixed venous oxygen saturation was found to be lower in the high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta group (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Ospina-Tascon et al. classified their patients according to the <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta value upon admission and after 6<span class="elsevierStyleHsp" style=""></span>h. The group with persistently elevated <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta (high after 0 and 6<span class="elsevierStyleHsp" style=""></span>h) showed greater lactate values compared with the patients that normalized their <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta value (high at 0<span class="elsevierStyleHsp" style=""></span>h and normal after 6<span class="elsevierStyleHsp" style=""></span>h) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Three studies<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">23,27,30</span></a> found the percentage decrease in lactate concentration to be greater in the presence of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta <6<span class="elsevierStyleHsp" style=""></span>mmHg. Vallée et al.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> recorded a decrease in lactate between 0 and 12<span class="elsevierStyleHsp" style=""></span>h of −38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>39 vs −17<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>33% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04), respectively, while Mallat et al.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> found the decrease in lactate between 0 and 6<span class="elsevierStyleHsp" style=""></span>h to be 33.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>28.9 vs 7.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>41.2 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.016). In turn, Du et al.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a> classified their patients according to the SvcO<span class="elsevierStyleInf">2</span> target value and <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta after 6<span class="elsevierStyleHsp" style=""></span>h. In the patients that reached the SvcO<span class="elsevierStyleInf">2</span> target, lactate clearance was greater in the subgroup with normal <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta versus the patients with high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta (0.21<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.31 vs 0.01<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.61, respectively; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.023), while no such differences were noted in the group that failed to reach the SvcO<span class="elsevierStyleInf">2</span> targets (−0.04<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.43 vs −0.09<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.59, respectively).<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">One study analyzed microvascular perfusion as assessed by videomicroscopy and the <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta value. The authors found increased <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values to be correlated to a lesser proportion of perfused small vessels, a lower functional capillary density, and a greater heterogeneity index (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090"><span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta and cardiac output or cardiac index</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nine articles evaluated the relationship between <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta and CO or CI.<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">21,28–30</span></a> Five compared mean CO or CI in the groups of patients with high or low <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values. All of them found <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta >6<span class="elsevierStyleHsp" style=""></span>mmHg to be associated to lower CO or CI.<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">22,23,28–30</span></a> In addition, the correlation between <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta and CO or CI was found to be discrete (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). In no case did the correlation coefficient exceed 0.7.</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095"><span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta and therapeutic interventions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Mallat et al.<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">31</span></a> recorded a statistically significant decrease in <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta on administering dobutamine at increasing doses between 5 and 15<span class="elsevierStyleHsp" style=""></span>μg/kg/min, while Mecher et al.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a> evaluated <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta response to fluid challenge – improvements in the variable being observed after the administration of colloids.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The present systematic review found most of the articles on <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in patients with severe sepsis and septic shock to have been published in the last 6 years. Although evidence of its potential usefulness has been available since the late 1980s,<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">16,17</span></a> and two of the identified articles date from the early 1990s,<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">21,22</span></a> the more recent interest in the investigation of this parameter is possibly related to the limitations identified in the variables most commonly recommended in the management of these patients: lactate and SvO<span class="elsevierStyleInf">2</span>.<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">33,34</span></a> Evaluation of the microcirculation using more novel techniques, and the evidence of microcirculatory alterations despite apparent normality of the macrodynamic variables – including SvO<span class="elsevierStyleInf">2</span> – point to the need to explore other possible variables.