Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients

Abstract

A strong association exists between positive DeltaSO(2) and Delta[Lac] and survival in critically ill patients. Whether therapy aimed at increasing DeltaSO(2) and Delta[Lac] results in improved ICU survival remains to be determined.

Diagnostic accuracy of central venous saturation in estimating mixed venous saturation is proportional to cardiac performance among cardiac surgical patients

“…While our study was larger in size than the aforementioned one, it was still underpowered to look at survival due to the excellent survival rates in the contemporary cardiac surgical practice. Our own data seemingly contradict the observations by Gutierrez and co-workes [22]. Patients in whom the central venous exceeded the mixed venous saturations (in our study denoted as a negative SvO 2 -ScvO 2 gradient) had inferior indicators of their hemodynamic status.…”

“…Gutierrez et al documented an association between a positive ScvO 2 -SvO 2 gradient and survival in a cohort of 106 critically ill patients [22]. The authors suggested that increasingly positive ScvO 2 -SvO 2 gradients reflected superior oxygen utilization [22]. While our study was larger in size than the aforementioned one, it was still underpowered to look at survival due to the excellent survival rates in the contemporary cardiac surgical practice.…”

“…When considering the high postoperative inotrope utilization among patients with a negative SvO 2 -ScvO 2 gradient as a surrogate for a suboptimal hemodynamics, however, one may extrapolate that this subgroup had inferior pre-treatment cardiac indices. Gutierrez et al documented an association between a positive ScvO 2 -SvO 2 gradient and survival in a cohort of 106 critically ill patients [22]. The authors suggested that increasingly positive ScvO 2 -SvO 2 gradients reflected superior oxygen utilization [22].…”

Discrepancy Between Superior Vena Cava Oxygen Saturation and Mixed Venous Oxygen Saturation Can Predict Postoperative Complications in Cardiac Surgery Patients

“…They drew blood samples from the proximal (ScvO 2 ) and distal (SvO 2 ) port of the PAC every 6 hours from the time of PAC insertion until its removal (30.9 Ϯ 11.0 hours) and reported that more survivors had mean positive ΔSO 2 than the deceased (p o 0.01). 23 This result seems to contradict the current study results, but continuous monitoring of ScvO 2 and SvO 2 was not performed in the study performed by Guiterrez et al Continuous monitoring of ScvO 2 and SvO 2 is a critical issue when ΔSO 2 is used as a predictor of clinical implications. If they performed continuous monitoring of ScvO 2 and SvO 2 , the results may have been different.…”

Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation*

“…No complications other than transient arrhythmias were observed during the insertion of any catheter. In case of the use of a PA catheter (Criticath SP 5507H TD, Becton Dickinson, Singapore) in the ICU, blood samples were drawn from the proximal port of the catheter as representative of central venous blood (21)(22)(23). All blood samples were analyzed by a co-oximeter (Radiometer ABL800 flex, Copenhagen, Denmark).…”