Impact of renal dysfunction on weaning from prolonged mechanical ventilation

Background

When used during extracorporeal membrane oxygenation (ECMO), jugular venous bulb catheters, known as cephalad cannulae, increase venous drainage, augment circuit flow and decompress cerebral venous pressure. Optimized cerebral oxygen delivery during ECMO may contribute to a reduction in neurological morbidity. This study describes the use of cephalad cannulae and identifies rudimentary data for jugular venous oxygen saturation (JVO₂) and arterial to jugular venous oxygen saturation difference (AVDO₂) in this patient population.

Results

Patients on venoarterial (VA) ECMO displayed higher JVO₂ (P < 0.01) and lower AVDO₂ (P = 0.01) than patients on venovenous (VV) ECMO (P < 0.01). During VV ECMO, JVO₂ was higher and AVDO₂ lower when systemic pH was < 7.35 rather than > 7.4 (P = 0.01). During VA ECMO, similar differences in AVDO₂ but not in JVO₂ were observed at different pH levels (P = 0.01).

Conclusions

Jugular venous saturation and AVDO₂ were influenced by systemic pH, ECMO type and patient age. These data provide the foundation for normative values of JVO₂ and AVDO₂ in neonates and children treated with ECMO.     

LabVIEW: A software system for data acquisition,data analysis,and instrument control

Computer-based data acquisition systems play an important role in clinical monitoring and in the development of new monitoring tools. LabVIEW (National Instruments, Austin, TX) is a data acquisition and programming environment that allows flexible acquisition and processing of analog and digital data. The main feature that distinguishes LabVIEW from other data acquisition programs is its highly modular graphical programming language, G, and a large library of mathematical and statistical functions. The advantage of graphical programming is that the code is flexible, reusable, and self-documenting. Subroutines can be saved in a library and reused without modification in other programs. This dramatically reduces development time and enables researchers to develop or modify their own programs. LabVIEW uses a large amount of processing power and computer memory, thus requiring a powerful computer. A large-screen monitor is desirable when developing larger applications. LabVIEW is excellently suited by testing new monitoring paradigms, analysis algorithms, or user interfaces. The typical LabVIEW user is the researcher who wants to develop a new monitoring technique, a set of new (derived) variables by integrating signals from several existing patient monitors, closed-loop control of a physiological variable, or a physiological simulator.     

Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study

The aim of this study was to investigate the effect of controlled hypotension on cerebral oxygen saturation (rSO₂) using near infrared spectroscopy (NIRS) and evaluation of postoperative cognitive function in patients undergoing rhinoplasty. Fifty adult patients who were scheduled for elective rhinoplasty surgery and required controlled hypotension were enrolled in this prospective study. Controlled hypotension was provided using a combination of propofol and remifentanil infusion supplemented with nitroglycerin infusion as necessary. rSO₂ was evaluated during controlled hypotension by NIRS. Cerebral desaturation was observed in 5 out of 50 patients (10 %) during hypotensive anesthesia. The greatest decrease from baseline was 28 % when MAP was 57 mmHg. In both non-desaturated and desaturated patients, postoperative MMSE scores were significantly lower than preoperative scores. There was a 4 % decrease in the non-desaturated patients and a 7 % decrease in the desaturated patients when preoperative and postoperative MMSE scores were compared. A decline in cognitive function 1 day after surgery was observed in 23 patients (46 %) and in all patients with intraoperative cerebral desaturation. The current study showed that even if SpO₂ is in the normal range, there might be a decrease of more than 20 % in cerebral oxygen saturation during controlled hypotension.     

Journal of clinical monitoring and computing 2016 end of year summary: monitoring cerebral oxygenation and autoregulation

In the perioperative and critical care setting, monitoring of cerebral oxygenation (ScO₂) and cerebral autoregulation enjoy increasing popularity in recent years, particularly in patients undergoing cardiac surgery. Monitoring ScO₂ is based on near infrared spectroscopy, and attempts to early detect cerebral hypoperfusion and thereby prevent cerebral dysfunction and postoperative neurologic complications. Autoregulation of cerebral blood flow provides a steady flow of blood towards the brain despite variations in mean arterial blood pressure (MAP) and cerebral perfusion pressure, and is effective in a MAP range between approximately 50–150 mmHg. This range of intact autoregulation may, however, vary considerably between individuals, and shifts to higher thresholds have been observed in elderly and hypertensive patients. As a consequence, intraoperative hypotension will be poorly tolerated, and might cause ischemic events and postoperative neurological complications. This article summarizes research investigating technologies for the assessment of ScO₂ and cerebral autoregulation published in the Journal of Clinical Monitoring and Computing in 2016.     