<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The studies generally showed high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values to be associated to poorer clinical outcomes, including worsened hemodynamic parameters, poorer tissue perfusion, and greater in-hospital mortality and mortality after 28 days. With regard to mortality, the importance of the serial determination of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in terms of its prognostic usefulness must be underscored. The studies offering data referred to serial measurements found the second measurement of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta to be more closely correlated to mortality than the first measurement.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">25,30</span></a> Although different studies have shown both SvO<span class="elsevierStyleInf">2</span> and lactate, considered individually, to be of prognostic value in terms of mortality,<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">5,6,35</span></a> the recording of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta appears to offer additional information. This was seen in three studies that analyzed patients that were able to reach adequate SvO<span class="elsevierStyleInf">2</span> goals after 6<span class="elsevierStyleHsp" style=""></span>h of resuscitation, in which the presence of a normal <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta was seen to imply a better prognosis. This may indicate the usefulness of serial measurements during the initial resuscitation of septic shock patients, where first the SvO<span class="elsevierStyleInf">2</span> goal is reached, followed by the achievement an additional target based on <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta. The cutoff point of 6<span class="elsevierStyleHsp" style=""></span>mmHg for stratifying the two groups (normal and high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta) was quite consistent in all the studies – the publication of Bakker et al.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a> generally being taken as the reference in recording this parameter.</p><p id="par0110" class="elsevierStylePara elsevierViewall">However, it must be noted that the importance of serial measurements has been best established in the case of 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.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">6,36</span></a> In our investigation, the studies that analyzed <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in relation to percentage lactose reduction<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">23,27,30</span></a> found such reduction to be greater in patients with low <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values, particularly when evaluated after 6<span class="elsevierStyleHsp" style=""></span>h. This underscores the importance of the serial determination of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta, and also evidences the potential usefulness of these measurements in combination with lactate concentration.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Taking into account that the increase in <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta is related to low flow states and the consequent accumulation of CO<span class="elsevierStyleInf">2</span>, a series of studies evaluated the association of this parameter to CO or CI. These publications generally recorded an expected inverse relationship between the two variables, though some recorded low (but still statistically significant) correlation or determination coefficients between them,<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">21,22,24</span></a> with additional important dispersion of the analyzed points. On the other hand, two studies reported no such relationship.<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">24,26</span></a> The above may reflect the physiopathological complexity in interpreting <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta elevation in the context of these patients, as well as the evident individual variability found. As a result, the usefulness of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in indirectly assessing CO may prove inconsistent.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In addition to its prognostic implications, two studies evaluated the impact of therapeutic interventions upon <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta, showing fluid or inotropic drug administration to exert a positive effect upon the variable. This is important, since prior knowledge of how <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta can be modified is relevant when constructing a management algorithm for these patients in the context of clinical studies evaluating <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta as a resuscitation goal in septic shock patients.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Despite the evidence found, different authors have addressed the limitations of this variable in evaluation tissue hypoperfusion. In effect, <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta may be normal in cases of evident hypoperfusion and high CO, and may also be elevated in the absence of hypoperfusion, taking into account the Haldane effect.<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">37</span></a> This is why the evaluation of CO<span class="elsevierStyleInf">2</span> content in relation to the oxygen levels has been proposed as another way to assess tissue perfusion status. The Cv-aCO<span class="elsevierStyleInf">2</span>/Da-vO<span class="elsevierStyleInf">2</span> ratio is a variable that can identify patients with anaerobic metabolism under different critical conditions, including septic shock.<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">38–40</span></a> This variable therefore might also be of clinical relevance in the management of patients with sepsis.</p><p id="par0130" class="elsevierStylePara elsevierViewall">New methods for more directly evaluating tissue perfusion have been developed in recent years.<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">41</span></a> One such method involves sidestream dark field sublingual videomicroscopy, which affords different parameters for assessing the microcirculation. This system has been used to document different microcirculatory alterations in patients with septic shock, and the improvements obtained as a result of certain interventions.