Lack of correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio and respiratory quotient in patients with septic shock: A prospective observational study

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"apellidos" => "Gutierrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Mario O." "apellidos" => "Pozo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Matías" "apellidos" => "Mugno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Sebastián P." "apellidos" => "Chapela" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Natalia" "apellidos" => "Llobera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "María J." 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"apellidos" => "Kanoore Edul" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 9 => array:4 [ "nombre" => "Arnaldo" "apellidos" => "Dubin" "email" => array:1 [ 0 => "dubina@otamendi.com.ar" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Terapia Intensiva, Hospital Británico, Perdriel 74 (C1280AEB), Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Terapia Intensiva, Sanatorio Otamendi, Azcuénaga 870 (C1115AAB), Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Bioquímica, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155 (C1121ABG), Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Equipo de Soporte Nutricional, Hospital Británico, Perdriel 74 (C1280AEB), Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Cátedras de Terapia Intensiva y Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Av.60 y Av. 120 (B1900), La Plata, Argentina" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Falta de correlación entre la relación PCO2 venosa central-arterial/contenido arterial-venoso central de O2 y cociente respiratorio en pacientes con shock séptico: Estudio prospectivo observacional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 3008 "Tamanyo" => 332565 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation and agreement of central venous minus arterial PCO2 to arterial minus central venous O2 content and central venous minus arterial CO2 content to arterial minus central venous O2 content ratio with respiratory quotient. Panel A: Correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) and respiratory quotient. Panel B: Bland and Altman analysis between Pcv-aCO2/Ca-cvO2 and respiratory quotient. Panel C: Correlation between central venous minus arterial CO2 content to arterial minus central venous O2 content ratio (Ccv-aCO2/Ca-cvO2) and respiratory quotient. Panel D: Bland and Altman analysis between Ccv-aCO2/Ca-cvO2 and respiratory quotient." ] ] ] "textoCompleto" => "IntroductionThe normalization of tissue perfusion and oxygenation is the final goal of septic shock resuscitation. Unfortunately, there is no gold standard for evaluation of tissue oxygenation. The presence of hyperlactatemia or alterations in peripheral perfusion does not necessarily indicate tissue hypoxia In experimental models of oxygen supply dependence, the abrupt increase in respiratory quotient (RQ)—the ratio of CO2 production (VCO2) to O2 consumption (VO2)—indicates the beginning of anaerobic metabolism.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a> The RQ rises because the drop in VO2 exceeds the reduction in VCO2. Although VCO2 and VO2 decrease as a reflection of oxidative metabolism derangement, the lower reduction in the former is explained by the surge in anaerobic VCO2 due to bicarbonate buffering of anaerobically generated protons.The measurement of RQ requires a metabolic cart, which is not usually available in the ICU. Thus, the ratio of mixed venous minus arterial PCO2 to arterial minus mixed venous O2 content (Pmv-aCO2/Ca-mvO2) was proposed as a surrogate for RQ. In an observational study, values of Pmv-aCO2/Ca-mvO2 higher than 1.4 were associated with hyperlactatemia and worse outcome.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Thereafter, other studies used the ratio of venous minus arterial PCO2 to arterial minus central venous O2 content (Pcv-aCO2/Ca-cvO2) to assess global oxygenation.<a class="elsevierStyleCrossRefs" href="#bib0030">6–9</a> To improve the ability of Pcv-aCO2/Ca-cvO2 and Pmv-aCO2/Ca-mvO2 to reflect RQ, calculated CO2 content difference has been used instead of PCO2 difference in the computation of the ratios.<a class="elsevierStyleCrossRefs" href="#bib0030">6,10</a> Pcv-aCO2/Ca-cvO2 is thus recommended for the assessment of tissue oxygenation.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> Even though Pcv-aCO2/Ca-cvO2 might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Besides, basic research suggested that Pmv-aCO2/Ca-mvO2 is more dependent on factors than modify the dissociation of CO2 from Hb than on the actual RQ and that it can increase in presence of preserved tissue oxygenation.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> In addition, experimental studies failed to show a good correlation between Pmv-aCO2/Ca-mvO2 and RQ.<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a>Our goal was to compare Pcv-aCO2/Ca-cvO2 and RQ in patients with septic shock. Our hypothesis was that Pcv-aCO2/Ca-cvO2 is a poor surrogate for RQ. A secondary goal was to assess Pcv-aCO2/Ca-cvO2 determinants.Patients and methodsThis study was approved by the Institutional Review Board (Comité de Revisión Institucional del Hospital Británico) on September 17, 2021 (CRIHB#865, project title: Comparison of Pcv-aCO2/Ca-cvO2 and respiratory quotient in patients with septic shock). The study was conducted in accordance with the Declaration of Helsinki of 1975. Informed consent was obtained from the patient's next of kin. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations for reporting cohort studies. The completed checklist is included in the Appendix.We studied patients older than 18 years recruited from two surgical/medical ICUs, from June 2020 to March 2023. Septic shock diagnosis was based on the presence of a source of infection, arterial hypotension refractory to fluid administration and so requiring vasopressors, and blood lactate levels higher than 2.0 mmol/L.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> All patients were intubated and mechanically ventilated on controlled mode, and received infusions of midazolam or propofol and fentanyl. The Richmond Agitation-Sedation Scale was -5 for all patients.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Patients were included after initial resuscitation, when respiratory settings and vasopressor dose remained stable over 1 h. Patients with FiO2 ≥0.60, PEEP > 10 cm H2O, tidal volume <300 mL, renal replacement therapy, or airway leaks, were excluded from the study since indirect calorimetry measurements might be unreliable in such conditions.Demographic and clinical data were registered. We measured VO2, VCO2, and RQ by indirect calorimetry (MedGraphics CPX Ultima, Medical Graphics Corporation, St. Paul, MN, and Mindray Metabolic Module, Mindray Medical International, Shenzhen, China). We used the mean of a 5-minute period of measurements when variations were less than 5%.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> During this period of time, arterial and central venous samples were simultaneously obtained for the determination of pH, PCO2, PO2, Hb, and O2Hb (Cobas b 221, Roche Diagnostics GmbH, Mannheim, Germany). We calculated Pcv-aCO2/Ca-cvO2 by standard formulae and the ratio central venous minus arterial CO2 content to arterial minus central venous O2 content (Ccv-aCO2/Ca-cvO2) by the Douglas’ algorithm.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> P50, the PO2 at which Hb is 50 % saturated, was also calculated. A complete depiction of the formulae is shown in the Appendix.Analysis of the dataWe estimated that 47 patients were required to demonstrate a moderate correlation between Pcv-aCO2/Ca-cvO2 and RQ (r = 0.40), with a significance level of 0.05 and power of 80 %. Shapiro-Wilk test and quantile-quantile plots of the differences were used to test data normality. Correlation and agreement between Pcv-aCO2/Ca-cvO2 and Pcv-aCO2/Ca-cvO2 with RQ were assessed with simple linear regression and Bland and Altman analysis. To identify independent determinants of Pcv-aCO2/Ca-cvO2, variables showing a P-value <0.20 in the simple linear regression and those physiologically plausible were entered into multiple linear regression analysis and a model was constructed. Differences between survivors and nonsurvivors patients were assessed by unpaired t-test, Mann-Whitney U-test, or Chi-square test. Patients were also compared according to arbitrary cutoffs of Pcv-aCO2/Ca-cvO2 and RQ (1.4 and 1.0, respectively). Data are shown as mean ± standard deviation, median [IQR], or n (%). A P-value <0.05 was considered as statistically significant.ResultsFrom 341 screened patients with septic shock, 47 of them were included. The time between the onset of shock and the measurements was 1 [1–3] days. Most of the patients were not studied because indirect calorimetry measurements were not available at the screening time. The flowchart of the study is shown in the Appendix (Figure A1).