Cerebral oxygen desaturation occurs frequently in patients with hypertension undergoing major abdominal surgery

Hypertensive patients are more likely to experience latent cerebral ischemia causing regional cerebral oxygen saturation (rSO₂) decrease during general anesthesia. The aim of this prospective observational study was to assess the incidence of decreased rSO₂ in hypertensive patients undergoing major abdominal surgery and the perioperative factors affecting this change in rSO₂. A total of 41 hypertensive patients were enrolled and stratified according to their hypertension as controlled and uncontrolled. The intraoperative rSO₂ and physiological data were routinely collected. The Mini-Mental State Exam (MMSE) was used to test cognitive function before surgery and after 4 days. Cerebral desaturation was defined as a decrease in rSO₂ of more than 20% of the baseline value. There were 20 patients (49%) suffering intraoperative cerebral desaturation classified into cerebral desaturation group (group D) and those 21 without intraoperative desaturation classified into normal group (group N). The area under the curve below 90 and 80% of baseline (AUC_{rSO2 <90% of baseline} and AUC_{rSO2 <80% of baseline}) was lower in patients of group N (2752.4?±?1453.3 min% and 0.0 min%) than in patients of group D (6264.9?±?1832.3 min% and 4486.5?±?1664.9 min%, P?<?0.001). Comparing the two groups, the number of uncontrolled hypertensive individuals in group D (12/20) was significantly more than group N (4/21) (P?=?0.007). A significant correlation was observed between relative decrease in MAP and relative decrease in rSO₂ (r²?=?0.495, P?<?0.001). Moreover, nine patients (45%) in group D occurred early postoperative cognitive function decline were more than three patients (14.3%) in group N (P?=?0.031). This pilot study showed a large proportion of hypertensive patient experienced cerebral desaturation during major abdominal surgery and uncontrolled hypertension predisposed to this desaturation. NCT02147275 (registered at http://www.clinicaltrials.gov).     

Effects of peripheral cold application on core body temperature and haemodynamic parameters in febrile patients

This study designed to assess the effects of peripheral cold application (PCA) on core body temperature and haemodynamic parameters in febrile patients. This study was an experimental, repeated‐measures performed in the neurosurgical intensive‐care unit. The research sample included all patients with fever in postoperative period. PCA was performed for 20 min. During fever, systolic blood pressure, mean arterial blood pressure and arterial oxygen saturation (O₂Sat) decreased by 5.07 ± 7.89 mm Hg, 0.191 ± 6.00 mm Hg and 0.742% ± 0.97%, respectively, whereas the pulse rate and diastolic blood pressure increased by 8.528 ± 4.42 beats/ min and 1.842 ± 6.9 mmHg, respectively. Immediately after PCA, core body temperature and pulse rate decreased by 0.3°C, 3.3 beats/min, respectively, whereas systolic, diastolic, mean arterial blood pressure and O₂Sat increased by, 1.40 mm Hg, 1.87 mm Hg, 0.98 mmHg and 0.27%, respectively. Thirty minutes after the end of PCA, core body temperature, diastolic, mean arterial blood pressure and pulse rate decreased by 0.57°C, 0.34 mm Hg, 0.60 mm Hg and 4.5 beats/min, respectively, whereas systolic blood pressure and O₂Sat increased by 0.98 mm Hg and 0.04%, respectively. The present results showed that PCA increases systolic, diastolic, mean arterial blood pressure and O₂Sat, and decreases core body temperature and pulse rate.     