<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">42–44</span></a> However, the use of this technology at the patient bedside faces many challenges, and its relevance in the management of patients of this kind remains to be established. This explains why the easily measurable parameters commented above are still considered to be valid. In this regard, the study of Ospina-Tascon et al.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">32</span></a> offers important information, considering that <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta was the variable best correlated to microcirculatory alterations – though the clinical significance of this association has not been well defined.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Considering the above, should <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta be used as a resuscitation goal or target in patients with septic shock? The answer is still not clear, and further evaluation in the context of clinical trials is needed. The variables most widely evaluated in these patients are SvO<span class="elsevierStyleInf">2</span> and lactate, and the most recent Surviving Sepsis Campaign guide only recommends the measurement of lactate.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">4</span></a> Consequently, the way in which <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta should be implicated in the management of these patients and related to the abovementioned variables is not clear. What should be “standardized” first; how many resuscitation goals must be reached; or how they should be reached, are issues still waiting for an answer. However, this does not mean that <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta should not be taken into account in the management of patients with septic shock, in the context of a multimodal approach combined with other variables, involving serial measurements, on an individualized basis during initial resuscitation. In fact, the most recent circulatory shock and hemodynamic monitoring consensus document of the European Society of Intensive Care Medicine recommends the measurement of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta as part of the evaluation and management of patients with septic shock in the presence of a central venous catheter.<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">45</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In the present study, we were unable to conduct a meta-analysis, due to the great heterogeneity of the study designs, the reporting of outcomes and the nature of the disease investigated. One of the limitations of our systematic review was that it included studies of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in patients exclusively presenting severe sepsis and septic shock—thereby precluding the possibility of extending the findings to a broader range of critically ill patients, and of expanding the analysis of its potential uses and limitations. However, this restriction was also an essential part of the purpose of the study. Some studies that analyzed <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in critical care populations were not taken into account, despite the inclusion of cases of severe sepsis and septic shock, since the outcomes in these latter cases were not always described.<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">38,46</span></a> Other publications involving septic shock patients analyzed <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta, though evaluation of the variable was limited, since it was not the primary objective of the study.<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">39,47,48</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">It can be concluded that <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta applied to the management of patients with severe sepsis and septic shock has been evaluated more frequently in recent years, and that in most cases high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values have been correlated to poorer clinical outcomes, including lower CI, higher lactate levels, lower SvO<span class="elsevierStyleInf">2</span> values, lower lactate clearance rates and higher mortality – though the studies have been heterogeneous and involve some methodological limitations. Although the usefulness of <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta has not been assessed in the context of clinical research within an initial resuscitation protocol for patients with severe sepsis and septic shock, the overall results show that it may be a parameter to be considered in the management of these patients.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0150" class="elsevierStylePara elsevierViewall">Juan José Diaztagle: research idea, protocol design, data search, analysis of results, discussion, drafting of the manuscript.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Jorge Camilo Rodríguez: protocol design, data search, analysis of results, discussion.</p><p id="par0160" class="elsevierStylePara elsevierViewall">John Jaime Sprockel-Díaz: protocol design, analysis of results, discussion.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres904234" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec884825" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres904233" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec884826" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "pCO delta and mortality" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "pCO delta and tissue perfusion variables" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "pCO delta and cardiac output or cardiac index" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "pCO delta and therapeutic interventions" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Authorship" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack301116" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-24" "fechaAceptado" => "2017-03-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec884825" "palabras" => array:5 [ 0 => "Septic shock" 1 => "Severe sepsis" 2 => "Venous-to-arterial difference of carbon dioxide" 3 => "Lactate" 4 => "Tissue perfusion" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec884826" "palabras" => array:5 [ 0 => "Shock séptico" 1 => "Sepsis grave" 2 => "Diferencia venoarterial de dióxido de carbono" 3 => "Lactato" 4 => "Perfusión tisular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The way to assess tissue perfusion during the resuscitation of patients with severe sepsis and septic shock is a current subject of research and debate. Venous oxygen saturation and lactate concentration have been the most frequently used criteria, though they involve known limitations. The venous-to-arterial difference of carbon dioxide (<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta) is a parameter than can be used to indicate tissue perfusion, and its determination therefore may be useful in these patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A qualitative systematic review of the literature was made, comprising studies that assessed <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta in adult patients with severe sepsis or septic shock, and published between January 1966 and November 2016 in the Medline-PubMed, Embase-Elsevier, Cochrane Library, and LILACS databases. There was no language restriction. The PRISMA statement was followed, and methodological quality was evaluated.