Critical Assessment of Use of Central Venous Oxygen Saturation as a Mirror of Mixed Venous Oxygen in Severely Ill Cardiac Patients

Scheinman, Melvin M.; Brown, Michael A.; Rapaport, Elliot

doi:10.1161/01.cir.40.2.165

Cited by 212 publications

(106 citation statements)

References 16 publications

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“…19,20 Reinhart et al 21 compared mixed venous saturation to saturation in the superior vena cava in an experimental model and demonstrated an excellent correlation (r = 0.97). Lee et al 22 studied 29 stable patients and 15 patients in circulatory shock (septic, hemorrhagic and neurogenic) and detected a good correlation between venous atrial and mixed saturation.…”

Section: Figure 4 -mentioning

confidence: 99%

Indirect calorimetry can be used to measure cardiac output in septic patients?

et al. 2008

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Purpose: The aim of this study was to compare two different cardiac output (CO) monitoring systems based on the thermodilution principle (Thermo-CO) and indirect calorimetry (Fick mixed-CO) in septic patients. Methods: Prospective study in septic patients admitted in an intensive care unit of a university hospital. Nineteen patients aged on average 45.4 ± 21.5 years were enrolled in the study. Four series of hourly measurements by the two techniques were carried out simultaneously. Results: No significant differences were observed between Thermo-CO and Fick mixed-CO (7.0 ± 1.8 L.min -1 and 6.4 ± 1.7 L.min -1. ). Parallel analysis of Fick mixed-CO and Fick atrial-CO was performed introducing a correction factor for the eight atrial samples in order to adjust the values of oxygen saturation obtained from atrial blood (Fick corrected atrial-CO) to those obtained from mixed venous blood. No significant differences could be detected between Fick mixed-CO and Fick corrected atrial-CO. The correlation coefficients of Thermo CO/Fick mixed-CO and Fick mixed-CO/ Fick corrected atrial-CO were 0.84 and 0.94, respectively. Conclusion: We observed that the agreement between the two methods was satisfactory on the basis of the decisions made for treatment. Indirect calorimetry is useful to measure CO in patients with septic shock.Key words: Indirect Calorimetry. Cardiac Output. Septic Shock. Intensive Care Setting. RESUMOObjetivo: O objetivo deste estudo foi comparar as medidas do débito cardíaco (DC) obtidas pela termodiluição (DC-termo) e pela calorimetria indireta (DC-Fick misto) em pacientes com choque séptico. Métodos: Estudo prospectivo em pacientes sépticos internados em unidade de terapia intensiva de um hospital universitário. Foram estudados 19 pacientes (45,4 ± 21,5 anos). Foram realizadas quatro séries de medidas do DC pelos dois métodos, simultaneamente. Resultados: Não houve diferenças significativas entre os valores do DC-termo e DC-Fick misto (7,0 ± 1,8 L.min -1 e 6,4 ± 1,7 L.min -1 , respectivamente). Na avaliação dos oito casos (DC-Fick misto/DC Fick atrial), introduziu-se um fator de correção para aproximar os valores do conteúdo de O 2 atrial (DC-Fick atrial corrigido) com o venoso misto. Não houve diferença significativa do DC-Fick misto e DC-Fick atrial corrigido nos 4 tempos. A correlação foi de 0.84 para o DC-termo/DC-Fick misto e de 0.94 para o DC-Fick misto/DC-Fick atrial corrigido. Conclusão: A calorimetria indireta é um bom método para a medida do DC em pacientes vítimas de choque séptico, sobretudo nos casos onde a monitorização hemodinâmica invasiva não está disponível ou está contra indicada.

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Section: Figure 4 -mentioning

confidence: 99%

Indirect calorimetry can be used to measure cardiac output in septic patients?

et al. 2008

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“…In the absence of toxicity from such agents, central venous oxygen saturations greater than 90 % are certainly not common, but have been described. Sepsis and resuscitation from cardiac arrest are two situations in which central venous oxygen saturations greater than 90 % have been described [89][90][91][92][93]. In both situations, mitochondrial dysfunction and the resulting diminished inability to extract oxygen may be responsible [94].…”

Section: How High Should Venous Oxygen Content Be To Help Make the DImentioning

confidence: 99%

“…Although studies have established what normal central venous oxygen content is and how it varies in many clinical situations, there appears to be very little corresponding information on peripheral venous oxygen content [89,92,93,95,96]. An elevated peripheral venous oxygen content has been reported in multiple case reports of cyanide poisoning [63,80,82].…”