Transition to an All-Digital Echocardiography Laboratory: A Large, Multi-site Private Cardiology Practice Experience

Acquisition, interpretation, and storage of digital echocardiographic images has many advantages over the standard videotape-based method. Archival, transmission, and comparative interpretation are all optimized with digital echocardiography. A study performed at one site can be immediately available for viewing and analysis at another site by means of standard data transfer technology. Echocardiograms can be interpreted in the context of prior studies, which are readily available for side-by-side comparison. The transition to an all-digital laboratory involves the commitment of persons at multiple levels in the cardiology practice, including administrators, information technology specialists, sonographers, and physicians. Quality of patient care, use of physicians' and sonographers' time, and long-term financial benefit are all areas where improvement may be realized with the use of digital echocardiography. We present our experience in the development of an all-digital echocardiography laboratory, and we conclude that digital echo-cardiography is practical and can be implemented readily in a clinical setting. We performed several correlative analyses during this transition to validate the consistency and accuracy of digital interpretation compared with those of analog methods. The transition process from analog (videotape) to digital, including full wide area network exchange, took approximately 8 months. As technology advances, issues surrounding storage, comparison, and acquisition formats will continue to develop. We hope that our experience will help others make the transition to the digital environment and benefit from the ease of image access, the ability to comparatively interpret echocardiograms, and the superior image quality afforded by this advancement.     

老年开胸患者术后不同镇痛方式的比较

目的：比较硬膜外自控镇痛（PCEA）、静脉自控镇痛（PCIA）和间断肌注镇痛三种方式用于老年患者开胸术后镇痛的效果及不良反应。方法：选择90例老年开胸手术病人，随机分为PCEA组（n=30）、PCIA组（n=30）和曲马多肌注组（n=30），分别记录患者VAS镇痛评分、镇静评分、不良反应及HR、MAP、SpO2值。结果：镇痛评分PCEA、PCIA组低于肌注组（P〈0．01），且PCEA组低于PCIA组（P〈0．01）；镇静评分PCEA、PCI-A组高于肌注组（P〈0．01），且PCIA组高于PCEA组（P〈0．01）；不良反应以PCEA组最低（P〈0．01）；HR、MAP、SpO2以PCEA组最平稳（P〈0．01）。结论：老年患者开胸术后3种镇痛方式中，肌注曲马多不能取得完善的镇痛效果，PCIA和PCEA镇痛效果满意，但PCEA优于PCIA。     

Comparison of radial and femoral arterial blood pressures in children after cardiopulmonary bypass

We compared radial and femoral arterial blood pressures in 29 patients, ranging in age from 1.25 to 17 years, during and after cardiopulmonary bypass for repair of congenital heart disease. Radial mean arterial pressure (MAP) was more than 10% lower than femoral MAP in 17 patients (58%), and in 7 of these patients (24%) radial MAP was more than 20% lower than femoral MAP. In 27 of 29 patients (93%) systolic radial pressure was 10% lower than systolic femoral pressure, and in 20 of these (69%) it was more than 20% lower. The ratio of radial to femoral pressure correlated with MAP (i.e., lower MAP produced greater differences), and the ratio of systolic radial to systolic femoral pressure inversely correlated with systemic vascular resistance index. We found no correlation between femoral-minus-radial pressure difference and postoperative course. These data demonstrate that radial arterial pressure may be misleadingly low in children undergoing operation for correction of congenital cardiac defects.     

The SvO2 study: General design and results of the feasibility phase of a multicenter,randomized trial of three different hemodynamic approaches and two monitoring techniques in the treatment of critically ill patients

Although the attainment of normal hemodynamic values has always been assumed to be the therapeutic target for critically ill patients, recent studies reported increased values in oxygen transport variables in survivors of high-risk surgery. It has been supposed that the higher values observed in survivors might indicate a physiological compensation for the increased metabolic requirements due to disease. We designed a randomized, multicentric trial to evaluate the effect of high values of cardiac index (CI) and oxygen delivery (DO₂) in critically ill patients. Patients enrolled in the study are randomized to three different hemodynamic targets: normal values of CI (2.5 ≤ CI ≤ 3.5 L min⁻¹ m⁻²), supranormal values of CI (CI ≥ 4.5 L min⁻ m⁻²), and mixed venous oxygen saturation (SvO₂) ≥ 70% or (Sat a—Sat v) ≤ 20%. Two different monitoring systems are used to maintain the target: conventional Swan-Ganz catheter with scheduled samples of mixed venous O₂ saturation, and optical catheter with continuous SvO₂ evaluation. The aim of the study is to answer three questions regarding the hypothesis reported above: (1) Are results in postoperative patients applicable to other pathological groups? (2) Does continuous monitoring of SvO₂ provide advantages over conventional hemodynamic monitoring? (3) Is a normal SvO₂ rather than a supranormal CI a good and predictable therapeutic goal? We report herein the protocol of the study and the results of the pilot phase, which was conducted in 98 critically ill patients enrolled by 56 participating centers to evaluate the safety and feasibility of the proposed trial.     