<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main epidemiological and clinical characteristics that did not differ between survivors and nonsurvivors. Neither there were differences according to the cutoffs of Pcv-aCO2/Ca-cvO2 and RQ (Tables A1 and A2). Nonsurvivors showed lower pH and higher lactate levels than survivors. Survivors and nonsurvivors had high mean values of Pcv-aCO2/Ca-cvO2 and Ccv-aCO2/Ca-cvO2, which were not different between groups. Values of RQ were in the normal range and not different between groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Patients with Pcv-aCO2/Ca-cvO2 <1.4 had lower arterial and central venous bicarbonate, and lower central venous PCO2 than patients with Pcv-aCO2/Ca-cvO2 >1.4 (Table A3) Patients with RQ < 1.0 showed higher VO2 and central venous PO2 than patients with RQ > 1.0 (Table A4). Arterial lactate was not different among these subgroups (Tables A3 and A4).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Pcv-aCO2/Ca-cvO2 and Ccv-aCO2/Ca-cvO2 showed weak correlations and wide 95 % limits of agreement with RQ (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Similar correlations were obtained considering the different metabolic carts used in each hospital (R2 = 0.00, P = 0.71 and R2 = 0.00, P = 0.81 for MedGraphics CPX Ultima, and R2 = 0.05, P = 0.57 and R2 = 0.03, P = 0.64 for Mindray Metabolic Module).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The multiple linear regression model showed hemoglobin, central venous PCO2, and central venous O2Hb as Pcv-aCO2/Ca-cvO2 determinants (R2 = 0.36, P = 0.0007) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionOur main finding was the absence of a significant correlation between of Pcv-aCO2/Ca-cvO2 and RQ. In addition, Pcv-aCO2/Ca-cvO2 was independently determined by factors that modify the dissociation of CO2 from Hb.Since RQ has sudden increases during experimental models of oxygen supply dependency,<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a> a surrogatePcv-aCO2/Ca-cvO2has been used as a tool to assess the adequacy of tissue oxygenation. Thus, observational studies found some relationship of Pcv-aCO2/Ca-cvO2 to hyperlactatemia and outcome.<a class="elsevierStyleCrossRefs" href="#bib0025">5–9</a> Nevertheless, the agreement between Pcv-aCO2/Ca-cvO2 and RQ, and its ability to reflect tissue hypoxia have never been shown. In addition, a randomized controlled trials failed to show usefulness of Pcv-aCO2/Ca-cvO2 as a goal for resuscitation.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Despite lack of clear evidence, some reviews have recommended its utilization and incorporated it in algorithms for the assessment and treatment of shock states.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> As recently shown in a systematic review and meta-analysis, high values of Pcv-aCO2/Ca-cvO2 have an association with mortality.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> The ability to predict outcome, however, is similar or probably lower than that of lactate. Moreover, its prognostic value might be related to some of its determinants—anemia and metabolic acidosis—and not to the ability to reflect anaerobic metabolism.The rationale for the use of Pcv-aCO2/Ca-cvO2 in the assessment of tissue oxygenation in patients with septic shock is based on the behavior of RQ in animal models of anaerobic metabolism.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a> Yet, no clinical study has comprehensively addressed this issue.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> On the other hand, experimental studies showed that Pmv-aCO2/Ca-mvO2 might not reflect the changes in the RQ and the adequacy of tissue oxygenation. During stepwise reductions in oxygen transport (DO2), Pmv-aCO2/Ca-mvO2 was almost five times higher in anemic than in ischemic hypoxia despite comparable degrees of anaerobic metabolism.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Moreover, Pmv-aCO2/Ca-mvO2 increased even before the beginning of the oxygen supply dependence and the rise of RQ. Similar results were reported in hypoxic hypoxia.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> In experimental hemorrhagic shock, blood transfusion was associated with restoration of oxidative metabolism, as shown by the normalization of oxygen transport, VO2, and RQ. Despite this, Pmv-aCO2/Ca-mvO2 remained elevated.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>In our series of patients with septic shock, there was no correlation between Pcv-aCO2/Ca-cvO2 and RQ. Moreover, high Pcv-aCO2/Ca-cvO2 values coexisted with normal values of RQ. These findings might be explained by the fact that Pcv-aCO2/Ca-cvO2 is more dependent on Hb levels, Haldane effect, metabolic acidosis, and the position in the CO2Hb dissociation, than on the actual RQ.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> In the present study, we also showed that Pcv-aCO2/Ca-cvO2 depends on some factors that modify dissociation of CO2 from Hb, such as Haldane effect and Hb levels. In contrast, we found that base excess or lactate did not behave as determinants Pcv-aCO2/Ca-cvO2.Unlike animal studies that show poor but significant correlations,<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> we found an almost null regression coefficient between Pcv-aCO2/Ca-cvO2 and RQ. Differences might be related to different facts. In animal studies, mixed venous instead of central venous samples were used for the calculation of the ratio. An observational study in patients with septic shock showed the lack of interchangeability between both determinations, with unacceptable wide 95% limits of agreement of 1.48.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> The main explanation, however, might be that in the experimental studies there was a wide range of variation in the RQ, which increased during the severe reductions in DO2. On the contrary, RQ remained in the normal physiologic range in the present study. Thus, RQ is a main determinant of Pcv-aCO2/Ca-cvO2 only in real anaerobic conditions.We found high values of Pcv-aCO2/Ca-cvO2 and Cv-aCO2/Ca-cvO2 (2.05 ± 1.07 and 1.38 ± 0.95, respectively) that could be considered indicative of anaerobic metabolism.<a class="elsevierStyleCrossRefs" href="#bib0005">1,4</a> Even though our patients were critically ill, the respiratory and the hemodynamic status and the norepinephrine requirement had been unchanged over the last hour. Moreover, the RQ stayed at normal range (0.96 ± 0.21). Consequently, their condition did not evoke a state of oxygen supply dependence, which is characterized by a rapid decline leading to cardiac arrest. The surge in RQ that develops in models of tissue hypoxia constitutes an extreme event associated with an impending death (i.e., mean blood pressure of 27 ± 2 mmHg in hemorrhagic shock or Hb of 1.2 ± 0.1 g/dL in hemodilution).<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Therefore, it is unlikely that the high Pcv-aCO2/Ca-cvO2 and Cv-aCO2/Ca-cvO2 found in this study can denote global tissue hypoxia. Accordingly, arterial lactate levels did not differ between patients with Pcv-aCO2/Ca-cvO2 lower or higher than 1.4. In line with our results, Pcv-aCO2/Ca-cvO2 did not predict the decrease blood lactate after increases in cardiac output induced by volume expansion in critically ill patients.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Pcv-aCO2/Ca-cvO2 neither correlated with lactate-to-pyruvate ratio during the resuscitation of septic shock.