Skip to main content
Top
Published in: Critical Care 4/2011

Open Access 01-08-2011 | Research

High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients

Authors: Dimitrios Velissaris, Charalampos Pierrakos, Sabino Scolletta, Daniel De Backer, Jean Louis Vincent

Published in: Critical Care | Issue 4/2011

Login to get access

Abstract

Introduction

The aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. We also sought to define whether fluid responsiveness would be less likely in the presence of a high SvO2 (>70%).

Methods

This observational study was conducted in a 32-bed university hospital medicosurgical ICU. The hemodynamic response to a fluid challenge was evaluated in 65 critically ill patients with severe sepsis. Patients were divided into two groups (responders and nonresponders) according to their cardiac index (CI) response to the challenge (>10% or <10%).

Results

Of the 65 patients, 34 (52%) were fluid responders. Baseline SvO2, CI, heart rate (HR) and mean arterial pressure (MAP) were not statistically different between groups. The responders had lower pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) at baseline than the nonresponders. After the fluid challenge, there were no differences between the two groups in MAP, CVP, PAOP or HR. There was no correlation between changes in CI or stroke volume index and baseline SvO2. Receiver operating characteristic analysis showed that SvO2 was not a predictor of fluid responsiveness.

Conclusions

The response of septic patients to a fluid challenge is independent of baseline SvO2. The presence of a high SvO2 does not necessarily exclude the need for further fluid administration.
Appendix
Available only for authorised users
Literature
1.
go back to reference Anning PB, Finney SJ, Singh S, Winlove CP, Evans TW: Fluids reverse the early lipopolysaccharide-induced albumin leakage in rodent mesenteric venules. Intensive Care Med 2004, 30: 1944-1949. 10.1007/s00134-004-2385-3PubMedCrossRef Anning PB, Finney SJ, Singh S, Winlove CP, Evans TW: Fluids reverse the early lipopolysaccharide-induced albumin leakage in rodent mesenteric venules. Intensive Care Med 2004, 30: 1944-1949. 10.1007/s00134-004-2385-3PubMedCrossRef
2.
go back to reference Haupt MT, Gilbert EM, Carlson RW: Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Respir Dis 1985, 131: 912-916.PubMed Haupt MT, Gilbert EM, Carlson RW: Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Respir Dis 1985, 131: 912-916.PubMed
3.
go back to reference Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P: Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 1998, 89: 1313-1321. 10.1097/00000542-199812000-00007PubMedCrossRef Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P: Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 1998, 89: 1313-1321. 10.1097/00000542-199812000-00007PubMedCrossRef
4.
go back to reference Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307PubMedCrossRef Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307PubMedCrossRef
5.
go back to reference Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008, 34: 17-60. 10.1007/s00134-007-0934-2PubMedPubMedCentralCrossRef Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008, 34: 17-60. 10.1007/s00134-007-0934-2PubMedPubMedCentralCrossRef
6.
go back to reference Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002, 121: 2000-2008. 10.1378/chest.121.6.2000PubMedCrossRef Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002, 121: 2000-2008. 10.1378/chest.121.6.2000PubMedCrossRef
7.
go back to reference Vincent JL, Gerlach H: Fluid resuscitation in severe sepsis and septic shock: an evidence-based review. Crit Care Med 2004, 32: S451-S454. 10.1097/01.CCM.0000142984.44321.A4PubMedCrossRef Vincent JL, Gerlach H: Fluid resuscitation in severe sepsis and septic shock: an evidence-based review. Crit Care Med 2004, 32: S451-S454. 10.1097/01.CCM.0000142984.44321.A4PubMedCrossRef
8.
go back to reference Vincent JL, Weil MH: Fluid challenge revisited. Crit Care Med 2006, 34: 1333-1337. 10.1097/01.CCM.0000214677.76535.A5PubMedCrossRef Vincent JL, Weil MH: Fluid challenge revisited. Crit Care Med 2006, 34: 1333-1337. 10.1097/01.CCM.0000214677.76535.A5PubMedCrossRef
9.
go back to reference Birman H, Haq A, Hew E, Aberman A: Continuous monitoring of mixed venous oxygen saturation in hemodynamically unstable patients. Chest 1984, 86: 753-756. 10.1378/chest.86.5.753PubMedCrossRef Birman H, Haq A, Hew E, Aberman A: Continuous monitoring of mixed venous oxygen saturation in hemodynamically unstable patients. Chest 1984, 86: 753-756. 10.1378/chest.86.5.753PubMedCrossRef
10.