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Twelve articles were included, all of an observational nature, and including 10 prospective studies (9 published since 2010). Five documented greater mortality among patients with high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values, in 3 cases even when achieving venous oxygen saturation targets. In 4 studies, a high <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta was related to lower venous oxygen saturation and higher lactate levels, and another 3 documented lesser percentage lactate reductions.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The parameter <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta has been more frequently assessed in the management of patients with severe sepsis during the last few years. The studies demonstrate its correlation to mortality and other clinical outcomes, defining <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta as a useful tool in the management of these patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La forma de evaluar la perfusión tisular durante la reanimación de pacientes con sepsis grave y shock séptico es tema de estudio y debate en la actualidad. La saturación venosa de oxígeno y el lactato han sido los criterios más utilizados; sin embargo, presentan limitaciones reconocidas. La diferencia venoarterial de dióxido de carbono (delta de pCO<span class="elsevierStyleInf">2</span>) es una variable que puede indicar el estado de perfusión tisular, por lo que su evaluación puede ser útil en estos pacientes.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisión sistemática cualitativa de la literatura que incluyó estudios que evaluaron el delta de pCO<span class="elsevierStyleInf">2</span> en pacientes adultos con sepsis grave o shock séptico, publicados entre enero de 1966 y noviembre de 2016 en las bases de datos Medline-PubMed, Embase-Elsevier, Cochrane Library y LILACS. No tuvo restricción de idiomas. Se siguió la declaración PRISMA y se evaluó la calidad metodológica.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Doce estudios fueron incluidos, todos observacionales, 10 prospectivos, 9 publicados a partir del 2010. Cinco documentaron una mayor mortalidad entre pacientes con delta de pCO<span class="elsevierStyleInf">2</span> alto, en 3 incluso cuando conseguían metas de saturación venosa de oxígeno. En 4 estudios, un delta de pCO<span class="elsevierStyleInf">2</span> alto se relacionó con una menor saturación venosa de oxígeno y niveles mayores de lactato, y otros 3 documentaron un menor porcentaje de disminución de lactato.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El delta de pCO<span class="elsevierStyleInf">2</span> ha sido evaluado en el manejo de los pacientes con sepsis grave y shock séptico con mayor frecuencia en los últimos años. Los estudios demuestran su relación con la mortalidad y otros desenlaces clínicos, de tal forma que puede ser una herramienta útil en el manejo de estos pacientes.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Please cite this article as: Diaztagle Fernández JJ, Rodríguez Murcia JC, Sprockel Díaz JJ. La diferencia venoarterial de dióxido de carbono en la reanimación de pacientes con sepsis grave y shock séptico: una revisión sistemática. Med Intensiva. 2017;41:401–410.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appex A" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1693 "Ancho" => 1626 "Tamanyo" => 141422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Summary of the literature search.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">SvcO<span class="elsevierStyleInf">2</span>: central venous oxygen saturation; T0: time zero (time of patient entry to the study); T6: 6<span class="elsevierStyleHsp" style=""></span>h after T0; T12: 12<span class="elsevierStyleHsp" style=""></span>h after T0; T24: 24<span class="elsevierStyleHsp" style=""></span>h after T0; ICU: Intensive Care Unit; MV: mechanical ventilation; Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>: venous-to-arterial difference of carbon dioxide.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author, year (ref.) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Principal analytical characteristic<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mecher et al., 1990<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Severe sepsis and hypoperfusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified before fluid challenge<br>Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>6 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bakker et al., 1992<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified upon admission to ICU<br>Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>6 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vallée et al., 2008<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock, MV, lactate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mmol/L, SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified at T0 (start of monitoring)<br>Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>6 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6<br>Evaluation at T0, T6 and T12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Troskot et al., 2010<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock or severe sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified upon admission: with MV and without MV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Van Beest et al., 2013<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock or