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Published in: Intensive Care Medicine 9/2006

01-09-2006 | Original

Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock

Authors: Marjut Varpula, Sari Karlsson, Esko Ruokonen, Ville Pettilä

Published in: Intensive Care Medicine | Issue 9/2006

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Abstract

Objective

Central venous oxygen saturation (ScvO2) in initial resuscitation is included in the Surviving Sepsis Campaign guidelines. ScvO2 monitoring has also been suggested to be comparable to mixed venous oxygen saturation (SvO2) for clinical purposes. The aim of our study was to assess the correlation and agreement of ScvO2 and SvO2 and compare ScvO2–SvO2 difference to lactate, oxygen-derived and hemodynamic parameters in early septic shock in ICU after initial resuscitation.

Design and setting

Prospective clinical study with 16 patients with septic shock at two university hospital ICUs. A dose of norepinephrine over 0.1 μg/kg/min was required for inclusion.

Measurements and results

Five paired ScvO2 and SvO2 samples at 6-h intervals, altogether 72 samples, were collected during 24 h. The mean SvO2 was below the mean ScvO2 at all time points. Bias of difference was 4.2% and 95% limits of agreement ranged from –8.1% to 16.5%. The difference correlated significantly to CI and DO2.

Conclusions

The difference between paired ScvO2 and SvO2 varies highly. Therefore, SvO2 may not be estimated on the basis of ScvO2 in treatment of septic shock after resuscitation period in ICU.
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Literature
1.
go back to reference Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRef Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRef
2.
go back to reference Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRef Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRef
3.
go back to reference Heiselman D, Jones J, Cannon L (1986) Continuous monitoring of mixed venous oxygen saturation in septic shock. J Clin Monit 2:237–245PubMedCrossRef Heiselman D, Jones J, Cannon L (1986) Continuous monitoring of mixed venous oxygen saturation in septic shock. J Clin Monit 2:237–245PubMedCrossRef
4.
go back to reference Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettila V (2005) Hemodynamic variables related to outcome in septic shock. Intensive Care Med 31:1066–1071PubMedCrossRef Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettila V (2005) Hemodynamic variables related to outcome in septic shock. Intensive Care Med 31:1066–1071PubMedCrossRef
5.
6.
go back to reference Reinhart K, Kuhn HJ, Hartog C, Bredle DL (2004) Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 30:1572–1578PubMedCrossRef Reinhart K, Kuhn HJ, Hartog C, Bredle DL (2004) Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 30:1572–1578PubMedCrossRef
7.
go back to reference Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U (2005) Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology 103:249–257PubMedCrossRef Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U (2005) Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology 103:249–257PubMedCrossRef
8.
go back to reference Tahvanainen J, Meretoja O, Nikki P (1982) Can central venous blood replace mixed venous blood samples? Crit Care Med 10:758–761PubMed Tahvanainen J, Meretoja O, Nikki P (1982) Can central venous blood replace mixed venous blood samples? Crit Care Med 10:758–761PubMed
9.
go back to reference Turnaoglu S, Tugrul M, Camci E, Cakar N, Akinci O, Ergin P (2001) Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. J Cardiothorac Vasc Anesth 15:574–579PubMedCrossRef Turnaoglu S, Tugrul M, Camci E, Cakar N, Akinci O, Ergin P (2001) Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. J Cardiothorac Vasc Anesth 15:574–579PubMedCrossRef
10.
go back to reference Edwards JD, Mayall RM (1998) Importance of the sampling site for measurement of mixed venous oxygen saturation in shock. Crit Care Med 26:1356–1360PubMedCrossRef Edwards JD, Mayall RM (1998) Importance of the sampling site for measurement of mixed venous oxygen saturation in shock. Crit Care Med 26:1356–1360PubMedCrossRef
11.
go back to reference Faber T (1995) Central venous versus mixed venous oxygen content. Acta Anaesthesiol Scand Suppl107:33–36PubMedCrossRef Faber T (1995) Central venous versus mixed venous oxygen content. Acta Anaesthesiol Scand Suppl107:33–36PubMedCrossRef
12.
go back to reference Lee J, Wright F, Barber R, Stanley L (1972) Central venous oxygen saturation in shock: A study in man. Anesthesiology 36:472–478PubMedCrossRef Lee J, Wright F, Barber R, Stanley L (1972) Central venous oxygen saturation in shock: A study in man. Anesthesiology 36:472–478PubMedCrossRef
