Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 2/2007

Open Access 01-04-2007 | Research

The concentration of oxygen, lactate and glucose in the central veins, right heart, and pulmonary artery: a study in patients with pulmonary hypertension

Authors: Guillermo Gutierrez, Anthony Venbrux, Elizabeth Ignacio, Jonathan Reiner, Lakhmir Chawla, Anish Desai

Published in: Critical Care | Issue 2/2007

Login to get access

Abstract

Introduction

Decreases in oxygen saturation (SO2) and lactate concentration [Lac] from superior vena cava (SVC) to pulmonary artery have been reported. These gradients (ΔSO2 and Δ[Lac]) are probably created by diluting SVC blood with blood of lower SO2 and [Lac]. We tested the hypothesis that ΔSO2 and Δ[Lac] result from mixing SVC and inferior vena cava (IVC) blood streams.

Methods

This was a prospective, sequential, observational study of hemodynamically stable individuals with pulmonary artery hypertension (n = 9) who were about to undergo right heart catheterization. Catheters were advanced under fluoroscopic guidance into the IVC, SVC, right atrium, right ventricle, and pulmonary artery. Samples were obtained at each site and analyzed for SO2, [Lac], and glucose concentration ([Glu]). Analysis of variance with Tukey HSD test was used to compare metabolite concentrations at each site.

Results

There were no differences in SO2 or [Lac] between IVC and SVC, both being greater than their respective pulmonary artery measurements (P < 0.01 for SO2 and P < 0.05 for [Lac]). SO2 and [Lac] in right atrium, right ventricle, and pulmonary artery were similar. ΔSO2 was 4.4 ± 1.4% (mean ± standard deviation) and Δ[Lac] was 0.16 ± 0.11 mmol/l (both > 0; P < 0.001). Δ[Glu] was -0.19 ± 0.31 mmol/l, which was not significantly different from zero, with SVC [Glu] being less than IVC [Glu].

