INTRODUÇÃO: Instabilidade hemodinâmica é uma condição comum nos pacientes críticos e usualmente associada aos quadros de choque. O débito cardíaco (DC) é o principal determinante da oferta de oxigênio, e uma importante variável a ser monitorizada nestes pacientes. A diferença arterio-venosa central de dióxido de carbono (△pCO2), é um índice que mostrou-se correlacionar inversamente com o DC em diversos estudos. OBJETIVOS: O objetivo deste estudo é avaliar o valor prognóstico do △pCO2 (utilizando uma amostra venosa central) em uma série heterogênea de pacientes com instabilidade hemodinâmica. MÉTODOS: Estudo prospectivo observacional conduzido em uma UTI geral de 18 leitos do Complexo Hospitalar da Santa Casa de Porto Alegre. Variáveis hemodinâmicos, coleta de gasometria arterial e venosa central, e lactato, foram realizadas na admissão e após 6, 12, 18 e 24 horas. A gravidade da doença foi avaliada pelo escore APACHE II e a a severidade da disfunção orgânica pelo escore SOFA. RESULTADOS: 60 pacientes foram analisados. A mortalidade ao fim de 28 dias foi de 43% (26/60). Não se observou diferença entre os valores médios de △pCO2 entre sobreviventes e óbitos em 28 dias. O tempo de permanência na UTI foi maior entre os pacientes com um △pCO2 “alargado”. Os valores médios de saturação venosa central de oxigênio (SvcO2) foram maiores no subgrupo de pacientes com △pCO2 normal. CONCLUSÃO: Este estudo mostrou que o △pCO2, em pacientes com instabilidade hemodinâmica, está relacionado com desfecho secundários importantes como uma maior permanência em UTI. A explicação fisiológica para isso deve-se a uma maior redução no fluxo sanguíneo (como sugerido por uma SvcO2 mais baixa) causando uma oferta inadequada de oxigênio na fase aguda da doença, resultando em maior tempo de recuperação. / BACKGROUND: Hemodynamic instability is a common condition in critically ill patients and is usually associated with shock. Cardiac output (CO) is the major determinant of oxygen supply and an important variable to be monitored in these patients. The venousarterial difference of partial pressure of carbon dioxide (△pCO2) ,is an index that have shown to be inversely correlate with the CO in several studies. OBJECTIVES: This study aims to evaluate the prognostic value of the △pCO2 (using a central venous sample) in a heterogeneous series of critically ill patients with hemodynamic instability. METHODS: A prospective observational clinical study was conducted in a 18-bed general ICU of the Santa Casa de Porto Alegre Hospital Complex. Hemodynamic measurements, collection of arterial and central venous blood gases, and lactate were performed on admission and after 6 , 12, 18 and 24 hours.The severity of patient’s disease was evaluated by the APACHE II score and the level of organic disfunction was evaluated by the SOFA score. RESULTS: A total of 60 patients were analyzed. The mortality rate at 28 days was 43% (26/60). There was no difference observed in mean △pCO2 between deaths and survivors after 28 days.The ICU stay was longer among patients with “enlarged” △pCO2.Mean central venous oxygen saturation values were higher in patients with normal △pCO2. CONCLUSION: This study showed that the △pCO2 in patients with hemodynamic instability is correlated with important secondary outcomes like higher ICU stay. The physiologic explanation is a reduction on blood flow (as suggested by lower ScvO2) causing a inadequate oxygen tissue delivery in the acute phase of the disease, resulting in a greater recovery time.