The Kodak approach to digital cardiovascular imaging laboratories

Cine film had been a global standard in the cardiac catheterization lab for the acquisition, archive, review and exchange for decades. The advent of digital imaging in the cath lab heightened the desire to store cath procedure images in a digital format. The issues related to the development of a digital exchange standard, the data capacities and data rates, lossless and lossy compression, and techniques to obtain digital image data from the lab are discussed. In addition, Kodak's approach to cine film replacement with digital systems is described.     

梅奥粘连概率评分对T1期肾癌患者外科治疗的指导效果研究

目的 探讨肾周脂肪梅奥粘连概率（MAP）评分对T₁期肾癌患者外科治疗的指导效果。方法 回顾性分析2014年1月－2018年12月该院收治的200例T₁期肾癌患者的临床资料,依据肿瘤切除术式进行分组。其中,A组行经腹腔开腹部分肾切除术（OPN）（n = 49）、B组行腹腔镜部分肾切除术（LPN）（n = 67）、C组行开放性肾癌根治术（ORN）（n = 33）、D组行腹腔镜根治性肾切除术（LRN）（n = 51）。按照MAP评分标准将各组进行亚分组：MAP低度组（0～1分）、MAP中度组（2～3分）和MAP高度组（4～5分）。分析MAP评分系统与肾切除术式的关系,并评估围术期不同术式组MAP评分与手术时间、术中出血量、术后并发症的相关性。结果 A组和C组患者中,MAP低度组、中度组、重度组的手术时间、术中出血量比较,差异无统计学意义（P > 0.05）;MAP低度组的术后并发症发生率低于中度组和高度组,中度组低于高度组,差异有统计学意义（P < 0.05）;B组和D组患者中,MAP低度组手术时间短于中度组和重度组、术中出血量少于中度组和重度组、术后并发症发生率低于中度组和重度组,且中度组低于重度组,差异有统计学意义（P < 0.05）。B组和D组影像学MAP评分与手术时间、术中出血量、术后并发症呈正相关（P < 0.05）。结论 MAP评分可有效指导T₁期肾癌切除术式的选择,MAP评分低度和中度患者可选择腹腔镜手术,MAP评分高度患者可选择开放性手术,且MAP评分可用于评估LPN及LRN的围手术期相关临床指标。     

Retrospective analysis of the hemodynamic consequences of prehospital supplemental oxygen in acute stroke

ObjectiveHyperoxia, the delivery of high levels of supplemental oxygen (sO₂) despite normoxia, may increase cerebral oxygenation to penumbral tissue and improve stroke outcomes. However, it may also alter peripheral hemodynamic profiles with potential negative effects on cerebral blood flow (CBF). This study examines the hemodynamic consequences of prehospital sO₂ in stroke.MethodsA retrospective analysis of adult acute stroke patients (aged ≥18 years) presenting via EMS to an academic Comprehensive Stroke Center between January 1, 2013 and December 31, 2017 was conducted using demographic and clinical characteristics obtained from Get with the Guidelines-Stroke registry and subjects' medical records. Outcomes were compared across three groups based on prehospital oxygen saturation and sO₂ administration. Chi-square, ANOVA, and multivariable linear regression were used to determine if sO₂ was associated with differences in peripheral hemodynamic profiles.ResultsAll subjects had similar initial EMS vitals except for oxygen saturation. However, both univariate and multivariable analysis revealed that hyperoxia subjects had slightly lower average ED mean arterial pressures (MAP) compared to normoxia (Cohen's d = 0.313).ConclusionsPrehospital-initiated hyperoxia for acute stroke is associated with a small, but significant decrease in average ED MAP, without changes in heart rate, compared to normoxia. While limited by the inability to link changes in peripheral hemodynamical profiles directly to changes in CBF, this study suggests that hyperoxia may result in a relative hypotension. Further studies are needed to determine if this small change in peripheral vascular resistance translates into a clinically significant reduced CBF.     

