Systematic review of the association of venous oxygenation and outcome in adult hospitalized patients

Chemtob, Raphaelle A.; Eskesen, Trine G.; Moeller-Soerensen, Hasse; Perner, Anders; Ravn, Hanne Berg

doi:10.1111/aas.12810

Cited by 10 publications

(12 citation statements)

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“…Low venous oxygen saturation reflects impaired tissue oxygenation and is routinely used as a predictive tool and a therapeutic target to improve the care of critically ill patients [ 2 ]. Previous studies have associated impaired venous oxygen saturation with increased mortality and morbidity in both surgical patients [ 3 – 9 ] and patients admitted in the Intensive Care Unit (ICU) [ 10 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Peripheral measurements of venous oxygen saturation and lactate as a less invasive alternative for hemodynamic monitoring

Chemtob

Møller‐Sørensen

2018

Scand J Trauma Resusc Emerg Med

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BackgroundPeripheral measurement of venous oxygen saturation and lactate is a less invasive alternative to monitor tissue oxygenation as compared to measurements from a central venous catheter. However, there is a lack of evidence to support the use of peripheral measurements. In this study, we investigated the agreement between central and peripheral venous oxygen saturation and lactate.MethodsWe conducted a prospective observational study including 115 patients who underwent elective cardiac surgery between April and May 2015 at Rigshospitalet, Copenhagen, Denmark. Measurements were obtained simultaneously at induction of anaesthesia, upon arrival in the ICU and 3–4 h postoperatively. Bias and trending ability was identified using Bland-Altman analysis and a four-quadrant plot.ResultsBias was 13.37% for venous oxygen saturation preoperatively (95% CI: 11.52–15.22, LoA: ±19.10, PE: 22.08%), 11.29% at arrival to the ICU (95% CI: 8.81–13.77, LoA: ±25.10, PE: 32.39%) and 16.49% at 3–4 h postoperatively (95% CI: 14.16–18.82, LoA: ±21.20, PE: 26.82%). A four-quadrant plot demonstrated an 89% concordance. Central and peripheral lactate showed a bias of 0.14 mmol/L preoperatively (95% CI: 0.11–0.17, LoA: ±0.30, PE: 32.08%), 0.16 mmol/L at arrival to ICU (95% CI: 0.09–0.23, LoA: ±0.70, PE: 38.88%) and 0.23 mmol/L at 3–4 h postoperatively (95% CI: 0.11–0.35, LoA: ±0.50, 25.18%).DiscussionMeasurements of peripheral oxygen saturation and lactate may be valuable in an emergency setting, avoiding unnecessary and time consuming application of a CVC.ConclusionWe found a high bias but an acceptable trending ability between central and peripheral venous oxygenation. Central and peripheral lactate had excellent agreement. Further studies are necessary to validate the use of peripheral venous samples to identify patients at risk of impaired tissue oxygenation.

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Section: Introductionmentioning

confidence: 99%

Peripheral measurements of venous oxygen saturation and lactate as a less invasive alternative for hemodynamic monitoring

Chemtob

Møller‐Sørensen

2018

Scand J Trauma Resusc Emerg Med

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“…In this prospective cohort study, we frequently found low SvO 2 values in over half of the patients before and after RVP episodes, lasting in the majority of patients at least as long as one minute after the pacing episode. However, these pe- [7] and it is a good marker of the adequacy of the systemic circulation.…”

Section: Discussionmentioning

confidence: 99%

“…The normal values of the SvO 2 lie between 65% and 80% [7] [21]. The associations between low SvO 2 and increased mortality and morbidity and an increased length of ICU stay after cardiac surgery, have been demonstrated in many studies [7]. In the study of Holm et al, [13] that examined 396 patients after aortic Little is known about the impact of the RVP on the SvO 2 and CO and the other different steps of the TAVR procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Adequate hemodynamic monitoring is essential for guiding hemodynamic management and thus invasive blood pressure monitoring and central venous access are routinely applied. In order to maintain tissue oxygenation, SvO 2 has been used as a marker to assess the adequacy of the circulation [7] in cardiac surgery patients but, there are rather few studies describing continuous SvO 2 monitoring during TAVR procedures [8] [9]. Low SvO 2 values were associated with higher morbidity and mortality after cardiac surgery [10] [11] [12].…”

Section: Introductionmentioning

confidence: 99%

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Mixed Venous Oxygen Saturation during the Transcatheter Aortic Valve Replacement—A Prospective Cohort Study