INTRODUÇÃO: Instabilidade hemodinâmica é uma condição comum nos pacientes críticos e usualmente associada aos quadros de choque. O débito cardíaco (DC) é o principal determinante da oferta de oxigênio, e uma importante variável a ser monitorizada nestes pacientes. A diferença arterio-venosa central de dióxido de carbono (△pCO2), é um índice que mostrou-se correlacionar inversamente com o DC em diversos estudos. OBJETIVOS: O objetivo deste estudo é avaliar o valor prognóstico do △pCO2 (utilizando uma amostra venosa central) em uma série heterogênea de pacientes com instabilidade hemodinâmica. MÉTODOS: Estudo prospectivo observacional conduzido em uma UTI geral de 18 leitos do Complexo Hospitalar da Santa Casa de Porto Alegre. Variáveis hemodinâmicos, coleta de gasometria arterial e venosa central, e lactato, foram realizadas na admissão e após 6, 12, 18 e 24 horas. A gravidade da doença foi avaliada pelo escore APACHE II e a a severidade da disfunção orgânica pelo escore SOFA. RESULTADOS: 60 pacientes foram analisados. A mortalidade ao fim de 28 dias foi de 43% (26/60). Não se observou diferença entre os valores médios de △pCO2 entre sobreviventes e óbitos em 28 dias. O tempo de permanência na UTI foi maior entre os pacientes com um △pCO2 “alargado”. Os valores médios de saturação venosa central de oxigênio (SvcO2) foram maiores no subgrupo de pacientes com △pCO2 normal. CONCLUSÃO: Este estudo mostrou que o △pCO2, em pacientes com instabilidade hemodinâmica, está relacionado com desfecho secundários importantes como uma maior permanência em UTI. A explicação fisiológica para isso deve-se a uma maior redução no fluxo sanguíneo (como sugerido por uma SvcO2 mais baixa) causando uma oferta inadequada de oxigênio na fase aguda da doença, resultando em maior tempo de recuperação. / BACKGROUND: Hemodynamic instability is a common condition in critically ill patients and is usually associated with shock. Cardiac output (CO) is the major determinant of oxygen supply and an important variable to be monitored in these patients. The venousarterial difference of partial pressure of carbon dioxide (△pCO2) ,is an index that have shown to be inversely correlate with the CO in several studies. OBJECTIVES: This study aims to evaluate the prognostic value of the △pCO2 (using a central venous sample) in a heterogeneous series of critically ill patients with hemodynamic instability. METHODS: A prospective observational clinical study was conducted in a 18-bed general ICU of the Santa Casa de Porto Alegre Hospital Complex. Hemodynamic measurements, collection of arterial and central venous blood gases, and lactate were performed on admission and after 6 , 12, 18 and 24 hours.The severity of patient’s disease was evaluated by the APACHE II score and the level of organic disfunction was evaluated by the SOFA score. RESULTS: A total of 60 patients were analyzed. The mortality rate at 28 days was 43% (26/60). There was no difference observed in mean △pCO2 between deaths and survivors after 28 days.The ICU stay was longer among patients with “enlarged” △pCO2.Mean central venous oxygen saturation values were higher in patients with normal △pCO2. CONCLUSION: This study showed that the △pCO2 in patients with hemodynamic instability is correlated with important secondary outcomes like higher ICU stay. The physiologic explanation is a reduction on blood flow (as suggested by lower ScvO2) causing a inadequate oxygen tissue delivery in the acute phase of the disease, resulting in a greater recovery time.

INTRODUÇÃO: Instabilidade hemodinâmica é uma condição comum nos pacientes críticos e usualmente associada aos quadros de choque. O débito cardíaco (DC) é o principal determinante da oferta de oxigênio, e uma importante variável a ser monitorizada nestes pacientes. A diferença arterio-venosa central de dióxido de carbono (△pCO2), é um índice que mostrou-se correlacionar inversamente com o DC em diversos estudos. OBJETIVOS: O objetivo deste estudo é avaliar o valor prognóstico do △pCO2 (utilizando uma amostra venosa central) em uma série heterogênea de pacientes com instabilidade hemodinâmica. MÉTODOS: Estudo prospectivo observacional conduzido em uma UTI geral de 18 leitos do Complexo Hospitalar da Santa Casa de Porto Alegre. Variáveis hemodinâmicos, coleta de gasometria arterial e venosa central, e lactato, foram realizadas na admissão e após 6, 12, 18 e 24 horas. A gravidade da doença foi avaliada pelo escore APACHE II e a a severidade da disfunção orgânica pelo escore SOFA. RESULTADOS: 60 pacientes foram analisados. A mortalidade ao fim de 28 dias foi de 43% (26/60). Não se observou diferença entre os valores médios de △pCO2 entre sobreviventes e óbitos em 28 dias. O tempo de permanência na UTI foi maior entre os pacientes com um △pCO2 “alargado”. Os valores médios de saturação venosa central de oxigênio (SvcO2) foram maiores no subgrupo de pacientes com △pCO2 normal. CONCLUSÃO: Este estudo mostrou que o △pCO2, em pacientes com instabilidade hemodinâmica, está relacionado com desfecho secundários importantes como uma maior permanência em UTI. A explicação fisiológica para isso deve-se a uma maior redução no fluxo sanguíneo (como sugerido por uma SvcO2 mais baixa) causando uma oferta inadequada de oxigênio na fase aguda da doença, resultando em maior tempo de recuperação. / BACKGROUND: Hemodynamic instability is a common condition in critically ill patients and is usually associated with shock. Cardiac output (CO) is the major determinant of oxygen supply and an important variable to be monitored in these patients. The venousarterial difference of partial pressure of carbon dioxide (△pCO2) ,is an index that have shown to be inversely correlate with the CO in several studies. OBJECTIVES: This study aims to evaluate the prognostic value of the △pCO2 (using a central venous sample) in a heterogeneous series of critically ill patients with hemodynamic instability. METHODS: A prospective observational clinical study was conducted in a 18-bed general ICU of the Santa Casa de Porto Alegre Hospital Complex. Hemodynamic measurements, collection of arterial and central venous blood gases, and lactate were performed on admission and after 6 , 12, 18 and 24 hours.The severity of patient’s disease was evaluated by the APACHE II score and the level of organic disfunction was evaluated by the SOFA score. RESULTS: A total of 60 patients were analyzed. The mortality rate at 28 days was 43% (26/60). There was no difference observed in mean △pCO2 between deaths and survivors after 28 days.The ICU stay was longer among patients with “enlarged” △pCO2.Mean central venous oxygen saturation values were higher in patients with normal △pCO2. CONCLUSION: This study showed that the △pCO2 in patients with hemodynamic instability is correlated with important secondary outcomes like higher ICU stay. The physiologic explanation is a reduction on blood flow (as suggested by lower ScvO2) causing a inadequate oxygen tissue delivery in the acute phase of the disease, resulting in a greater recovery time.