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>Although the incorporation of CO2 content instead of PCO2 difference in the calculation might improve the performance of the ratio, Ccv-aCO2/Ca-cvO2 also showed poor correlation with RQ. This finding is probably related to limitations of the calculation of CO2 content: it frequently results in unacceptable errors, such as negative Ccv-aCO2/Ca-cvO2. Indeed, this occurred in three of our measurements suggesting that the algorithm might be misleading for this purpose (see <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> Panel C).Our study has some limitations. We only performed a single set of measurements at a particular timepoint, which could not be representative of patients’ evolution over time. In addition, many patients were not included because indirect calorimetry was unavailable. This might limit the generalizability of our findings. Finally, each center used a different metabolic cart, each of which was previously validated.<a class="elsevierStyleCrossRefs" href="#bib0130">26–28</a> Since the results of different devices are not interchangeable, this could be a further drawback of the study.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> In spite of this, the results were quite similar considering each device separately.ConclusionsTo our knowledge, this is the first study comparing Pcv-aCO2/Ca-cvO2 and Ccv-aCO2/Ca-cvO2 with RQ, in patients with septic shock. Neither Pcv-aCO2/Ca-cvO2 nor Ccv-aCO2/Ca-cvO2 was correlated with RQ. Our results suggest that in patients with septic shock Pcv-aCO2/Ca-cvO2 should be interpreted cautiously.Conflict of interestThe authors declare that they have no competing interests.Authors’ contributionsConception and design: FJG, MOP, and AD; acquisition of data: FJG, MN, SPC, NL, MJR, PNRB, and VSKE; statistical analysis: FJG; drafting of the manuscript: FJG and AD. All authors critically revised the article and approved the final version.FundingThis study was supported by the grant PICT-2018-03977, Agencia Nacional de Promoción Científica y Tecnológica, Argentina, which was not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2169655" "titulo" => "Abstract" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Main variables of interest" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1839808" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2169656" "titulo" => "Resumen" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables de interés principales" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1839809" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Analysis of the data" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "Authors’ contributions" ] 11 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-03-25" "fechaAceptado" => "2024-05-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1839808" "palabras" => array:4 [ 0 => "Carbon dioxide production" 1 => "Oxygen consumption" 2 => "Anaerobic metabolism" 3 => "Respiratory quotient" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1839809" "palabras" => array:4 [ 0 => "Producción de dióxido de carbono" 1 => "Consumo de oxígeno" 2 => "Metabolismo anaeróbico" 3 => "Cociente respiratorio" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveCentral venous-arterial PCO2 to arterial-central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although Pcv-aCO2/Ca-cvO2 might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Our goal was to compare Pcv-aCO2/Ca-cvO2 and RQ in patients with septic shock. DesignProspective, observational study. SettingTwo adult ICUs. PatientsForty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation. InterventionsNone. Main variables of interestWe measured arterial and central venous gases, Hb, and O2Hb. Pcv-aCO2/Ca-cvO2 and the ratio of central venous-arterial CO2 content to arterial-central venous O2 content (Ccv-aCO2/Ca-cvO2) were calculated. RQ was determined by indirect calorimetry. ResultsPcv-aCO2/Ca-cvO2 and Ccv-aCO2/Ca-cvO2 were not correlated with RQ (R2 = 0.01, P = 0.50 and R2 = 0.01, P = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10−3.27 and 0.42, -1.53−2.37). A multiple linear regression model showed Hb, and central venous PCO2 and O2Hb, but not RQ, as Pcv-aCO2/Ca-cvO2 determinants (R2 = 0.36, P = 0.0007). ConclusionsIn patients with septic shock, Pcv-aCO2/Ca-cvO2 did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO2 from Hb. Pcv-aCO2/Ca-cvO2 seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution." "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Main variables of interest" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoLa relación entre la PCO2 venosa central-arterial y el contenido arterial-venoso central de O2 (Pvc-aCO2/Ca-vcO2) se emplea comúnmente como sustituto del cociente respiratorio (CR). Aunque la Pvc-aCO2/Ca-vcO2 puede asociarse a hiperlactacidemia y mayor mortalidad, la intercambiabilidad con CR y la correlación con variables definidas de metabolismo anaeróbico no se han demostrado en el shock séptico. Nuestro objetivo fue comparar Pvc-aCO2/Ca-vcO2 y CR en pacientes con shock séptico. DiseñoEstudio observacional y prospectivo. ÁmbitoDos UCIs de adultos. PacientesCuarenta y siete pacientes con shock séptico, ventilados mecánicamente, y con condiciones respiratorias y dosis de vasopresores estables, luego de la resucitación inicial. IntervencionesNinguna. Variables de interés principalesSe midieron gases arteriales y venosos centrales, Hb y O2Hb. Se calcularon Pcv-aCO2/Ca-cvO2 y la relación entre contenido venoso central-arterial de CO2 y el contenido arterial-venoso central de O2 (Cvc-aCO2/Ca-vcO2). El CR se determinó por calorimetría indirecta. ResultadosPvc-aCO2/Ca-vcO2 y Cvc-aCO2/Ca-vcO2 no correlacionaron con CR (R2 = 0.01, P = 0.50 and R2 = 0.01, P = 0.58, respectivamente) y tuvieron amplios sesgos y límites de concordancia del 95 % (1.09, -1.10−3.27 y 0.42, -1.53−2.37). El modelo de regresión lineal múltiple encontró Hb, PCO2 venosa central y O2Hb, pero no CR, como determinantes de Pvc-aCO2/Ca-vcO2 (R2 = 0.36, P = 0.0007). ConclusionesIn pacientes con shock séptico, Pvc-aCO2/Ca-vcO2 no tuvo correlación con CR y estuvo determinada principalmente por factores que modifican la disociación de CO2 desde la Hb. Pvc-aCO2/Ca-vcO2 parece ser un pobre sustituto de CR y sus valores deben interpretarse con precaución." "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables de interés principales" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0055" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 3008 "Tamanyo" => 332565 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation and agreement of central venous minus arterial PCO2 to arterial minus central venous O2 content and central venous minus arterial CO2 content to arterial minus central venous O2 content ratio with respiratory quotient. Panel A: Correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) and respiratory quotient. Panel B: Bland and Altman analysis between Pcv-aCO2/Ca-cvO2 and respiratory quotient. Panel C: Correlation between central venous minus arterial CO2 content to arterial minus central venous O2 content ratio (Ccv-aCO2/Ca-cvO2) and respiratory quotient. Panel D: Bland and Altman analysis between Ccv-aCO2/Ca-cvO2 and respiratory quotient." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: SOFA, Sepsis-related Organ Failure Assessment; APACHE, Acute Physiology and Chronic Health Evaluation.Data are expressed as mean ± standard deviation, median [IQR], or n (%)." "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survivors (n = 29) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nonsurvivors (n = 18) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 ± 13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 ± 15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 ± 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SOFA score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 ± 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 ± 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 ± 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">APACHE II score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 ± 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 ± 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 ± 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ICU mortality, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Source of sepsis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intraabdominal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intravascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Soft tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Norepinephrine (μg/kg/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12 [0.02−0.30] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09 (0.01−0.