Central venous saturation in septic shock: co-oximetry vs gasometry

Romero, Carlos; Luengo, Cecilia; Tobar, Eduardo; Fábrega, L.; Vial, María Jesús; Cornejo, Rodrigo; Gálvez, Ricardo; Llanos, Osvaldo

doi:10.1016/j.ajem.2014.07.027

Cited by 3 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are in line with previous results [ 5 , 6 ]. Indeed, a prior study by Romero et al [ 5 ] in 16 septic shock patients with 111 pairs of measurements also showed lack of agreement between Co-oximetry_ScvO 2 and calculated ScvO 2 with wide apart limits of agreement on Bland and Altman plot analysis. A recent study using 141 paired samples from 82 pediatric ICU patients by Subramanian et al [ 6 ] also failed to show adequate agreement between the two methodologies.…”

Section: Discussionsupporting

confidence: 94%

“…Also, our multiple linear regression model was very good (adjusted R 2 = 0.8) without including temperature and 2,3-diphosphoglycerate levels. Furthermore, our findings are in line with the results of other studies [ 5 , 6 ].…”

Section: Discussionsupporting

confidence: 94%

“…A cut-off ≥ 36 mmHg was demonstrated to be the best discriminative value for all population and ≥ 35 mmHg for septic patients. Our results are also in agreement with previously published data by Romero et al [ 5 ] who found, in septic shock patients, an excellent AUROC (0.87) but a little different cut-off point (40 mmHg) to predict CO-oximetry_ScvO 2 values > 70%. From a practical standpoint, considering that CO-oximetry_ScvO 2 is not readily available in all institutions and that the primary intent of a physician when ordering a test aimed at determining venous oxygen saturation is to know if the patients saturation is under or over the 70% threshold, we found that using PcvO 2 is highly specific and sensitive to predict CO-oximetry_ScvO 2 above 70%.…”

Section: Discussionsupporting

confidence: 93%

“…To our knowledge, this is the first prospective study comparing calculated saturation and CO-oximetry in a large ICU population of septic shock and non-septic shock patients. The strengths of our study compared to the others [ 4 – 6 ] are: (1) only 1 measurement per patient was performed whereas the other studies [ 4 , 5 ] included fewer patients with multiple measurements per patient without adjusting for that [ 18 ], introducing potential errors in the results; (2) Co-oximetry_ScvO 2 and Calc_ScvO 2 values were provided by the same point-of-care blood gas analyzer (GEM 4000) while in the other studies two different machines were used to compare the two methodologies, which could increase the pre-analytical errors (by increasing the waiting time for each sample to be analyzed by two devices) and the analytical errors related to each machine; (3) we used different methods to examine the agreement between the two variables, and sample size calculation with power analysis was performed.…”

Section: Discussionmentioning

confidence: 98%

See 3 more Smart Citations

A comparison between measured and calculated central venous oxygen saturation in critically ill patients

et al. 2018

View full text Add to dashboard Cite

BackgroundCentral venous oxygen saturation (ScvO2) is often used to help to guide resuscitation of critically ill patients. The standard gold technique for ScvO2 measurement is the co-oximetry (Co-oximetry_ScvO2), which is usually incorporated in most recent blood gas analyzers. However, in some hospitals, those machines are not available and only calculated ScvO2 (Calc_ScvO2) is provided. Therefore, we aimed to investigate the agreement between Co-oximetry_ScvO2 and Calc_ScvO2 in a general population of critically ill patients and septic shock patients.MethodsA total of 100 patients with a central venous catheter were included in the study. One hundred central venous blood samples were collected and analyzed using the same point-of-care blood gas analyzer, which provides both the calculated and measured ScvO2 values. Bland and Altman plot, intra-class correlation coefficient (ICC), and Cohen’s Kappa coefficient were used to assess the agreement between Co-oximetry_ScvO2 and Calc_ScvO2. Multiple linear regression analysis was performed to investigate the independent explanatory variables of the difference between Co-oximetry_ScvO2 and Calc_ScvO2.ResultsIn all population, Bland and Altman’s analysis showed poor agreement (+4.5 [-7.1, +16.1]%) between the two techniques. The ICC was 0.754 [(95% CI: 0.393–0.880), P< 0.001], and the Cohen’s Kappa coefficient, after categorizing the two variables into two groups using a cutoff value of 70%, was 0.470 (P <0.001). In septic shock patients (49%), Bland and Altman’s analysis also showed poor agreement (+5.6 [–6.7 to 17.8]%). The ICC was 0.720 [95% CI: 0.222–0.881], and the Cohen’s Kappa coefficient was 0.501 (P <0.001). Four independent variables (PcvO2, Co-oximetry_ScvO2, venous pH, and Hb) were found to be associated with the difference between the measured and calculated ScvO2 (adjusted R2 = 0.8, P<0.001), with PcvO2 being the main independent explanatory variable because of its highest absolute standardized coefficient. The area under the receiver operator characteristic curves (AUC) of PcvO2 to predict Co-oximetry_ScvO2 ≥ 70% was 0.911 [95% CI: 0.837–0.959], in all patients, and 0.903 [95% CI: 0.784–0.969], in septic shock patients. The best cutoff value was ≥ 36 mmHg (sensitivity, 88%; specificity, 83%), in all patients, and ≥ 35 mmHg (sensitivity, 94%; specificity, 71%) in septic shock patients.ConclusionsThe discrepancy between the measured and calculated ScvO2 is clinically not acceptable. We do not recommend the use of calculated ScvO2 to guide resuscitation in critically ill patients. In situations where the Co-oximetry technique is not available, relying on PcvO2 to predict the measured ScvO2 value above or below 70% could be an option.