<p><strong><p>Studie av koldioxidgradienter i havets ytskikt</p><p>Sofia Söderholm</p></strong></p><p>Denna studie bygger på ett nyligen utvecklat instrument som har mätt koldioxidkoncentrationer på tre olika djup i vattnet samt en nivå i luften. Då detta instrument var oprövat i vatten har en utvärdering av mätmetodens lämplighet för vattenmätningar utförts. Syftet med mätningarna var att undersöka ytvattnets vertikala koldioxidgradient för att med hjälp av denna kunna beskriva flödet av koldioxid mellan hav och atmosfär bättre. Detta flöde är en viktig del av den globala kolcykeln och en djupare förståelse för koldioxidflödets beteende kan i framtiden bidra till mer noggranna klimatprognoser. Hur de beräknade flödena från profilinstrumentet påverkas av temperaturgradienterna i vattnets ytskikt har även det studerats. Mätningarna utfördes i vattnet utanför mätstationen på Östergarnsholm, öster om Gotland. En del av studien fokuserar på de horisontella koldioxidgradienterna i ytvattnet som erhållits genom fartygsdata.</p><p>Instrumentet som har använts vid mätningarna bygger på hydrofoba, luftgenomträngliga membran och förefaller fungera mycket väl i vatten. Vid vindhastigheter som inte är högre än 3 - 4 m/s kan tydliga koldioxidgradienter i vattnets ytskikt ses, men detta samband behöver verifieras med en större mängd mätdata. Temperaturgradienten i vattnets ytskikt har ingen större påverkan på vare sig koldioxidgradienten eller flödet av koldioxid och dess effekt kan försummas i detta fall. De horisontella koldioxidgradienterna påverkas huvudsakligen av temperaturen, den biologiska aktiviteten samt transport av vattenmassor. På en större skala kan tydliga effekter av temperaturen på koldioxidhalterna ses och på en mindre skala samt nära kuster och under våren är den biologiska aktiviteten dominerande.</p><p><em><p>Nyckelord: Koldioxidgradient, koldioxidflöde, temperaturgradient, hydrofoba luftgenomträngliga membran, transferhastighet, vindhastighet, biologisk aktivitet.</p></em></p> / <p><strong><p>A study regarding the carbon dioxide gradients in the surface water.</p><p>Sofia Söderholm</p></strong></p><p>This study is based on a recently developed instrument that measures the concentration of carbon dioxide at three different depths in the water and one level in the air. Since this instrument has not previously been used for measurements in water, an evaluation regarding the usefulness of the instruments for measurements in water was made. The purpose of the measurements was to study the vertical gradient of carbon dioxide in the surface water and to describe the vertical flux of carbon dioxide between the ocean and the atmosphere in an improved way. This flux is an important part of the global carbon cycle and a deeper understanding of the behavior of the air-sea exchange of carbon dioxide could contribute to more accurate forecasts of the future climate. The impact on the calculated carbon dioxide flux by the temperature gradients in the surface waters was also analyzed. The measurements were performed in the waters outside of the island of Östergarnsholm, east of Gotland. Part of the study focuses on the horizontal carbon dioxide in the surface water, which was obtained by ship data.</p><p>The instrument used when performing the measurements is based on hydrophobic, air-permeable membranes and appears to function very well in water. During wind speeds below 3 - 4 m/s distinct carbon dioxide gradients can be seen for the investigated data, but more data is needed to quantify this gradient for different situations. The temperature gradient in the surface water doesn't have a significant effect on the carbon dioxide gradient or the flow of carbon dioxide, and the effect of the temperature gradient can in this particular case be neglected. The horizontal gradients of carbon dioxide are mainly affected by temperature, biological activity and transportation of water mass. On a larger scale the effects of temperature on the concentrations of carbon dioxide are visible and on a smaller scale along with the coastal areas and during springtime, the biological activity is the dominating influence.</p><p><em><p>Keywords: Carbon dioxide gradient, carbon dioxide flux, temperature gradient, hydrophobic airpermeable membranes , transfer velocity, wind speeds, biological activity.</p></em></p>