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2 (0.09−0.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean arterial pressure (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 ± 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 ± 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 ± 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart rate (beats/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 ± 18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 ± 16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 ± 21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temperature (°C) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7 ± 0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 ± 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 ± 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3573822.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and epidemiologic characteristics of the patients." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: Pcv-aCO2/Ca-cvO2, central venous-arterial PCO2 to arterial-central venous O2 content ratio; Pcv-aCO2/Ca-cvO2, central venous-arterial PCO2 to arterial-central venous O2 content ratio." "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survivors (n = 29) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nonsurvivors (n = 18) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial lactate on admission (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.32 ± 2.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.02 ± 1.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.80 ± 2.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial lactate on measurement (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.61 ± 2.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.84 ± 1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.74 ± 3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin (g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 ± 2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.90 ± 2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.95 ± 2.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.36 ± 0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.38 ± 0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.33 ± 0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial PCO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 ± 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 ± 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 ± 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial PO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 ± 23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 ± 19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 ± 28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial HCO3− (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 ± 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial base excess (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−3 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1 ± 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−4 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial O2Hb (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96 ± 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 ± 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 ± 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.33 ± 0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.35 ± 0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.29 ± 0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous PCO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 ± 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 ± 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 ± 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous PO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 ± 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 ± 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous HCO3− (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 ± 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous base excess (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−2 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 ± 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−3 ± 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous O2Hb (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 ± 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 ± 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 ± 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P50 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 ± 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 ± 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 ± 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pcv-aCO2/Ca-cvO2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.05 ± 1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.96 ± 0.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.18 ± 1.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ccv-aCO2/Ca-cvO2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.38 ± 0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.38 ± 1.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.38 ± 0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O2 consumption (mL/min/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">136 ± 47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">141 ± 39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">126 ± 59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CO2 production (mL/min/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124 ± 36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 ± 27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116 ± 46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory quotient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.96 ± 0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.94 ± 0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 ± 0.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3573823.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Values of arterial and central venous gases, co-oximetry, CO2-derived variables, and expired gases analysis." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pv-aCO2/Ca-vO2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coefficient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Standard error \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">t-ratio \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">[95% Confidence Interval] \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin (g/100 mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−2.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.27 to −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="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous O2Hb (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01–0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous PCO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04–0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3573824.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Multiple linear regression model for central venous-arterial PCO2 to arterial minus central venous O2 content ratio (Pcv-aCO2/Ca-cvO2)." ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 839942 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of hemorrhagic shock and reperfusion on the respiratory quotient in swine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.L. 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Original article

Lack of correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio and respiratory quotient in patients with septic shock: A prospective observational study

Falta de correlación entre la relación PCO2 venosa central-arterial/contenido arterial-venoso central de O2 y cociente respiratorio en pacientes con shock séptico: Estudio prospectivo observacional

Facundo J. Gutierreza, Mario O. Pozoa, Matías Mugnob, Sebastián P. Chapelac,d, Natalia Lloberad, María J. Reberendod, Gastón E. Muriasa, Paolo N. Rubatto Birrib, Vanina S. Kanoore Edulb, Arnaldo Dubinb,e,

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dubina@otamendi.com.ar

Corresponding author.

