الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Septic shock is a common health problem we face every day with increasing concern in recent years so early detection and proper management of septic shock will help in better prognosis.
Different modalities had been developed to be applied within the first hour of patient’s admission to the critical care department to assist in patient’s prognosis like qSOFA Score, APACHE II Score, ScvO2, CO2 gap till Combined P (cv-a) CO2 with C (a-v) O2 difference which presented more accurate prognostic tool.
The aim of this study was to assess the benefit of combining Central venous to arterial carbon dioxide difference with arterial to venous Oxygen content as a prognostic factor of tissue perfusion during early resuscitation of patients with septic shock.
We conducted an observational prospective cohort study in Critical Care Department of Alexandria University Hospitals applied to forty eight patients of both sexes within first hour of hospital admission with resuscitation according to surviving sepsis campaign guidelines.
In our study 23 male patients and 25 female patients were included with diabetes mellitus being the most common risk factor regarding past medical history in both groups and pneumonia as the most common source of infection accounting for 31.2% of total cases.
It was found that PcvaCO2/CavO2 ratio was more accurate parameter than ScvO2 and CO2 gap when applied in first hour and after six hours of resuscitation and the PcvaCO2/CavO2 ratio with cut off value >1.3 after 6 hours of resuscitation showed poor prognosis and higher mortality rate with sensitivity 85% and specificity 71.43% and it was associated with increased lactate level, higher Nor Epinephrine dose and lower MAP in severe shocked patients indicating the need for more effective resuscitation.
In our study the mean PcvaCO2/CavO2 ratio at T0 was 1.24 ± 0.27 in lactate improvers group compared to mean 1.69 ± 0.48 in lactate non improvers group and at T6 the mean was 1.15 ± 0.25 in lactate improvers group compared to mean 2.10 ± 0.76 in lactate non improvers group and the mean lactate level at T0 was 4.88 ± 2.41 in lactate improvers group compared to mean 7.60 ± 4.07 in lactate non improvers group and at T6 lactate level decreased with mean 2.86 ± 1.60 in lactate improvers group and increased with mean 10.85 ± 3.77 in lactate non improvers group.