Conclusion

Mixing of SVC with IVC blood does not account for the development of ΔSO2 and Δ[Lac] in hemodynamically stable individuals with pulmonary artery hypertension. An alternate mechanism is mixing with coronary sinus blood, implying that ΔSO2 and Δ[Lac] may reflect changes in coronary sinus SO2 and [Lac] in this patient population.
Appendix
Available only for authorised users
Literature
1.
Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M: Lack of equivalence between central and mixed venous oxygen saturation. Chest 2004, 126: 1891-1896. 10.1378/chest.126.6.1891CrossRefPubMed
2.
Edwards JD, Mayall RM: Importance of the sampling site for measurement of mixed venous oxygen saturation in shock. Crit Care Med 1998, 26: 1356-1360. 10.1097/00003246-199808000-00020CrossRefPubMed
3.
Reinhart K, Kuhn HJ, Hartog C, Bredle DL: Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 2004, 30: 1572-1578. 10.1007/s00134-004-2337-yCrossRefPubMed
4.
Gutierrez G, Chawla LS, Seneff MG, Katz NM, Zia H: Lactate concentration gradient from right atrium to pulmonary artery. Crit Care 2005, 9: R425-R429. 10.1186/cc3489PubMedCentralCrossRefPubMed
5.
Rivers E: Mixed vs. central venous oxygen saturation may not be numerically equal, but both are still clinically useful. Chest 2006, 129: 507-508. 10.1378/chest.129.3.507CrossRefPubMed
6.
7.
8.
Stanley WC, Chandler MP: Energy metabolism in the normal and failing heart: potential for therapeutic interventions. Heart Fail Rev 2002, 7: 115-130. 10.1023/A:1015320423577CrossRefPubMed
9.
De Backer D, Creteur J, Zhang H, Norrenberg M, Vincent JL: Lactate production by the lungs in acute lung injury. Am J Respir Crit Care Med 1997, 156: 1099-1104.CrossRefPubMed
10.
Brown SD, Clark C, Gutierrez G: Pulmonary lactate release in patients with sepsis and the adult respiratory distress syndrome. J Crit Care 1996, 11: 2-8. 10.1016/S0883-9441(96)90014-3CrossRefPubMed
11.
Kellum JA, Kramer DJ, Lee K, Mankad S, Bellomo R, Pinsky MR: Release of lactate by the lung in acute lung injury. Chest 1997, 111: 1301-1305.CrossRefPubMed
12.
Clark LC Jr, Noyes LK, Grooms TA, Moore MS: Rapid micromeasurement of lactate in whole blood. Crit Care Med 1984, 12: 461-464. 10.1097/00003246-198405000-00011CrossRefPubMed
13.
Walsh TS, McLellan S, Mackenzie SJ, Lee A: Hyperlactatemia and pulmonary lactate production in patients with fulminant hepatic failure. Chest 1999, 116: 471-476. 10.1378/chest.116.2.471CrossRefPubMed
14.
Zar JH: Simple linear correlation. In Biostatistical Analysis. 4th edition. Upper Saddle River, NJ: Prentice-Hall, Inc; 1999:377-383.
15.
Berridge JC: Influence of cardiac output on the correlation between mixed venous and central venous oxygen saturation. Br J Anaesth 1992, 69: 409-410. 10.1093/bja/69.4.409CrossRefPubMed
16.
Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U: Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology 2005, 103: 249-257. 10.1097/00000542-200508000-00007CrossRefPubMed
17.
Faber T: Central venous versus mixed venous oxygen content. Acta Anaesthesiol Scand Suppl 1995, 107: 33-36.CrossRefPubMed
18.
Herrera A, Pajuelo A, Morano MJ, Ureta MP, Gutierrez-Garcia J, de las Mulas M: Comparison of oxygen saturations in mixed venous and central blood during thoracic anesthesia with selective single-lung ventilation [in Spanish]. Rev Esp Anestesiol Reanim 1993, 40: 349-353.PubMed
19.
Ladakis C, Myrianthefs P, Karabinis A, Karatzas G, Dosios T, Fildissis G, Gogas J, Baltopoulos G: Central venous and mixed venous oxygen saturation in critically ill patients. Respiration 2001, 68: 279-285. 10.1159/000050511CrossRefPubMed
20.
Martin C, Auffray JP, Badetti C, Perrin G, Papazian L, Gouin F: Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients. Intensive Care Med 1992, 18: 101-104. 10.1007/BF01705041CrossRefPubMed
21.
Pieri M, Brandi LS, Bertolini R, Calafa M, Giunta F: Comparison of bench central and mixed pulmonary venous oxygen saturation in critically ill postsurgical patients [in Italian]. Minerva Anestesiol 1995, 61: 285-291.PubMed
22.
Scheinman MM, Brown MA, Rapaport E: Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients. Circulation 1969, 40: 165-172.CrossRefPubMed
23.
Tahvanainen J, Meretoja O, Nikki P: Can central venous blood replace mixed venous blood samples? Crit Care Med 1982, 10: 758-761.CrossRefPubMed
24.
Turnaoglu S, Tugrul M, Camci E, Cakar N, Akinci O, Ergin P: Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. J Cardiothorac Vasc Anesth 2001, 15: 574-579. 10.1053/jcan.2001.26534CrossRefPubMed
25.
Wendt M, Hachenberg T, Albert A, Janzen R: Mixed venous versus central venous oxygen saturation in intensive medicine [in German]. Anasth Intensivther Notfallmed 1990, 25: 102-106.CrossRefPubMed
26.
Varpula M, Karlsson S, Ruokonen E, Pettila V: Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock. Intensive Care Med 2006, 32: 1336-1343. 10.1007/s00134-006-0270-yCrossRefPubMed
27.
Barratt-Boyes BG, Wood EH: The oxygen saturation of blood in the vena cavae, right heart chambers and pulmonary vessels of healthy subjects. J Lab Clin Med 1957, 50: 93-106.PubMed
28.
Gasul BM, Arcilla RA, Lev M: Heart Disease in Children: Diagnosis and Treatment. Philadelphia, PA: JB Lippincott Co; 1960:190.
29.
Gutgesell HP, Williams RL: Caval samples as indicators of mixed venous oxygen saturation: Implications in atrial septal defect. Cardiovasc Dis 1974, 1: 160-164.PubMedCentralPubMed
30.
Kjellberg SR, Mannheimer E, Rudhe U, Jonsson B: Diagnosis of Congenital Heart Disease. Chicago, IL: The Yearbook Publishers, Inc; 1959:123-124.
31.
Lee J, Wright F, Barber R, Stanley L: Central venous oxygen saturation in shock: a study in man. Anesthesiology 1972, 36: 472-478. 10.1097/00000542-197205000-00012CrossRefPubMed
32.
Salim MA, DiSessa TG, Arheart KL, Alpert BS: Contribution of superior vena caval flow to total cardiac output in children. A Doppler echocardiographic study. Circulation 1995, 92: 1860-1865.CrossRefPubMed
33.
Dahn MS, Lange MP, Jacobs LA: Central mixed and splanchnic venous oxygen saturation monitoring. Intensive Care Med 1988, 14: 373-378. 10.1007/BF00262891CrossRefPubMed
34.
De Backer D, Creteur J, Noordally O, Smail N, Gulbis B, Vincent JL: Does hepato-splanchnic VO 2 /DO 2 dependency exist in critically ill septic patients? Am J Respir Crit Care Med 1998, 157: 1219-1225.CrossRefPubMed
35.
Weil MH, Michaels S, Rackow EC: Comparison of blood lactate concentrations in central venous, pulmonary artery, and arterial blood. Crit Care Med 1987, 15: 489-490. 10.1097/00003246-198705000-00006CrossRefPubMed
36.
Robinson PJ, Rapoport SI: Glucose transport and metabolism in the brain. Am J Physiol 1986, 250: R127-R136.PubMed
37.
Zauner A, Muizelaar JP: Brain metabolism and cerebral blood flow. In Head Injury. Edited by: Reilly P, Bullock R. London, UK: Chapman and Hall; 1997:89-99.
38.
Dhainaut JF, Huyghebaert MF, Monsallier JF, Lefevre G, Dall'Ava-Santucci J, Brunet F, Villemant D, Carli A, Raichvarg D: Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock. Circulation 1987, 75: 533-541.CrossRefPubMed
Metadata
Title
The concentration of oxygen, lactate and glucose in the central veins, right heart, and pulmonary artery: a study in patients with pulmonary hypertension
Authors
Guillermo Gutierrez
Anthony Venbrux
Elizabeth Ignacio
Jonathan Reiner
Lakhmir Chawla
Anish Desai
Publication date
01-04-2007
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2007
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5739

Other articles of this Issue 2/2007

Critical Care 2/2007 Go to the issue

Research

The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study

Research

The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting

Review

Clinical review: Update of avian influenza A infections in humans

Research

Optimizing intensive care capacity using individual length-of-stay prediction models

Commentary

Hyperoxic acute lung injury and ventilator-induced/associated lung injury: new insights into intracellular signaling pathways

Research

Computer simulation allows goal-oriented mechanical ventilation in acute respiratory distress syndrome