Musialowicz¹,

Ellam²,

Valtola³

et al. 2019

OJAnes

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Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this study was to determine the incidence of insufficient oxygen delivery as measured by mixed venous oxygen saturation (SvO 2 ) via invasive continuous cardiopulmonary monitoring and the low cardiac output syndrome (LCOS) in patients undergoing the TAVR procedure. The second objective was to examine how these hemodynamic measurements would change during critical events, such as rapid ventricular pacing (RVP) during this procedure. Methods: This prospective, observational study, examined twenty patients undergoing TAVR under general anesthesia. Hemodynamic variables, SvO 2 and the continuous cardiac output (CO) were assessed using pulmonary artery catheter (PAC) and a Vigilance ® monitor. Insufficient oxygen delivery was defined as a SvO 2 value under 58% and LCOS as a cardiac index (CI) under 2 L/min/m 2 . Total intravenous anesthesia and hemodynamic management protocol were standardized. RVP was induced twice during the procedure at a frequency of 180 -200/min. Predefined clinical endpoints were assessed during the procedure and hemodynamic values were analyzed before and after twelve critical events. Results: The data of twenty patients with a mean age of 80 ± 4 years and EuroSCORE 18 ± 10 were analyzed. Fourteen (70%) of the TAVR procedures were performed transapically, the other six (30%) transfemorally. The SvO 2 value under 58% (mean 54 ± 6) and the CI under 2 L/min/m 2 (mean 1.6 ± 0.2) were detected in 60% of patients (n = 12) before the use of RVP. All of these patients received perioperative inotropic medication and required norepinephrine infusion for maintenance of adequate blood pressure. The SvO 2 , CO and CI were significantly decreased after the use of RVP (P < 0.001 and P < 0.03). The SvO 2 reverted rapidly to the same level as before the application How to cite this paper: Musialowicz, T., Ellam, S., Valtola, A., Halonen, J. and Lahtinen, P. (2019) Mixed Venous Oxygen Saturation during the Transcatheter Aortic Valve Replacement-A Prospective Cohort Study. Open Journal of Anesthesiology,9,[140][141][142][143][144][145][146][147][148][149][150][151][152][153] of RVP (1 min), CO, and CI 10 min later. At the end of the operation SvO 2 values were at same level as before RVP and CO and CI were higher than before RVP. Conclusion: A high incidence of insufficient oxygen delivery and low cardiac output syndrome were detected in patients undergoing TAVR procedures. Nonetheless, all hemodynamic values returned rather rapidly to the same level as before the use of the RVP and were at the optimal level at the end of the procedure. According to the current study, the most hemodynamically hazardous steps during TAVR are the use of RVP sequences, the induction of anesthesia and the initiation of surgery.

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“…Increased oxygen extraction, i.e the ratio of oxygen consumption (VO2) to oxygen delivery (DO2), has been associated with increased mortality following major surgery . A systematic review on central venous saturation (ScvO2) as a surrogate marker of oxygen extraction confirmed that low values were associated with increased morbidity in patients undergoing abdominal surgery, but cut‐off levels were varying between studies . Enhancement of intraoperative oxygen delivery to pre‐specified targets is a key concept in many goal‐directed hemodynamic treatment protocols .…”

Section: Introductionmentioning

confidence: 99%

The effects of general anaesthesia on oxygen consumption: A meta‐analysis guiding future studies on perioperative oxygen transport

Jakobsson

Vadman

Hagel

et al. 2018

Acta Anaesthesiol Scand

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Funding informationDepartmental funding only.Background: Increased oxygen extraction, the ratio of consumption to delivery, has been associated with poor outcome after surgery. Oxygen consumption (VO2) can change in several ways in the perioperative period, but is seldom monitored directly in routine care. This study investigates the effects of general anaesthesia on VO2. Methods:We searched PubMed, EMBASE, and Cochrane Library 1946-2018 for studies including VO2 measurements before and after anaesthesia induction. Quality was assessed by Cochrane risk of bias tool and NIH Quality Assessment tool for before-and-after studies. Changes in VO2 after anaesthesia induction were pooled in a random effects model meta-analysis with standardized mean differences transformed to absolute changes of VO2. Changes in VO2 after surgical incision and after recovery from anaesthesia were analysed as secondary outcomes in the included studies. Results:Twenty-four studies including 453 patients were analysed for VO2 changes induced by anaesthesia. Studies were published during 1969-2000 and mean age of patients ranged 28-70 years. VO2 decreased after anaesthesia induction by −65 (−75; −55, 95% CI) mL min −1 and indexed VO2 (VO2I) by −33 (−38; −28, 95% CI) mL min −1 m −2 . After surgical incision and in the post-operative period VO2 increased again. Heterogeneity was considerable among the studies and the overall quality of evidence was very low. Conclusions:General anaesthesia probably reduces oxygen consumption but the effect estimate is uncertain. Given the limited generalizability and low quality of the available evidence, new studies in modern perioperative settings and in today's older high-risk surgical patient populations are needed.

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Systematic review of the association of venous oxygenation and outcome in adult hospitalized patients

Cited by 10 publications

References 54 publications

Peripheral measurements of venous oxygen saturation and lactate as a less invasive alternative for hemodynamic monitoring

Peripheral measurements of venous oxygen saturation and lactate as a less invasive alternative for hemodynamic monitoring

Mixed Venous Oxygen Saturation during the Transcatheter Aortic Valve Replacement—A Prospective Cohort Study

The effects of general anaesthesia on oxygen consumption: A meta‐analysis guiding future studies on perioperative oxygen transport

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