13.
go back to reference American College of Chest Physicians/Society of Critical Care Medicine consensus conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis (1992) Crit Care Med 20:864–874 American College of Chest Physicians/Society of Critical Care Medicine consensus conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis (1992) Crit Care Med 20:864–874
14.
go back to reference Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMed Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMed
15.
go back to reference Rady MY, Rivers EP, Martin GB, Smithline H, Appelton T, Nowak RM (1992) Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock. Am J Emerg Med 10:538–541PubMedCrossRef Rady MY, Rivers EP, Martin GB, Smithline H, Appelton T, Nowak RM (1992) Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock. Am J Emerg Med 10:538–541PubMedCrossRef
16.
go back to reference Ander DS, Jaggi M, Rivers E, Rady MY, Levine TB, Masura J, Gryzbowski M (1998) Undetected cardiogenic shock in patients with congestive heart failure presenting to the emergency department. Am J Cardiol 82:888–891PubMedCrossRef Ander DS, Jaggi M, Rivers E, Rady MY, Levine TB, Masura J, Gryzbowski M (1998) Undetected cardiogenic shock in patients with congestive heart failure presenting to the emergency department. Am J Cardiol 82:888–891PubMedCrossRef
17.
go back to reference Goldman RH, Klughaupt M, Metcalf T, Spivack AP, Harrison DC (1968) Measurement of central venous oxygen saturation in patients with myocardial infarction. Circulation 38:941–946PubMed Goldman RH, Klughaupt M, Metcalf T, Spivack AP, Harrison DC (1968) Measurement of central venous oxygen saturation in patients with myocardial infarction. Circulation 38:941–946PubMed
18.
go back to reference Scalea TM, Hartnett RW, Duncan AO, Atweh NA, Phillips TF, Sclafani SJ, Fuortes M, Shaftan GW (1990) Central venous oxygen saturation: a useful clinical tool in trauma patients. J Trauma 30:1539–1543PubMed Scalea TM, Hartnett RW, Duncan AO, Atweh NA, Phillips TF, Sclafani SJ, Fuortes M, Shaftan GW (1990) Central venous oxygen saturation: a useful clinical tool in trauma patients. J Trauma 30:1539–1543PubMed
19.
go back to reference Madsen P, Iversen H, Secher NH (1993) Central venous oxygen saturation during hypovolaemic shock in humans. Scand J Clin Lab Invest 53:67–72PubMedCrossRef Madsen P, Iversen H, Secher NH (1993) Central venous oxygen saturation during hypovolaemic shock in humans. Scand J Clin Lab Invest 53:67–72PubMedCrossRef
20.
go back to reference Perko G, Payne G, Linkis P, Jorgensen LG, Landow L, Warberg J, Secher NH (1994) Thoracic impedance and pulmonary atrial natriuretic peptide during head-up tilt induced hypovolaemic shock in humans. Acta Physiol Scand 150:449–454PubMedCrossRef Perko G, Payne G, Linkis P, Jorgensen LG, Landow L, Warberg J, Secher NH (1994) Thoracic impedance and pulmonary atrial natriuretic peptide during head-up tilt induced hypovolaemic shock in humans. Acta Physiol Scand 150:449–454PubMedCrossRef
21.
go back to reference Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J (2000) A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059PubMedCrossRef Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J (2000) A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059PubMedCrossRef
22.
go back to reference Gattinoni L, Braggi L, Pelosi P, Latini R, Tognoni G, Pesentii A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy on critically ill patients. N Engl J Med 333:1026–1031CrossRef Gattinoni L, Braggi L, Pelosi P, Latini R, Tognoni G, Pesentii A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy on critically ill patients. N Engl J Med 333:1026–1031CrossRef
23.
go back to reference Scheinman M, Brown M, Rapaport E (1969) Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients. Circulation 40:165–172PubMed Scheinman M, Brown M, Rapaport E (1969) Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients. Circulation 40:165–172PubMed
24.
go back to reference Ackland G, Grocott M, Mythen M (2000) Understanding gastrointestinal perfusion in critical care: so near, and yet so far. Crit Care 4:269–281PubMedCrossRef Ackland G, Grocott M, Mythen M (2000) Understanding gastrointestinal perfusion in critical care: so near, and yet so far. Crit Care 4:269–281PubMedCrossRef
25.
go back to reference Marik PE (1993) Gastric intramucosal pH. A better predictor of multiorgan dysfunction syndrome and death than oxygen-derived variables in patients with sepsis. Chest 104:225–229PubMedCrossRef Marik PE (1993) Gastric intramucosal pH. A better predictor of multiorgan dysfunction syndrome and death than oxygen-derived variables in patients with sepsis. Chest 104:225–229PubMedCrossRef