Section: How High Should Venous Oxygen Content Be To Help Make the DImentioning

confidence: 99%

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Villano

O'Connell

et al. 2015

J. Med. Toxicol.

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A 28-year-old man was brought to the Emergency Department (ED) for evaluation of a depressed level of consciousness that developed while in jail. Sixteen hours previously, he had been arrested on charges of murder. The patient's mental status was reported as normal at the time of arrest, and it had remained so during several hours of interrogation and during the booking process at jail. Following interrogation, the patient was placed into a cell with no other inmates. During the jail intake process, the patient had not reported any history of medical problems nor was he prescribed with any medications. Paramedics arrived to find him unresponsive, but maintaining airway reflexes and hemodynamically stable. They measured a blood glucose of 300 mg/dL and noted one episode of blood-tinged emesis during transport to the ED. No seizure activity was witnessed.On arrival to the ED, vital signs were: heart rate 132/min, blood pressure 129/74 mmHg, temperature 35.3°C (95.5°F), respiratory rate 24/min, and 100 % oxygen saturation on 15 l/ min of oxygen delivered by non-rebreather face mask.Physical examination was notable for a depressed level of consciousness. His eyes remained closed to pain, he withdrew all extremities equally to pain, and he was non-verbal. He had no signs of trauma, and his pupils were normal in size and reactive. Rapid sequence tracheal intubation was performed for airway protection. An electrocardiogram was normal except for sinus tachycardia at a rate of 111/min. An initial peripherally drawn arterial blood gas obtained immediately after intubation revealed: pH 6.97, pCO 2 40 mmHg, pO 2 215 mmHg. A computed tomography scan of the brain was normal. Initial blood chemistry panel was significant for a serum bicarbonate of 7 mEq/L, glucose of 362 mg/dL, and a normal potassium, blood urea nitrogen (BUN), creatinine, and calcium. The initial serum anion gap was 34 mEq/L. Measured serum osmolality was 320 mOsm/kg, yielding an osmol gap of 9 mOsm/kg (using formula of [2(Na)+BUN/2.8+glu-cose/18] for calculated serum osmolarity). Initial lactate was 156.5 mg/dL (normal reference range 4.5-19.8 mg/dL) and beta-hydroxybutyrate (βHB) 2.9 mg/dL (normal reference range 0.0-2.8 mg/dL). Initial liver panel included an aspartate aminotransferase (AST) of 64 U/L, alanine aminotransferase (ALT) of 27 U/L, and bilirubin of 0.4 mg/dL. Prothrombin time was 13.1 s (reference range 9.7-12.5), and lipase was normal at 25 U/L. Initial creatinine phosphokinase (CK) was slightly elevated at 373 U/L (0-175). Urinalysis was positive for small ketones and crystals were not present. Measurements of acetone and acetoacetate were not performed. Serum ethanol and salicylate levels were undetectable, and a urine drug of abuse panel by immunoassay was negative for amphetamines as a class, barbiturates as a class, benzodiazepines as a class, benzoylecgonine (cocaine metabolite), methadone, opiates as class, oxycodone, phencyclidine, and tetrahydrocannabinoids. Iron concentration was normal at 87 mcg/dL.Over the first hour of management,...

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“…In these conditions (due to a blood flow redistribution in the upper parts of the body, decreased splanchnic and renal circulation and increased ERO2) ScVO2 may outmatch SVO2 by up to 20% . (27)(28)(29)(30)(31) The use of individual ScVO2 and ERO2 values as transfusion indicators in these conditions is questionable. In the most common situations in the ICU, when SaO2 is near 100%, ERO2 may be calculated from the SaO2 and SVO2 difference, without a need for VO2 and DO2 measurements.…”

Section: Global Oxygenation Param-eters In Critical Illnessmentioning

confidence: 99%

“…The authors' comment on the lack of significant changes in the ERO2 was that about 60% of the patients had a baseline ERO2 below 0. 30 …”

Section: Global Oxygenation Param-eters As Indicators For Blood Transmentioning

confidence: 99%

Indications for blood transfusions in critical illness

Baronica

Tonković²,

Mržljak³

et al. 2015

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Transfusion of blood products should improve tissue oxygenation and reduce negative consequences of anaemia. At the same time, adverse effects of transfusion, such as infections, immunologic reactions and mistransfusion, could be deleterious. Most transfusion guidelines suggest looking at the combination of haemoglobin or haematocrit levels in addition to clinical signs in the decision making process for a blood transfusion. The problem with such indications is that the clinical evaluation may be misleading in severely ill patients and haemoglobin levels that impair oxygen delivery cannot be determined easily. Many studies attempted to establish more convenient parameters, such as oxygen saturation from mixed and central venous blood, tissue oxygen extraction and other methods. Although the results from these studies are conflicting, it appears that global oxygenation parameters are a good indicator for a blood transfusion in some categories of critically ill patients.

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Critical Assessment of Use of Central Venous Oxygen Saturation as a Mirror of Mixed Venous Oxygen in Severely Ill Cardiac Patients

Cited by 212 publications

References 16 publications

Indirect calorimetry can be used to measure cardiac output in septic patients?

Indirect calorimetry can be used to measure cardiac output in septic patients?

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Indications for blood transfusions in critical illness

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