show abstract

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

See 2 more Smart Citations

A comparison between measured and calculated central venous oxygen saturation in critically ill patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Although the value of ScvO 2 yields more information than the PvjO 2 both in critically ill people 5,23,24 and dogs, 5,7,8 2 recent studies in critically ill human patients have shown a high correlation between the central partial pressure of oxygen (PcvO 2 ) and ScvO 2 measured when measured by co-oximetry. 25,26 Because the agreement between ScvO 2 measured by co-oximetry and the ScvO 2 calculated from blood gases in those studies was low, the authors suggested using PcvO 2 instead of ScvO 2 to guide therapy if measuring ScvO 2 by co-oximetry is not possible. 25,26 Jugular venous partial pressure of oxygen was a strong independent predictor of mortality in the present study.…”

Section: Discussionmentioning

confidence: 99%

Retrospective evaluation of jugular venous blood variables and mortality in critically ill hospitalized cats

Donati

Rabelo²,

Araos

et al. 2022

J Vet Emergen Crit Care

View full text Add to dashboard Cite

ObjectiveTo evaluate clinicopathological variables associated with hospital mortality in critically ill cats with compromised hemodynamics and tissue hypoperfusion.DesignRetrospective observational study.SettingPrivate referral center.AnimalsFifty‐seven critically ill cats with compromised hemodynamics or tissue hypoperfusion.InterventionsNone.Measurements and Main ResultsThe electronic medical records were searched for all cats admitted from June 2014 to November 2020. Cats were included in the study if the medical records clearly identified the presence of compromised hemodynamics and tissue hypoperfusion. Blood samples were obtained by percutaneous puncture of the external jugular vein, and blood gases, electrolytes, L‐lactate concentration, and glucose were measured by a point‐of‐care analyzer. A predictive logistic regression model for mortality was performed. A total of 57 cats were ultimately included in the study. Thirty‐five cats died. Eighteen of them were euthanized because of the severity of illness, and 17 died naturally. Twenty‐two cats were discharged alive from the hospital. After adjusting for the Acute Patient Physiologic and Laboratory Evaluation (APPLE) fast score and disease category, jugular venous partial pressure of oxygen (Pvjo2) and HCT at admission were independent predictors of hospital mortality (HCT: odds ratio [OR], 0.763, 95% confidence interval [CI]: 0.625–0.930; P = 0.008; Pjvo2: OR, 0.858; 95% CI: 0.749–0.984; P = 0.029). The association of these variables with mortality was maintained after conducting a sensitivity analysis and excluding cats that died by euthanasia.ConclusionsIn cats with hemodynamic instability and tissue hypoperfusion, HCT and Pvjo2 behaved as independent predictors of mortality. Both variables seem to reflect the magnitude of oxygen debt and tissue hypoperfusion.

show abstract

Monitoring and End-Points of Trauma Resuscitation

McBeth

Chow

2017

Curr Trauma Rep

View full text Add to dashboard Cite

Central venous saturation in septic shock: co-oximetry vs gasometry

Cited by 3 publications

References 19 publications

A comparison between measured and calculated central venous oxygen saturation in critically ill patients

A comparison between measured and calculated central venous oxygen saturation in critically ill patients

Retrospective evaluation of jugular venous blood variables and mortality in critically ill hospitalized cats

Monitoring and End-Points of Trauma Resuscitation

Contact Info

Product

Resources

About