The incidence of hyperchloremia at the end of surgery is elevated, and it is associated with metabolic acidosis, longer surgeries, greater volumes of crystalloids, and higher postoperative mortality.
ObjectivesThe purpose of this study was to test if venous blood drawn from femoral
access can be used to estimate the central venous oxygen saturation
and arterial lactate levels in critically ill patients.MethodsBland-Altman analysis and Spearman correlations were used to compare the
femoral venous oxygen saturation and central venous oxygen saturation
as well as arterial lactate levels and femoral lactate. A
pre-specified subgroup analysis was conducted in patients with signs
of hypoperfusion. In addition, the clinical agreement was also
investigated.ResultsBlood samples were obtained in 26 patients. In 107 paired samples, there
was a moderate correlation (r = 0.686, p < 0.0001) between the
central venous oxygen saturation and femoral venous oxygen saturation
with a bias of 8.24 ± 10.44 (95% limits of agreement: -12.23 to
28.70). In 102 paired samples, there was a strong correlation between
the arterial lactate levels and femoral lactate levels (r = 0.972, p
< 0.001) with a bias of -2.71 ± 9.86 (95% limits of
agreement: -22.03 to 16.61). The presence of hypoperfusion did not
significantly change these results. The clinical agreement for venous
saturation was inadequate, with different therapeutic decisions in
22.4% of the situation; for lactate, this was the case only in 5.2% of
the situations.ConclusionFemoral venous oxygen saturation should not be used as a surrogate of
central venous oxygen saturation. However, femoral lactate levels can
be used in clinical practice, albeit with caution.
The use of central venous oxygen saturation (SvcO2) and arterial lactate
in the diagnosis of severe tissue hypoperfusion is well established, and the
optimization of these parameters is currently under investigation, particularly in
patients with severe sepsis/septic shock. However, the only place for deep venous
puncture or the first choice for puncture is often the femoral vein. Although venous
saturation obtained from blood sampling from this catheter, instead of
SvcO2, has already been used in the diagnosis of severe tissue
hypoperfusion, little is known about the accuracy of the results. The venous lactate
in place of arterial puncture has also been used to guide therapeutic decisions. We
conducted this literature review to seek evidence on the correlation and concordance
of parameters obtained by collecting femoral venous blood gases in relation to
SvcO2 and arterial lactate. Few studies in the literature have
evaluated the use of femoral venous oxygen saturation (SvfO2) or venous
lactate. The results obtained thus far demonstrate no adequate agreement between
SvfO2 and SvcO2, which limits the clinical use of
SvfO2. However, the apparent strong correlation between arterial and
peripheral and central venous lactate values suggests that venous lactate obtained
from the femoral vein could eventually be used instead of arterial lactate, although
there is insufficient evidence on which to base this procedure at this time.
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