Studie av koldioxidgradienter i havets ytskikt Sofia Söderholm Denna studie bygger på ett nyligen utvecklat instrument som har mätt koldioxidkoncentrationer på tre olika djup i vattnet samt en nivå i luften. Då detta instrument var oprövat i vatten har en utvärdering av mätmetodens lämplighet för vattenmätningar utförts. Syftet med mätningarna var att undersöka ytvattnets vertikala koldioxidgradient för att med hjälp av denna kunna beskriva flödet av koldioxid mellan hav och atmosfär bättre. Detta flöde är en viktig del av den globala kolcykeln och en djupare förståelse för koldioxidflödets beteende kan i framtiden bidra till mer noggranna klimatprognoser. Hur de beräknade flödena från profilinstrumentet påverkas av temperaturgradienterna i vattnets ytskikt har även det studerats. Mätningarna utfördes i vattnet utanför mätstationen på Östergarnsholm, öster om Gotland. En del av studien fokuserar på de horisontella koldioxidgradienterna i ytvattnet som erhållits genom fartygsdata. Instrumentet som har använts vid mätningarna bygger på hydrofoba, luftgenomträngliga membran och förefaller fungera mycket väl i vatten. Vid vindhastigheter som inte är högre än 3 - 4 m/s kan tydliga koldioxidgradienter i vattnets ytskikt ses, men detta samband behöver verifieras med en större mängd mätdata. Temperaturgradienten i vattnets ytskikt har ingen större påverkan på vare sig koldioxidgradienten eller flödet av koldioxid och dess effekt kan försummas i detta fall. De horisontella koldioxidgradienterna påverkas huvudsakligen av temperaturen, den biologiska aktiviteten samt transport av vattenmassor. På en större skala kan tydliga effekter av temperaturen på koldioxidhalterna ses och på en mindre skala samt nära kuster och under våren är den biologiska aktiviteten dominerande. Nyckelord: Koldioxidgradient, koldioxidflöde, temperaturgradient, hydrofoba luftgenomträngliga membran, transferhastighet, vindhastighet, biologisk aktivitet. / A study regarding the carbon dioxide gradients in the surface water. Sofia Söderholm This study is based on a recently developed instrument that measures the concentration of carbon dioxide at three different depths in the water and one level in the air. Since this instrument has not previously been used for measurements in water, an evaluation regarding the usefulness of the instruments for measurements in water was made. The purpose of the measurements was to study the vertical gradient of carbon dioxide in the surface water and to describe the vertical flux of carbon dioxide between the ocean and the atmosphere in an improved way. This flux is an important part of the global carbon cycle and a deeper understanding of the behavior of the air-sea exchange of carbon dioxide could contribute to more accurate forecasts of the future climate. The impact on the calculated carbon dioxide flux by the temperature gradients in the surface waters was also analyzed. The measurements were performed in the waters outside of the island of Östergarnsholm, east of Gotland. Part of the study focuses on the horizontal carbon dioxide in the surface water, which was obtained by ship data. The instrument used when performing the measurements is based on hydrophobic, air-permeable membranes and appears to function very well in water. During wind speeds below 3 - 4 m/s distinct carbon dioxide gradients can be seen for the investigated data, but more data is needed to quantify this gradient for different situations. The temperature gradient in the surface water doesn't have a significant effect on the carbon dioxide gradient or the flow of carbon dioxide, and the effect of the temperature gradient can in this particular case be neglected. The horizontal gradients of carbon dioxide are mainly affected by temperature, biological activity and transportation of water mass. On a larger scale the effects of temperature on the concentrations of carbon dioxide are visible and on a smaller scale along with the coastal areas and during springtime, the biological activity is the dominating influence. Keywords: Carbon dioxide gradient, carbon dioxide flux, temperature gradient, hydrophobic airpermeable membranes , transfer velocity, wind speeds, biological activity.