go back to reference Casserly B, Read R, Levy MM: Hemodynamic monitoring in sepsis. Crit Care Clin 2009, 25: 803-823. ix 10.1016/j.ccc.2009.08.006PubMedCrossRef Casserly B, Read R, Levy MM: Hemodynamic monitoring in sepsis. Crit Care Clin 2009, 25: 803-823. ix 10.1016/j.ccc.2009.08.006PubMedCrossRef
11.
go back to reference Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003, 29: 530-538.PubMedCrossRef Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003, 29: 530-538.PubMedCrossRef
12.
go back to reference Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med 1998, 26: 1793-1800. 10.1097/00003246-199811000-00016PubMedCrossRef Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med 1998, 26: 1793-1800. 10.1097/00003246-199811000-00016PubMedCrossRef
13.
go back to reference Cariou A, Monchi M, Dhainaut JF: Continuous cardiac output and mixed venous oxygen saturation monitoring. J Crit Care 1998, 13: 198-213. 10.1016/S0883-9441(98)90006-5PubMedCrossRef Cariou A, Monchi M, Dhainaut JF: Continuous cardiac output and mixed venous oxygen saturation monitoring. J Crit Care 1998, 13: 198-213. 10.1016/S0883-9441(98)90006-5PubMedCrossRef
14.
15.
go back to reference Pinsky MR, Vincent JL: Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med 2005, 33: 1119-1122. 10.1097/01.CCM.0000163238.64905.56PubMedCrossRef Pinsky MR, Vincent JL: Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med 2005, 33: 1119-1122. 10.1097/01.CCM.0000163238.64905.56PubMedCrossRef
16.
go back to reference Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO 2 Collaborative Group. N Engl J Med 1995, 333: 1025-1032. 10.1056/NEJM199510193331601PubMedCrossRef Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO 2 Collaborative Group. N Engl J Med 1995, 333: 1025-1032. 10.1056/NEJM199510193331601PubMedCrossRef
17.
go back to reference Heyland DK, Cook DJ, King D, Kernerman P, Brun-Buisson C: Maximizing oxygen delivery in critically ill patients: a methodologic appraisal of the evidence. Crit Care Med 1996, 24: 517-524. 10.1097/00003246-199603000-00025PubMedCrossRef Heyland DK, Cook DJ, King D, Kernerman P, Brun-Buisson C: Maximizing oxygen delivery in critically ill patients: a methodologic appraisal of the evidence. Crit Care Med 1996, 24: 517-524. 10.1097/00003246-199603000-00025PubMedCrossRef
18.
go back to reference Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL: Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007, 35: 64-68. 10.1097/01.CCM.0000249851.94101.4FPubMedCrossRef Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL: Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007, 35: 64-68. 10.1097/01.CCM.0000249851.94101.4FPubMedCrossRef
19.
go back to reference Schneider AJ, Teule GJ, Groeneveld AB, Nauta J, Heidendal GA, Thijs LG: Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J 1988, 116: 103-112. 10.1016/0002-8703(88)90256-6PubMedCrossRef Schneider AJ, Teule GJ, Groeneveld AB, Nauta J, Heidendal GA, Thijs LG: Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J 1988, 116: 103-112. 10.1016/0002-8703(88)90256-6PubMedCrossRef
20.
go back to reference Packman MI, Rackow EC: Optimum left heart filling pressure during fluid resuscitation of patients with hypovolemic and septic shock. Crit Care Med 1983, 11: 165-169. 10.1097/00003246-198303000-00003PubMedCrossRef Packman MI, Rackow EC: Optimum left heart filling pressure during fluid resuscitation of patients with hypovolemic and septic shock. Crit Care Med 1983, 11: 165-169. 10.1097/00003246-198303000-00003PubMedCrossRef
21.
go back to reference Perel A: Bench-to-bedside review: the initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines-does one size fit all? Crit Care 2008, 12: 223. 10.1186/cc6979PubMedPubMedCentralCrossRef Perel A: Bench-to-bedside review: the initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines-does one size fit all? Crit Care 2008, 12: 223. 10.1186/cc6979PubMedPubMedCentralCrossRef
22.
go back to reference Bendjelid K, Romand JA: Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 2003, 29: 352-360.PubMedCrossRef Bendjelid K, Romand JA: Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 2003, 29: 352-360.PubMedCrossRef
23.
go back to reference Sevransky JE, Nour S, Susla GM, Needham DM, Hollenberg S, Pronovost P: Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature. Crit Care 2007, 11: R67. 10.1186/cc5948PubMedPubMedCentralCrossRef Sevransky JE, Nour S, Susla GM, Needham DM, Hollenberg S, Pronovost P: Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature. Crit Care 2007, 11: R67. 10.1186/cc5948PubMedPubMedCentralCrossRef
Metadata
Title
High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients
Authors
Dimitrios Velissaris
Charalampos Pierrakos
Sabino Scolletta
Daniel De Backer
Jean Louis Vincent
Publication date
01-08-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/10326

Other articles of this Issue 4/2011

Critical Care 4/2011 Go to the issue