Importance of the sampling site for measurement of mixed venous oxgen saturation in shock

Edwards, Joseph; Mayall, R.

doi:10.1097/00003246-199808000-00020

Cited by 113 publications

(45 citation statements)

References 18 publications

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“…16 O 2 saturation in atrial blood and in the superior vena cava differs from that in mixed blood. This is due to the fact that oxygen consumption varies in the different organs, with greater oxygen consumption in the brain and lower oxygen consumption in the kidneys out of proportion with its flow in blood, causing O 2 saturation to be lower in the superior vena cava than in the inferior vena cava.…”

Section: Figure 4 -mentioning

confidence: 82%

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: 82%

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

et al. 2008

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“…Reinhart et al have shown that ScvO 2 has a good correlation with SvO 2 [86]. However, there is still debate regarding the equivalence between these two values [87][88][89][90] especially when they are low [91]. The surviving Sepsis Campaign recognized the clinical importance of ScvO 2 and recommended to keep ScvO 2 more than 70 % during the resuscitation of septic shock patients.…”

Section: Scvomentioning

confidence: 99%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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Several studies have demonstrated that perioperative hemodynamic optimization (or ''goal directed therapy'') using minimally invasive hemodynamic monitoring technologies has the ability to improve postoperative patients' outcome with lower complication rates, shorter hospital lengths of stay, and lower cost of surgery. This specific concept of goal-directed therapy (GDT) uses perioperative cardiac output monitoring and manipulation of physiologic parameters (dynamic parameters of fluid responsiveness) to guide intravenous fluids and inotropic therapy with the goal of ensuring adequate tissue perfusion. Recently, the evidence related to the implementation of GDT strategies has been considered strong enough to allow for the creation of national recommendations in the UK, in France, and by the European Society of Anaesthesiology. The aims of the programs are to apply best practices to high-risk surgical patients and requires the participation of all clinicians involved in patients' care. Considering the potential clinical and economic benefits of GDT protocols and the positive recommendations from influential scientific societies, more and more hospitals around the world have become interested in implementing hemodynamic optimization in their departments. This review provides the information about the evolution of hemodynamic monitoring from invasive to the more recent noninvasive devices, and how these devices can be used in the operating rooms through well-defined algorithms of GDT.

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“…Lee and co-workers described similar findings (51). Other more detailed studies in mixed groups of critically-ill patients designed to test if the ScvO2 measurements could substitute the SvO2 showed problematically large confidence limits (52) and poor correlation between the two values (53). The hypothesis that slower skeletal muscle StO2 deoxygenation rate (more disturbed tissue oxygen extraction) is proportional to the ScvO2-SvO2 difference in patients with severe heart failure with additional sepsis/septic shock was confirmed (54).…”

Section: Nirs For Evaluation Of Skeletal Muscle Tissue Oxygenation Inmentioning

confidence: 73%

How I use skeletal muscle Near Infrared Spectroscopy to non-invasively assess hemodynamic status of the critically ill

Podbregar¹

2017

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The major goal of hemodynamic treatment is to reach adequate flow. Near infrared spectroscopy (NIRS) allows non-invasive assessment of skeletal muscle tissue oxygenation during rest and also during vascular occlusion test (VOT). VOT allows estimation of tissue oxygen extraction capability, which could be preserved (i.e. hypovolemic, obstructive and cardiogenic shock) or inappropriate (i.e. sepsis/ septic shock). By using ultrasound to estimate cardiac output, arterial hemoglobin oxygen saturation, skeletal muscle NIRS, arterial lactate and hemoglobin, therapeutic goals in critically ill patients with preserved oxygen extraction capability can easily be targeted. Current controversies of NIRS technology and approach to patients with impaired oxygen extraction are discussed as well.

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Importance of the sampling site for measurement of mixed venous oxgen saturation in shock

Cited by 113 publications

References 18 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?

Guiding Goal-Directed Therapy

How I use skeletal muscle Near Infrared Spectroscopy to non-invasively assess hemodynamic status of the critically ill

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