a Servicio de Terapia Intensiva, Hospital Británico, Perdriel 74 (C1280AEB), Ciudad Autónoma de Buenos Aires, Argentina

b Servicio de Terapia Intensiva, Sanatorio Otamendi, Azcuénaga 870 (C1115AAB), Ciudad Autónoma de Buenos Aires, Argentina

c Departamento de Bioquímica, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155 (C1121ABG), Ciudad Autónoma de Buenos Aires, Argentina

d Equipo de Soporte Nutricional, Hospital Británico, Perdriel 74 (C1280AEB), Ciudad Autónoma de Buenos Aires, Argentina

e Cátedras de Terapia Intensiva y Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Av.60 y Av. 120 (B1900), La Plata, Argentina

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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Correlation and agreement of central venous minus arterial PCO<span class="elsevierStyleInf">2</span> to arterial minus central venous O<span class="elsevierStyleInf">2</span> content and central venous minus arterial CO<span class="elsevierStyleInf">2</span> content to arterial minus central venous O<span class="elsevierStyleInf">2</span> content ratio with respiratory quotient&#46; Panel A&#58; Correlation between central venous minus arterial PCO<span class="elsevierStyleInf">2</span> to arterial minus central venous O<span class="elsevierStyleInf">2</span> content ratio &#40;P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; and respiratory quotient&#46; Panel B&#58; Bland and Altman analysis between P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and respiratory quotient&#46; Panel C&#58; Correlation between central venous minus arterial CO<span class="elsevierStyleInf">2</span> content to arterial minus central venous O<span class="elsevierStyleInf">2</span> content ratio &#40;C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; and respiratory quotient&#46; Panel D&#58; Bland and Altman analysis between C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and respiratory quotient&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The normalization of tissue perfusion and oxygenation is the final goal of septic shock resuscitation&#46; Unfortunately&#44; there is no gold standard for evaluation of tissue oxygenation&#46; The presence of hyperlactatemia or alterations in peripheral perfusion does not necessarily indicate tissue hypoxia In experimental models of oxygen supply dependence&#44; the abrupt increase in respiratory quotient &#40;RQ&#41;&#8212;the ratio of CO<span class="elsevierStyleInf">2</span> production &#40;VCO<span class="elsevierStyleInf">2</span>&#41; to O<span class="elsevierStyleInf">2</span> consumption &#40;VO<span class="elsevierStyleInf">2</span>&#41;&#8212;indicates the beginning of anaerobic metabolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> The RQ rises because the drop in VO<span class="elsevierStyleInf">2</span> exceeds the reduction in VCO<span class="elsevierStyleInf">2</span>&#46; Although VCO<span class="elsevierStyleInf">2</span> and VO<span class="elsevierStyleInf">2</span> decrease as a reflection of oxidative metabolism derangement&#44; the lower reduction in the former is explained by the surge in anaerobic VCO<span class="elsevierStyleInf">2</span> due to bicarbonate buffering of anaerobically generated protons&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The measurement of RQ requires a metabolic cart&#44; which is not usually available in the ICU&#46; Thus&#44; the ratio of mixed venous minus arterial PCO<span class="elsevierStyleInf">2</span> to arterial minus mixed venous O<span class="elsevierStyleInf">2</span> content &#40;P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span>&#41; was proposed as a surrogate for RQ&#46; In an observational study&#44; values of P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> higher than 1&#46;4 were associated with hyperlactatemia and worse outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Thereafter&#44; other studies used the ratio of venous minus arterial PCO<span class="elsevierStyleInf">2</span> to arterial minus central venous O<span class="elsevierStyleInf">2</span> content &#40;P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; to assess global oxygenation&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;9</span></a> To improve the ability of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> to reflect RQ&#44; calculated CO<span class="elsevierStyleInf">2</span> content difference has been used instead of PCO<span class="elsevierStyleInf">2</span> difference in the computation of the ratios&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> is thus recommended for the assessment of tissue oxygenation&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> Even though P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> might be associated with hyperlactatemia and outcome&#44; neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock&#46; Besides&#44; basic research suggested that P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> is more dependent on factors than modify the dissociation of CO<span class="elsevierStyleInf">2</span> from Hb than on the actual RQ and that it can increase in presence of preserved tissue oxygenation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In addition&#44; experimental studies failed to show a good correlation between P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> and RQ&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our goal was to compare P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ in patients with septic shock&#46; Our hypothesis was that P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> is a poor surrogate for RQ&#46; A secondary goal was to assess P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> determinants&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study was approved by the Institutional Review Board &#40;Comit&#233; de Revisi&#243;n Institucional del Hospital Brit&#225;nico&#41; on September 17&#44; 2021 &#40;CRIHB&#35;865&#44; project title&#58; Comparison of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and respiratory quotient in patients with septic shock&#41;&#46; The study was conducted in accordance with the Declaration of Helsinki of 1975&#46; Informed consent was obtained from the patient&#39;s next of kin&#46; We followed the Strengthening the Reporting of Observational Studies in Epidemiology &#40;STROBE&#41; recommendations for reporting cohort studies&#46; The completed checklist is included in the Appendix&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We studied patients older than 18 years recruited from two surgical&#47;medical ICUs&#44; from June 2020 to March 2023&#46; Septic shock diagnosis was based on the presence of a source of infection&#44; arterial hypotension refractory to fluid administration and so requiring vasopressors&#44; and blood lactate levels higher than 2&#46;0 mmol&#47;L&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> All patients were intubated and mechanically ventilated on controlled mode&#44; and received infusions of midazolam or propofol and fentanyl&#46; The Richmond Agitation-Sedation Scale was -5 for all patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Patients were included after initial resuscitation&#44; when respiratory settings and vasopressor dose remained stable over 1 h&#46; Patients with FiO<span class="elsevierStyleInf">2</span> &#8805;0&#46;60&#44; PEEP &#62; 10 cm H<span class="elsevierStyleInf">2</span>O&#44; tidal volume &#60;300 mL&#44; renal replacement therapy&#44; or airway leaks&#44; were excluded from the study since indirect calorimetry measurements might be unreliable in such conditions&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Demographic and clinical data were registered&#46; We measured VO<span class="elsevierStyleInf">2</span>&#44; VCO<span class="elsevierStyleInf">2</span>&#44; and RQ by indirect calorimetry &#40;MedGraphics CPX Ultima&#44; Medical Graphics Corporation&#44; St&#46; Paul&#44; MN&#44; and Mindray Metabolic Module&#44; Mindray Medical International&#44; Shenzhen&#44; China&#41;&#46; We used the mean of a 5-minute period of measurements when variations were less than 5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> During this period of time&#44; arterial and central venous samples were simultaneously obtained for the determination of pH&#44; PCO<span class="elsevierStyleInf">2</span>&#44; PO<span class="elsevierStyleInf">2</span>&#44; Hb&#44; and O<span class="elsevierStyleInf">2</span>Hb &#40;Cobas b 221&#44; Roche Diagnostics GmbH&#44; Mannheim&#44; Germany&#41;&#46; We calculated P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> by standard formulae and the ratio central venous minus arterial CO<span class="elsevierStyleInf">2</span> content to arterial minus central venous O<span class="elsevierStyleInf">2</span> content &#40;C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; by the Douglas&#8217; algorithm&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> P50&#44; the PO<span class="elsevierStyleInf">2</span> at which Hb is 50 &#37; saturated&#44; was also calculated&#46; A complete depiction of the formulae is shown in the Appendix&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Analysis of the data</span><p id="par0035" class="elsevierStylePara elsevierViewall">We estimated that 47 patients were required to demonstrate a moderate correlation between P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ &#40;r &#61; 0&#46;40&#41;&#44; with a significance level of 0&#46;05 and power of 80 &#37;&#46; Shapiro-Wilk test and quantile-quantile plots of the differences were used to test data normality&#46; Correlation and agreement between P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> with RQ were assessed with simple linear regression and Bland and Altman analysis&#46; To identify independent determinants of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#44; variables showing a <span class="elsevierStyleItalic">P</span>-value &#60;0&#46;20 in the simple linear regression and those physiologically plausible were entered into multiple linear regression analysis and a model was constructed&#46; Differences between survivors and nonsurvivors patients were assessed by unpaired <span class="elsevierStyleItalic">t</span>-test&#44; Mann-Whitney <span class="elsevierStyleItalic">U</span>-test&#44; or Chi-square test&#46; Patients were also compared according to arbitrary cutoffs of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ &#40;1&#46;4 and 1&#46;0&#44; respectively&#41;&#46; Data are shown as mean &#177; standard deviation&#44; median &#91;IQR&#93;&#44; or n &#40;&#37;&#41;&#46; A <span class="elsevierStyleItalic">P</span>-value &#60;0&#46;05 was considered as statistically significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">From 341 screened patients with septic shock&#44; 47 of