저혈량성 쇼크 환자에서 병원 내 사망률 예측과 초기 소생술의 치료 지표로서쇼크인덱스, 혈청 젖산 농도, 동맥혈-호기말 이산화탄소 분압차의 유용성 = Shock Index, Serum Lactate Level, andArterial-End Tidal Carbon DioxideDifference as Hospital MortalityMarkers and Guidelines of EarlyResuscitation in Hypovolemic Shock

다국어 초록 (Multilingual Abstract)

Purpose: To determine whether differences in arterial and
end-tidal carbon dioxide [P(a-et)CO2], shock index, and
serum lactate levels are helpful for predicting the outcome
of resuscitation in hypovolemic shock patients in the emergency
department.
Methods: A prospective study of end-tidal carbon dioxide
(EtCO2)-derived variables and patient outcomes in hypovolemic
shock was conducted in the emergency department
of a university hospital from January 2005 to February
2006. A total of fifty-eight hypovolemic shock patients over
20 years old were included. During resuscitation, patients
received volume replacement including blood transfusions,
as well as vasopressor or inotropic therapy if needed.
Results: Twenty-one patients died in the hospital. At the
time of admission (hour 0) and after resuscitation (hour 4),
there were no differences related to age, respiration and
heart rate, CVP, arterial blood gases, or EtCO2 between
survivors and non-survivors. Non-survivors had significantly
higher shock index scores, serum lactate levels, and P(a-et)
CO2 than the survivors. The Receiver operator characteristic
(ROC) curves at hour 4 hour for P(a-et)CO2 were as
effective for predicting mortality as were the shock index
and serum lactate levels. Shock index > 1.0, P(a-et)CO2 > 4
mmHg, and serum lactate > 5.0 mmol/L after resuscitation
were all associated with a high early mortality rate
(p=0.074, 0.001, 0.000, respectively).
Conclusion: P(a-et)CO2, shock index, and serum lactate
levels are predictive of in-hospital mortality and may be useful
as guidelines in the resuscitation of hypovolemic shock
patients in the emergency department.

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