severe sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified upon admission<br>Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ospina-Tascon et al., 2013<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Classified according to change in Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> between T0 and T6 (normal: Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6)<br>Persistently normal<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>36<br>Decreasing (high-normal)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17<br>Persistently high<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24<br>Increasing (normal-high)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8<br>Measurements at T0, T6, T12 and T24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Du et al., 2013<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">172 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In T6 classified patients:<br>Group 1: SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>6<br>Group 2: SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>6<br>Group 3: SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6<br>Group 4: SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhao et al., 2012<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified upon admission<br>Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhang et al., 2012<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">29</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock or severe sepsis and SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified upon admission<br>Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6<br>Measurements at T0, T6, T12 and T24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mallat et al., 2014<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock and MV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 2 groups classified according to Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>6 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6 at T0 and T6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mallat et al., 2014<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">31</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock, MV, lactate<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mM, 24<span class="elsevierStyleHsp" style=""></span>h evolution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dobutamine infusion, initial dose: 5<span class="elsevierStyleHsp" style=""></span>μg/kg/min<br>Dose increments of 5<span class="elsevierStyleHsp" style=""></span>μg/kg/min every 30<span class="elsevierStyleHsp" style=""></span>min, to 15<span class="elsevierStyleHsp" style=""></span>μg/kg/min<br>Evaluation in the 3 dose ranges \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ospina-Tascón et al., 2016<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">32</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comparison of 3 groups classified upon admission:<br>Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6, Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> 6–9.9 and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>10 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1520363.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> values are reported in mmHg.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Principal characteristics of the studies meeting the inclusion criteria.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">T0: time zero (time of patient entry to the study); T6: 6<span class="elsevierStyleHsp" style=""></span>h after T0; Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>: venous-to-arterial difference of carbon dioxide.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Time of analysis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage mortality</th><th class="td" title="table-head " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">High Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vallée et al.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Van Beest et al.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Du et al.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhao et al.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mallat et al.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1520361.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Percentage mortality according to <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta group.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">HR: hazard ratio; 95%CI: 95% confidence interval; OR: odds ratio; RR: relative risk; SvcO<span class="elsevierStyleInf">2</span>: central venous oxygen saturation; T0: time zero (time of patient entry to the study); T4: 4<span class="elsevierStyleHsp" style=""></span>h after T0; T6: 6<span class="elsevierStyleHsp" style=""></span>h after T0; T12: 12<span class="elsevierStyleHsp" style=""></span>h after T0; MV: mechanical ventilation; Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>: venous-to-arterial difference of carbon dioxide.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time of analysis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Statistical analysis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Troskot et al.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0</td><td class="td" title="table-entry " align="left" valign="top">HR 4.33 (CI 95% 1.33–14.11) (sin MV)<br> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR 1.25 (CI 95% 0.84–1.86) (con MV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Van Beest et al.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a></td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 1.6 (0.5–5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 5.3 (0.9–30.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Ospina-Tascon et al.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a></td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1.77 (0.97–3.22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2.23 (1.20–4.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2.41 (1.42–4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Du et al.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Percentage mortality according to groups:<br>G1 SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>6: 50%<br>G2 SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>6: 56.1%<br>G3 SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6: 50%<br>G4 SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6: 16.