them were included&#46; The time between the onset of shock and the measurements was 1 &#91;1&#8211;3&#93; days&#46; Most of the patients were not studied because indirect calorimetry measurements were not available at the screening time&#46; The flowchart of the study is shown in the Appendix &#40;Figure A1&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main epidemiological and clinical characteristics that did not differ between survivors and nonsurvivors&#46; Neither there were differences according to the cutoffs of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ &#40;Tables A1 and A2&#41;&#46; Nonsurvivors showed lower pH and higher lactate levels than survivors&#46; Survivors and nonsurvivors had high mean values of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#44; which were not different between groups&#46; Values of RQ were in the normal range and not different between groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Patients with P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> &#60;1&#46;4 had lower arterial and central venous bicarbonate&#44; and lower central venous PCO<span class="elsevierStyleInf">2</span> than patients with P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> &#62;1&#46;4 &#40;Table A3&#41; Patients with RQ &#60; 1&#46;0 showed higher VO<span class="elsevierStyleInf">2</span> and central venous PO<span class="elsevierStyleInf">2</span> than patients with RQ &#62; 1&#46;0 &#40;Table A4&#41;&#46; Arterial lactate was not different among these subgroups &#40;Tables A3 and A4&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> showed weak correlations and wide 95 &#37; limits of agreement with RQ &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Similar correlations were obtained considering the different metabolic carts used in each hospital &#40;R<span class="elsevierStyleSup">2</span> &#61; 0&#46;00&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;71 and R<span class="elsevierStyleSup">2</span> &#61; 0&#46;00&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;81 for MedGraphics CPX Ultima&#44; and R<span class="elsevierStyleSup">2</span> &#61; 0&#46;05&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;57 and R<span class="elsevierStyleSup">2</span> &#61; 0&#46;03&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;64 for Mindray Metabolic Module&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The multiple linear regression model showed hemoglobin&#44; central venous PCO<span class="elsevierStyleInf">2</span>&#44; and central venous O<span class="elsevierStyleInf">2</span>Hb as P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> determinants &#40;R<span class="elsevierStyleSup">2</span> &#61; 0&#46;36&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;0007&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Our main finding was the absence of a significant correlation between of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ&#46; In addition&#44; P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> was independently determined by factors that modify the dissociation of CO<span class="elsevierStyleInf">2</span> from Hb&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Since RQ has sudden increases during experimental models of oxygen supply dependency&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> a surrogate<span class="elsevierStyleGlyphsbnd"></span>P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphsbnd"></span>has been used as a tool to assess the adequacy of tissue oxygenation&#46; Thus&#44; observational studies found some relationship of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> to hyperlactatemia and outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;9</span></a> Nevertheless&#44; the agreement between P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ&#44; and its ability to reflect tissue hypoxia have never been shown&#46; In addition&#44; a randomized controlled trials failed to show usefulness of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> as a goal for resuscitation&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Despite lack of clear evidence&#44; some reviews have recommended its utilization and incorporated it in algorithms for the assessment and treatment of shock states&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> As recently shown in a systematic review and meta-analysis&#44; high values of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> have an association with mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The ability to predict outcome&#44; however&#44; is similar or probably lower than that of lactate&#46; Moreover&#44; its prognostic value might be related to some of its determinants&#8212;anemia and metabolic acidosis&#8212;and not to the ability to reflect anaerobic metabolism&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The rationale for the use of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> in the assessment of tissue oxygenation in patients with septic shock is based on the behavior of RQ in animal models of anaerobic metabolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> Yet&#44; no clinical study has comprehensively addressed this issue&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> On the other hand&#44; experimental studies showed that P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> might not reflect the changes in the RQ and the adequacy of tissue oxygenation&#46; During stepwise reductions in oxygen transport &#40;DO<span class="elsevierStyleInf">2</span>&#41;&#44; P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> was almost five times higher in anemic than in ischemic hypoxia despite comparable degrees of anaerobic metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Moreover&#44; P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> increased even before the beginning of the oxygen supply dependence and the rise of RQ&#46; Similar results were reported in hypoxic hypoxia&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In experimental hemorrhagic shock&#44; blood transfusion was associated with restoration of oxidative metabolism&#44; as shown by the normalization of oxygen transport&#44; VO<span class="elsevierStyleInf">2</span>&#44; and RQ&#46; Despite this&#44; P<span class="elsevierStyleInf">mv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-mv</span>O<span class="elsevierStyleInf">2</span> remained elevated&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In our series of patients with septic shock&#44; there was no correlation between P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ&#46; Moreover&#44; high P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> values coexisted with normal values of RQ&#46; These findings might be explained by the fact that P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> is more dependent on Hb levels&#44; Haldane effect&#44; metabolic acidosis&#44; and the position in the CO<span class="elsevierStyleInf">2</span>Hb dissociation&#44; than on the actual RQ&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In the present study&#44; we also showed that P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> depends on some factors that modify dissociation of CO<span class="elsevierStyleInf">2</span> from Hb&#44; such as Haldane effect and Hb levels&#46; In contrast&#44; we found that base excess or lactate did not behave as determinants P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Unlike animal studies that show poor but significant correlations&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> we found an almost null regression coefficient between P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ&#46; Differences might be related to different facts&#46; In animal studies&#44; mixed venous instead of central venous samples were used for the calculation of the ratio&#46; An observational study in patients with septic shock showed the lack of interchangeability between both determinations&#44; with unacceptable wide 95&#37; limits of agreement of 1&#46;48&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The main explanation&#44; however&#44; might be that in the experimental studies there was a wide range of variation in the RQ&#44; which increased during the severe reductions in DO<span class="elsevierStyleInf">2</span>&#46; On the contrary&#44; RQ remained in the normal physiologic range in the present study&#46; Thus&#44; RQ is a main determinant of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> only in real anaerobic conditions&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We found high values of P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and C<span class="elsevierStyleInf">v-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> &#40;2&#46;05 &#177; 1&#46;07 and 1&#46;38 &#177; 0&#46;95&#44; respectively&#41; that could be considered indicative of anaerobic metabolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Even though our patients were critically ill&#44; the respiratory and the hemodynamic status and the norepinephrine requirement had been unchanged over the last hour&#46; Moreover&#44; the RQ stayed at normal range &#40;0&#46;96 &#177; 0&#46;21&#41;&#46; Consequently&#44; their condition did not evoke a state of oxygen supply dependence&#44; which is characterized by a rapid decline leading to cardiac arrest&#46; The surge in RQ that develops in models of tissue hypoxia constitutes an extreme event associated with an impending death &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; mean blood pressure of 27 &#177; 2 mmHg in hemorrhagic shock or Hb of 1&#46;2 &#177; 0&#46;1 g&#47;dL in hemodilution&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Therefore&#44; it is unlikely that the high P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and C<span class="elsevierStyleInf">v-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> found in this study can denote global tissue hypoxia&#46; Accordingly&#44; arterial lactate levels did not differ between patients with P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> lower or higher than 1&#46;4&#46; In line with our results&#44; P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> did not predict the decrease blood lactate after increases in cardiac output induced by volume expansion in critically ill patients&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> neither correlated with lactate-to-pyruvate ratio during the resuscitation of septic shock&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Although the incorporation of CO<span class="elsevierStyleInf">2</span> content instead of PCO<span class="elsevierStyleInf">2</span> difference in the calculation might improve the performance of the ratio&#44; C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> also showed poor correlation