Reproducibility of the alterations in circulation and cerebral oxygenation from supine rest to head-up tilt

Cardiovascular stability, as affected by several diseases, may be assessed by head-up tilt testing. Follow-up studies are essential in both evaluating interventions and assessing progression. However, data on the reproducibility of the changes in circulatory status and cerebral oxygenation provoked by head-up tilt testing are fundamental to follow-up studies. The aim of this study was, therefore, to assess the reproducibility of the alterations in stroke volume (SV), mean arterial pressure (MAP), as well as oxygenated ([O₂Hb]) and deoxygenated haemoglobin ([HHb]) concentration in cerebral tissue from supine rest (SUP) to head-up tilt (HUT). SV was calculated by Modelflow, a pulse contour method, from the finger arterial pressure wave measured by Portapres, the portable version of Finapres. [O₂Hb] and [HHb] were measured using near-infrared spectroscopy (NIRS). Ten healthy individuals visited the laboratory on two different days. On both days, they underwent 10 min SUP followed by 10 min 70° HUT twice. SV decreased, which was (in part) compensated for by an increased heart rate, while MAP increased slightly during HUT compared with SUP. Although [HHb] increased during HUT, no presyncope symptoms were experienced. The circulatory variables (SV, HR and MAP) as well as [HHb] showed an acceptably small systematic and random error as well as reproducibility error compared with the observed difference between HUT and SUP and were similar between and within visits. Therefore, it is concluded that MAP measured by Portapres and SV calculated by Modelflow as well as HHb measured by NIRS seem to be reproducible and may therefore be used in follow-up studies.     

Graphical display of variability and inter-relationships of pressure signals in children with traumatic brain injury

A prospective observational study was undertaken to examine time series ICU data of pressure variables (mean arterial pressure (MAP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP)) and relate their variability (SD) to outcome, together with simple graphical displays which could be useful at the ICU bedspace. Forty-three children (aged < 1-15 years) were admitted to the intensive care unit for Regional Neurosurgical Service, Edinburgh, following traumatic brain injury (TBI). The standard deviations from 221,291 validated pressure data measurements (representing three variables) were calculated for the duration of ICP monitoring (and in 48 h epochs from the time of injury). Data were displayed on polygraphs, and several well-defined 'patterns' were described. The standard deviations of MAP, ICP and CPP for the total duration of monitoring were found to be significantly related to survival (p = 0.003, <0.001 and 0.005, respectively), while the SD of ICP alone was strongly related to global recovery (p = 0.008) in the first 48 h post-injury. Patterns in 104 epochs (each of 48 h) were identified. Ninety-two were of the type I (MAP > CPP > ICP) pattern and 12 were of the non-type I pattern. Glasgow Outcome Scale scores at 12 months were significantly related to the dichotomized pattern type (Fisher's exact test p < 0.001 for both alive versus dead and independent versus dependent outcomes). Only one patient with type I pattern died in this series. While variability of ICP during the first 48 h post-injury is predictive of the outcome, the pattern behaviour of three pressure signals gives useful outcome prediction information throughout monitoring. These displays may help interpret some of the plethora of data produced at the bedside.     

A data acquisition system for clinical research

We developed a system for automatic collection and synchronization of multiple physiological variables during clinical investigations. Centered around an eight-track instrumentation tape recorder, the system solves several problems encountered in gathering this type of research data: (1) slowly changing variables are digitized and compressed onto a single track by recording them in one serial message, allowing for recording many more variables than there are tape tracks available; (2) simultaneous analog recording allows retention of original data for variables that may be processed subsequently by multiple schemes; (3) data acquisition is verified with both analog chart recording and numerical video display monitors; (4) off-line computer processing time is decreased at least twofold by using tape playback speeds faster than the recording speed; (5) cost is kept low by using an inexpensive 1/4-inch (0.64-cm) tape medium and dedicated microcomputers; and (6) the system is unobtrusive, portable, and easily reconfigured for different clinical studies. It proved to be reliable in a study of more than 80 patients undergoing cardiac surgery.     