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mallat et al.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Percentage mortality according to groups:<br>SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6: 57%<br>SvcO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>70% and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> ≤ 6: 37%<br> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1520364.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta values are reported in mmHg.</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Analysis in the group with <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>delta<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mmHg at T0.</p>" ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Patients with SvmO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>65%.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Relationship between mortality and <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta.<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">FCD: functional capillary density; HI: heterogeneity index; PPV: percentage of perfused small vessels; SvcO<span class="elsevierStyleInf">2</span>: central venous oxygen saturation; SvmO<span class="elsevierStyleInf">2</span>: mixed venous oxygen saturation; T0: time zero (time of patient entry to the study); T6: 6<span class="elsevierStyleHsp" style=""></span>h after T0; T12: 12<span class="elsevierStyleHsp" style=""></span>h after T0; T24: 24<span class="elsevierStyleHsp" style=""></span>h after T0; Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>: venous-to-arterial difference of carbon dioxide.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time of analysis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">High Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Bakker et al.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SvmO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Vallée et al.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SvcO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Van Beest et al.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SvcO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74.5%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.1%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Ospina-Tascon et al.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T6</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1: 1.3 (0.9–2.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3: 3.3 (2.1–6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2: 2 (1–3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G4: 2.9 (1.1–7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Zhao et al.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SvcO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T24</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SvcO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Zhang et al.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">29</span></a></td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.57<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.31<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.89<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Mallat et al.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.2 (1.6–5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6 (2.2–8.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SvcO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73% (65–80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61% (53–63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T6</td><td class="td" title="table-entry " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.0 (1.2–3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6 (2.1–8.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SvcO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73% (70–76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63% (51–71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="7" align="left" valign="top">Ospina-Tascón et al.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">32</span></a></td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> (6–9.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> (≥10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">T0</td><td class="td" title="table-entry " align="left" valign="top">PPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FCD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">T6</td><td class="td" title="table-entry " align="left" valign="top">PPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FCD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1520365.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">G1: Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> high at T0 and normal at T6; G2: Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> normal at T0 and normal at T6; G3: Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> high at T0 and high at T6; G4: Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> normal at T0 and high at T6.</p>" ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Statistical significance only between the normal Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> group and Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> 6–9.9<span class="elsevierStyleHsp" style=""></span>mmHg.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Tissue perfusion variables and <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CO: cardiac output; CI: cardiac index; r: correlation coefficient; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>: coefficient of determination; T0: time zero (time of patient entry to the study); T6: 6<span class="elsevierStyleHsp" style=""></span>h after T0; T12: 12<span class="elsevierStyleHsp" style=""></span>h after T0; T24: 24<span class="elsevierStyleHsp" style=""></span>h after T0; Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span>: venous-to-arterial difference of carbon dioxide.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Time of analysis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Analytical group</th><th class="td" title="table-head " align="left" valign="top" scope="col">Correlation statistic \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">High Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mecher et al.