with RQ&#46; This finding is probably related to limitations of the calculation of CO<span class="elsevierStyleInf">2</span> content&#58; it frequently results in unacceptable errors&#44; such as negative C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#46; Indeed&#44; this occurred in three of our measurements suggesting that the algorithm might be misleading for this purpose &#40;see <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> Panel C&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Our study has some limitations&#46; We only performed a single set of measurements at a particular timepoint&#44; which could not be representative of patients&#8217; evolution over time&#46; In addition&#44; many patients were not included because indirect calorimetry was unavailable&#46; This might limit the generalizability of our findings&#46; Finally&#44; each center used a different metabolic cart&#44; each of which was previously validated&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#8211;28</span></a> Since the results of different devices are not interchangeable&#44; this could be a further drawback of the study&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In spite of this&#44; the results were quite similar considering each device separately&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first study comparing P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> with RQ&#44; in patients with septic shock&#46; Neither P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> nor C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> was correlated with RQ&#46; Our results suggest that in patients with septic shock P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> should be interpreted cautiously&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no competing interests&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Authors&#8217; contributions</span><p id="par0110" class="elsevierStylePara elsevierViewall">Conception and design&#58; FJG&#44; MOP&#44; and AD&#59; acquisition of data&#58; FJG&#44; MN&#44; SPC&#44; NL&#44; MJR&#44; PNRB&#44; and VSKE&#59; statistical analysis&#58; FJG&#59; drafting of the manuscript&#58; FJG and AD&#46; All authors critically revised the article and approved the final version&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study was supported by the grant <span class="elsevierStyleGrantNumber" refid="gs0005">PICT-2018-03977</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0005">Agencia Nacional de Promoci&#243;n Cient&#237;fica y Tecnol&#243;gica</span>&#44; Argentina&#44; which was not involved in study design&#59; in the collection&#44; analysis and interpretation of data&#59; in the writing of the report&#59; and in the decision to submit the article for publication&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Central venous-arterial PCO<span class="elsevierStyleInf">2</span> to arterial-central venous O<span class="elsevierStyleInf">2</span> content ratio &#40;P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; is commonly used as a surrogate for respiratory quotient &#40;RQ&#41; and tissue oxygenation&#46; Although P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> might be associated with hyperlactatemia and outcome&#44; neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock&#46; Our goal was to compare P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and RQ in patients with septic shock&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; observational study&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Two adult ICUs&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables of interest</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">We measured arterial and central venous gases&#44; Hb&#44; and O<span class="elsevierStyleInf">2</span>Hb&#46; P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and the ratio of central venous-arterial CO<span class="elsevierStyleInf">2</span> content to arterial-central venous O<span class="elsevierStyleInf">2</span> content &#40;C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; were calculated&#46; RQ was determined by indirect calorimetry&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> were not correlated with RQ &#40;R<span class="elsevierStyleSup">2</span> &#61; 0&#46;01&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;50 and R<span class="elsevierStyleSup">2</span> &#61; 0&#46;01&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;58&#44; respectively&#41;&#44; showing large bias and wide 95 &#37; limits of agreement with RQ &#40;1&#46;09&#44; -1&#46;10&#8722;3&#46;27 and 0&#46;42&#44; -1&#46;53&#8722;2&#46;37&#41;&#46; A multiple linear regression model showed Hb&#44; and central venous PCO<span class="elsevierStyleInf">2</span> and O<span class="elsevierStyleInf">2</span>Hb&#44; but not RQ&#44; as P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> determinants &#40;R<span class="elsevierStyleSup">2</span> &#61; 0&#46;36&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;0007&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">In patients with septic shock&#44; P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO<span class="elsevierStyleInf">2</span> from Hb&#46; P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> seems to be a poor surrogate for RQ&#59; therefore&#44; its values should be interpreted with caution&#46;</p></span>"
        "secciones" => array:8 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Setting"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Patients"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Interventions"
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          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Main variables of interest"
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          6 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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          7 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La relaci&#243;n entre la PCO<span class="elsevierStyleInf">2</span> venosa central-arterial y el contenido arterial-venoso central de O<span class="elsevierStyleInf">2</span> &#40;P<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span>&#41; se emplea com&#250;nmente como sustituto del cociente respiratorio &#40;CR&#41;&#46; Aunque la P<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span> puede asociarse a hiperlactacidemia y mayor mortalidad&#44; la intercambiabilidad con CR y la correlaci&#243;n con variables definidas de metabolismo anaer&#243;bico no se han demostrado en el shock s&#233;ptico&#46; Nuestro objetivo fue comparar P<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span> y CR en pacientes con shock s&#233;ptico&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional y prospectivo&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Dos UCIs de adultos&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Cuarenta y siete pacientes con shock s&#233;ptico&#44; ventilados mec&#225;nicamente&#44; y con condiciones respiratorias y dosis de vasopresores estables&#44; luego de la resucitaci&#243;n inicial&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de inter&#233;s principales</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Se midieron gases arteriales y venosos centrales&#44; Hb y O<span class="elsevierStyleInf">2</span>Hb&#46; Se calcularon P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> y la relaci&#243;n entre contenido venoso central-arterial de CO<span class="elsevierStyleInf">2</span> y el contenido arterial-venoso central de O<span class="elsevierStyleInf">2</span> &#40;C<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span>&#41;&#46; El CR se determin&#243; por calorimetr&#237;a indirecta&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">P<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span> y C<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span> no correlacionaron con CR &#40;R<span class="elsevierStyleSup">2</span> &#61; 0&#46;01&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;50 and R<span class="elsevierStyleSup">2</span> &#61; 0&#46;01&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;58&#44; respectivamente&#41; y tuvieron amplios sesgos y l&#237;mites de concordancia del 95 &#37; &#40;1&#46;09&#44; -1&#46;10&#8722;3&#46;27 y 0&#46;42&#44; -1&#46;53&#8722;2&#46;37&#41;&#46; El modelo de regresi&#243;n lineal m&#250;ltiple encontr&#243; Hb&#44; PCO<span class="elsevierStyleInf">2</span> venosa central y O<span class="elsevierStyleInf">2</span>Hb&#44; pero no CR&#44; como determinantes de P<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span> &#40;R<span class="elsevierStyleSup">2</span> &#61; 0&#46;36&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;0007&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">In pacientes con shock s&#233;ptico&#44; P<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span> no tuvo correlaci&#243;n con CR y estuvo determinada principalmente por factores que modifican la disociaci&#243;n de CO<span class="elsevierStyleInf">2</span> desde la Hb&#46; P<span class="elsevierStyleInf">vc-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-vc</span>O<span class="elsevierStyleInf">2</span> parece ser un pobre sustituto de CR y sus valores deben interpretarse con precauci&#243;n&#46;</p></span>"
        "secciones" => array:8 [
          0 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "&#193;mbito"
          ]
          3 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Pacientes"
          ]
          4 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Intervenciones"
          ]
          5 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Variables de inter&#233;s principales"
          ]
          6 => array:2 [
            "identificador" => "abst0075"
            "titulo" => "Resultados"
          ]
          7 => array:2 [
            "identificador" => "abst0080"
            "titulo" => "Conclusiones"
          ]
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    "apendice" => array:1 [
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        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0125" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0055"
          ]
        ]
      ]
    ]
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      0 => array:8 [