26.
go back to reference Meier-Hellmann A, Hannemann L, Specht M, Schaffartzik W, Spies C, Reinhart K (1994) The relationship between mixed venous and hepatic venous O2 saturation in patients with septic shock. Adv Exp Med Biol 345:701–707PubMed Meier-Hellmann A, Hannemann L, Specht M, Schaffartzik W, Spies C, Reinhart K (1994) The relationship between mixed venous and hepatic venous O2 saturation in patients with septic shock. Adv Exp Med Biol 345:701–707PubMed
27.
go back to reference Ruokonen E, Takala J, Uusaro A (1991) Effect of vasoactive treatment on the relationship between mixed venous and regional oxygen saturation. Crit Care Med 19:1365–1369PubMedCrossRef Ruokonen E, Takala J, Uusaro A (1991) Effect of vasoactive treatment on the relationship between mixed venous and regional oxygen saturation. Crit Care Med 19:1365–1369PubMedCrossRef
28.
go back to reference De Backer D, Creteur J, Silva E, Vincent JL (2003) Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: Which is best? Crit Care Med 31:1659–1667PubMedCrossRef De Backer D, Creteur J, Silva E, Vincent JL (2003) Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: Which is best? Crit Care Med 31:1659–1667PubMedCrossRef
29.
go back to reference Edouard AR, Degremont A-C, Duranteau J, Pussard E, Berdeaux A, Samii K (1993) Heterogeneous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 20:414–420CrossRef Edouard AR, Degremont A-C, Duranteau J, Pussard E, Berdeaux A, Samii K (1993) Heterogeneous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 20:414–420CrossRef
30.
go back to reference Oud L, Haupt MT (1999) Persistent gastric intramucosal ischemia in patients with sepsis following resuscitation from shock. Chest 115:1390–1396PubMedCrossRef Oud L, Haupt MT (1999) Persistent gastric intramucosal ischemia in patients with sepsis following resuscitation from shock. Chest 115:1390–1396PubMedCrossRef
31.
go back to reference Martin C, Auffray JP, Badetti C, Perrin G, Papazian L, Gouin F (1992) Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients. Intensive Care Med 18:101–104PubMedCrossRef Martin C, Auffray JP, Badetti C, Perrin G, Papazian L, Gouin F (1992) Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients. Intensive Care Med 18:101–104PubMedCrossRef
32.
go back to reference Krafft P, Steltzer H, Hiesmayr M, Klimscha W, Hammerle AF (1993) Mixed venous oxygen saturation in critically ill septic shock patients: the role of defined events. Chest 103:900–906PubMedCrossRef Krafft P, Steltzer H, Hiesmayr M, Klimscha W, Hammerle AF (1993) Mixed venous oxygen saturation in critically ill septic shock patients: the role of defined events. Chest 103:900–906PubMedCrossRef
33.
go back to reference Schremmer B, Dhainaut JF (1990) Regulation of myocardial oxygen delivery. Intensive Care Med 16:S157–S163PubMedCrossRef Schremmer B, Dhainaut JF (1990) Regulation of myocardial oxygen delivery. Intensive Care Med 16:S157–S163PubMedCrossRef
34.
go back to reference Dhainaut JF, Huyghebaert MF, Monsallier JF, Lefevre G, Dall'Ava-Santucci J, Brunet F, Villemant D, Carli A, Raichvarg D (1987) Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock. Circulation 75:533–541PubMed Dhainaut JF, Huyghebaert MF, Monsallier JF, Lefevre G, Dall'Ava-Santucci J, Brunet F, Villemant D, Carli A, Raichvarg D (1987) Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock. Circulation 75:533–541PubMed
35.
go back to reference Gutierrez G, Chawla LS, Seneff MG, Katz NM, Zia H (2005) Lactate concentration gradient from right atrium to pulmonary artery. Critical Care 9:R425–R429PubMedCrossRef Gutierrez G, Chawla LS, Seneff MG, Katz NM, Zia H (2005) Lactate concentration gradient from right atrium to pulmonary artery. Critical Care 9:R425–R429PubMedCrossRef
36.
go back to reference Schremmer B, Dhainaut JF (1990) Regulation of myocardial oxygen delivery. Intensive Care Med 16:157–163CrossRef Schremmer B, Dhainaut JF (1990) Regulation of myocardial oxygen delivery. Intensive Care Med 16:157–163CrossRef
37.
go back to reference Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M (2004) Lack of equivalence between central and mixed venous oxygen saturation. Chest 126:1891–1896PubMedCrossRef Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M (2004) Lack of equivalence between central and mixed venous oxygen saturation. Chest 126:1891–1896PubMedCrossRef
Metadata
Title
Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock
Authors
Marjut Varpula
Sari Karlsson
Esko Ruokonen
Ville Pettilä
Publication date
01-09-2006
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0270-y

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