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Basal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.42 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01)<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bakker et al.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Vallée et al.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a></td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.8 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.57 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.58 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.58 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Troskot et al.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.21 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.162) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Van Beest et al.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.07 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ospina-Tascon et al.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.16 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Zhao et al.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a></td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.5 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.8 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Zhang et al.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">29</span></a></td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CO<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7.19<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.23<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.84 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.50 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CO<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7.32<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.78 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.62 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CO<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.72<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.64 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.46 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Mallat et al.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a></td><td class="td" title="table-entry " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.9 (3.3–4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.9 (2.3–3.1). <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.69 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.2 (3.2–5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3 (2.5–4.2). <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.54 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1520362.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Cardiac output is expressed as L/min, and cardiac index as L/min/m<span class="elsevierStyleSup">2</span>.</p>" ] 1 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Change in cardiac index vs change in Δ<span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> following fluid loading.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Cardiac output or cardiac index and its correlation to <span class="elsevierStyleItalic">p</span>CO<span class="elsevierStyleInf">2</span> delta<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>.</p>" ] ] 6 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 72821 ] ] 7 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc2.pdf" "ficheroTamanyo" => 57984 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:48 [ 0 => array:3 [ "identificador" => "bib0245" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe sepsis and septic shock" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 160 | 110 | 270 |
| 2024 September | 162 | 95 | 257 |
| 2024 August | 158 | 89 | 247 |
| 2024 July | 169 | 64 | 233 |
| 2024 June | 150 | 93 | 243 |
| 2024 May | 119 | 73 | 192 |
| 2024 April | 99 | 78 | 177 |
| 2024 March | 100 | 63 | 163 |
| 2024 February | 76 | 81 | 157 |
| 2024 January | 88 | 88 | 176 |
| 2023 December | 103 | 116 | 219 |
| 2023 November | 111 | 99 | 210 |
| 2023 October | 102 | 162 | 264 |
| 2023 September | 67 | 105 | 172 |
| 2023 August | 107 | 56 | 163 |
| 2023 July | 86 | 81 | 167 |
| 2023 June | 88 | 53 | 141 |
| 2023 May | 129 | 99 | 228 |
| 2023 April | 99 | 87 | 186 |
| 2023 March | 153 | 88 | 241 |
| 2023 February | 146 | 102 | 248 |
| 2023 January | 115 | 118 | 233 |
| 2022 December | 145 | 108 | 253 |
| 2022 November | 162 | 100 | 262 |
| 2022 October | 173 | 98 | 271 |
| 2022 September | 115 | 87 | 202 |
| 2022 August | 185 | 106 | 291 |
| 2022 July | 152 | 83 | 235 |
| 2022 June | 188 | 75 | 263 |
| 2022 May | 177 | 73 | 250 |
| 2022 April | 191 | 86 | 277 |
| 2022 March | 155 | 145 | 300 |
| 2022 February | 137 | 96 | 233 |
| 2022 January | 111 | 141 | 252 |
| 2021 December | 103 | 115 | 218 |
| 2021 November | 159 | 142 | 301 |
| 2021 October | 94 | 141 | 235 |
| 2021 September | 95 | 60 | 155 |
| 2021 August | 81 | 115 | 196 |
| 2021 July | 48 | 97 | 145 |
| 2021 June | 78 | 80 | 158 |
| 2021 May | 138 | 136 | 274 |
| 2021 April | 351 | 263 | 614 |
| 2021 March | 213 | 149 | 362 |
| 2021 February | 166 | 79 | 245 |
| 2021 January | 279 | 95 | 374 |
| 2020 December | 137 | 86 | 223 |
| 2020 November | 115 | 73 | 188 |
| 2020 October | 99 | 81 | 180 |
| 2020 September | 93 | 76 | 169 |
| 2020 August | 93 | 83 | 176 |
| 2020 July | 92 | 72 | 164 |
| 2020 June | 112 | 56 | 168 |
| 2020 May | 123 | 66 | 189 |
| 2020 April | 100 | 91 | 191 |
| 2020 March | 78 | 74 | 152 |
| 2020 February | 220 | 150 | 370 |
| 2020 January | 96 | 88 | 184 |
| 2019 December | 108 | 130 | 238 |
| 2019 November | 127 | 108 | 235 |
| 2019 October | 164 | 149 | 313 |
| 2019 September | 122 | 113 | 235 |
| 2019 August | 100 | 92 | 192 |
| 2019 July | 88 | 79 | 167 |
| 2019 June | 87 | 53 | 140 |
| 2019 May | 149 | 121 | 270 |
| 2019 April | 91 | 112 | 203 |
| 2019 March | 155 | 106 | 261 |
| 2019 February | 107 | 88 | 195 |
| 2019 January | 84 | 73 | 157 |
| 2018 December | 166 | 92 | 258 |
| 2018 November | 327 | 104 | 431 |
| 2018 October | 274 | 48 | 322 |
| 2018 September | 145 | 30 | 175 |
| 2018 August | 100 | 24 | 124 |
| 2018 July | 56 | 26 | 82 |
| 2018 June | 76 | 22 | 98 |
| 2018 May | 63 | 12 | 75 |
| 2018 April | 62 | 17 | 79 |
| 2018 March | 65 | 26 | 91 |
| 2018 February | 55 | 11 | 66 |
| 2018 January | 1 | 0 | 1 |
| 2017 November | 0 | 1 | 1 |
| 2017 September | 0 | 2 | 2 |
| 2017 August | 0 | 1 | 1 |
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