基于LabVIEW显微CT图像采集控制系统软件的设计

背景:LabVIEW作为著名的虚拟仪器开发平台,数据采集、信号处理与分析是其强项与优势。目的:设计一套完整的CT控制与图像采集系统应用程序。方法:通过LabVIEW8.5虚拟仪器开发平台,设计CT控制及图像采集系统,与X射线源、转台以及探测器等硬件仪器一同构建了一套完整的高分辨率显微CT成像系统。结果与结论:将该软件与实验室显微CT硬件系统配合进行实验,很好的实现了对平台参数的设置及初始化、对载物台移动的控制、CT图像采集并保存和读取等功能,成功构建了一套显微CT图像采集控制系统软件,系统参数可根据实际需要修改,长期运行性能稳定。     

Changes in cerebral oxygenation and haemodynamics during postural blood pressure changes in patients with autonomic failure

Patients with autonomic failure suffer severe postural hypotension that may be associated with symptoms of cerebral hypoperfusion. This study utilized near-infrared spectroscopy (NIRS) to measure changes in cerebral oxygenation and haemodynamics during the head-up tilt table test in 18 patients with autonomic failure and 10 healthy age-matched volunteers. Heart rate, blood pressure (MAP), oxygen saturation, cerebral tissue oxygen index (TOI) and total cerebral haemoglobin concentration [HbT] were measured continuously. In patients with autonomic failure there was a mean (SD) reduction in MAP of 46.7 (26.5) mmHg (p < 0.005) associated with a reduction in TOI of 8.6 (6.2)% (p < 0.005) during the head-up tilt table test. In healthy volunteers mean (SD) MAP rose by 12.3 (8.0) mmHg (p < 0.005) and TOI fell by 2.6 (3.2)% (p < 0.05). There was a mean (SD) reduction in [HbT] of 3.09 (2.82) micromol l(-1) (p < 0.005) in patients, equivalent to a decrease in cerebral blood volume of 0.2 (0.18) ml/100 g. There were no changes in [HbT] in the healthy volunteers. Postural hypotension in patients with autonomic failure is associated with a substantial decrease in absolute cerebral oxygenation measured by NIRS and this might reflect a critical reduction in cerebral oxygen delivery.     

Digital videofluorography for direct digital spot filming of gastrointestinal studies

Digital videofluorography (DVF) refers to a new computer-aided televised fluoroscopy technique that uses short (10–20 ms) intense pulses of radiation to produce a motion-free latent image, which is then transferred into digital storage. Because gastrointestinal imaging has lagged behind other body systems in the evaluation of digital acquisition, we investigated the potential utility of this technique for direct digital fluoroscopic spot filming of gastrointestinal examinations.In order to assess the level of clinical image quality achieved by this technique, we conducted an observer performance comparison study of digitally acquired and conventional analog 100 mm spot films. Sequentially acquired spot films and digital radiographs of 111 anatomic regions in 60 patients undergoing routine barium and cholangiographic examinations were compared. Evaluation was made of on-line interactive performance as well as side-by-side analysis of digital and analog hard copy images. Parameters evaluated include detection of normal and pathologic features, image contrast, image resolution, and image sharpness. Direct digital and analog spot films were of comparable diagnostic quality in all parameters studied. Added benefits of the digital mode included postprocessing to enhance detail in regions of low contrast and accommodation of a large field of view (14 inch) image intensifier format.     

Hemodynamic variables related to outcome in septic shock

Objective To assess the impact of hemodynamic variables on the outcome of critically ill patients in septic shock and to identify the optimal threshold values related to outcome with special reference to continuously monitored mean arterial pressure (MAP) and mixed venous oxygen saturation (SvO₂).Design and setting Retrospective cohort study in a university hospital intensive care unit (ICU).Patients All consecutive 111 patients with septic shock treated in our ICU between 1 Jan. 1999 and 30 Jan. 2002.Measurements and results The data on the hemodynamic and respiratory monitoring and circulation-related laboratory tests over the first 48 h of treatment in the ICU were collected from the clinical data management system. Data from 6 h and 48 h were analyzed separately. The 30-day mortality rate was 33% (36 of 111). Univariate analysis and forward stepwise logistic regression analysis were performed using the 30-day mortality as the primary endpoint. Mean MAP and lactate on arrival during 6 h, while mean MAP, the area of SvO₂ under 70%, and mean CVP during 48 h were independently associated with mortality. MAP level of 65 mmHg and SvO₂ of 70% had the highest areas under receiver characteristics curves.Conclusions MAP, SvO₂, CVP, and initial lactate were independently associated with mortality in septic shock, with threshold values supporting those published in recent guidelines.