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        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Correlation and agreement of central venous minus arterial PCO<span class="elsevierStyleInf">2</span> to arterial minus central venous O<span class="elsevierStyleInf">2</span> content and central venous minus arterial CO<span class="elsevierStyleInf">2</span> content to arterial minus central venous O<span class="elsevierStyleInf">2</span> content ratio with respiratory quotient&#46; Panel A&#58; Correlation between central venous minus arterial PCO<span class="elsevierStyleInf">2</span> to arterial minus central venous O<span class="elsevierStyleInf">2</span> content ratio &#40;P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; and respiratory quotient&#46; Panel B&#58; Bland and Altman analysis between P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and respiratory quotient&#46; Panel C&#58; Correlation between central venous minus arterial CO<span class="elsevierStyleInf">2</span> content to arterial minus central venous O<span class="elsevierStyleInf">2</span> content ratio &#40;C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41; and respiratory quotient&#46; Panel D&#58; Bland and Altman analysis between C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span> and respiratory quotient&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; SOFA&#44; Sepsis-related Organ Failure Assessment&#59; APACHE&#44; Acute Physiology and Chronic Health Evaluation&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Data are expressed as mean &#177; standard deviation&#44; median &#91;IQR&#93;&#44; or n &#40;&#37;&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survivors &#40;n &#61; 29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nonsurvivors &#40;n &#61; 18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#177; 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#177; 15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#177; 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender male&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">SOFA score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#177; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#177; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#177; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">APACHE II score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#177; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#177; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#177; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ICU mortality&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Source of sepsis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intraabdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urinary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intravascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soft tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Norepinephrine &#40;&#956;g&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12 &#91;0&#46;02&#8722;0&#46;30&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;09 &#40;0&#46;01&#8722;0&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2 &#40;0&#46;09&#8722;0&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean arterial pressure &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#177; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#177; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#177; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart rate &#40;beats&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#177; 18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#177; 16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#177; 21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Temperature &#40;&#176;C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;7 &#177; 0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#177; 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#177; 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3573822.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical and epidemiologic characteristics of the patients&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#44; central venous-arterial PCO<span class="elsevierStyleInf">2</span> to arterial-central venous O<span class="elsevierStyleInf">2</span> content ratio&#59; P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#44; central venous-arterial PCO<span class="elsevierStyleInf">2</span> to arterial-central venous O<span class="elsevierStyleInf">2</span> content ratio&#46;</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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survivors &#40;n &#61; 29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nonsurvivors &#40;n &#61; 18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial lactate on admission &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;32 &#177; 2&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;02 &#177; 1&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;80 &#177; 2&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial lactate on measurement &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;61 &#177; 2&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;84 &#177; 1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;74 &#177; 3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobin &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;5 &#177; 2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;90 &#177; 2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;95 &#177; 2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;36 &#177; 0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;38 &#177; 0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;33 &#177; 0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial PCO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#177; 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#177; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#177; 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial PO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92 &#177; 23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#177; 19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#177; 28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8722;</span> &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial base excess &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;3 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;4 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial O<span class="elsevierStyleInf">2</span>Hb &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#177; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97 &#177; 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#177; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;33 &#177; 0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;35 &#177; 0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;29 &#177; 0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous PCO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#177; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#177; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#177; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous PO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#177; 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#177; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8722;</span> &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous base excess &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;3 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous O<span class="elsevierStyleInf">2</span>Hb &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#177; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#177; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#177; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P50 &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#177; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#177; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#177; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;05 &#177; 1&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;96 &#177; 0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;18 &#177; 1&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;38 &#177; 0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;38 &#177; 1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;38 &#177; 0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O<span class="elsevierStyleInf">2</span> consumption &#40;mL&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136 &#177; 47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141 &#177; 39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126 &#177; 59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CO<span class="elsevierStyleInf">2</span> production &#40;mL&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#177; 36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#177; 27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116 &#177; 46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Respiratory quotient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96 &#177; 0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94 &#177; 0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99 &#177; 0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3573823.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Values of arterial and central venous gases&#44; co-oximetry&#44; CO<span class="elsevierStyleInf">2</span>-derived variables&#44; and expired gases analysis&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
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            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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P<span class="elsevierStyleInf">v-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-v</span>O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coefficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Standard error&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">t</span>-ratio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P-</span>value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#91;95&#37; Confidence Interval&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobin &#40;g&#47;100 mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;27 to &#8722;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous O<span class="elsevierStyleInf">2</span>Hb &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&#8211;0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous PCO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&#8211;0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3573824.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Multiple linear regression model for central venous-arterial PCO<span class="elsevierStyleInf">2</span> to arterial minus central venous O<span class="elsevierStyleInf">2</span> content ratio &#40;P<span class="elsevierStyleInf">cv-a</span>CO<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">a-cv</span>O<span class="elsevierStyleInf">2</span>&#41;&#46;</p>"
        ]
      ]
      4 => array:5 [
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Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2024.06.005

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