Original

Intensive Care Medicine

, Volume 37, Issue 1, pp 52-59

Low and “supranormal” central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study

  • Suzanne PerzAffiliated withDepartment of Anesthesiology and Critical Care Therapy, Jena University Hospital
  • , Thomas UhligAffiliated withDepartment of Anesthesiology and Critical Care Therapy, Jena University Hospital
  • , Matthias KohlAffiliated withDepartment of Anesthesiology and Critical Care Therapy, Jena University Hospital
  • , Donald L. BredleAffiliated withDepartment of Kinesiology, University of Wisconsin
  • , Konrad ReinhartAffiliated withDepartment of Anesthesiology and Critical Care Therapy, Jena University Hospital
  • , Michael BauerAffiliated withDepartment of Anesthesiology and Critical Care Therapy, Jena University Hospital
  • , Andreas KortgenAffiliated withDepartment of Anesthesiology and Critical Care Therapy, Jena University HospitalKlinik für Anaesthesiologie und Intensivtherapie, Universitätsklinikum Jena Email author 

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Abstract

Purpose

To characterize incidence of low, normal and “supranormal” central venous oxygen saturation (ScvO2) and the relation to markers of tissue hypoxia, course and outcome in cardiac surgery patients.

Methods

Prospective, observational study in a university multidisciplinary 50-bed intensive care unit including 205 consecutive patients undergoing elective cardiac surgery. Data were split into training and test data sets and subjected to 50 replications of fivefold cross-validation to estimate lower and upper bounds of ScvO2 indicative of impaired tissue oxygenation.

Results

Both low (≤60.8%) and supranormal (≥77.4%) ScvO2 were associated with an unfavorable course, while the logistic EuroSCORE for risk adjustment was comparable between groups. Incidences of abnormal ScvO2 were 13.2% low and 30.7% supranormal. Patients with low ScvO2 and an uneventful course initially presented with normal lactate levels, whereas patients with supranormal ScvO2 displayed consistently higher serum lactate levels. High ScvO2 values were associated with the use of β-mimetics and signs of systemic inflammation. Mortality rates were comparable for patient populations presenting either low (14.8%) or supranormal ScvO2 (7.9%) and higher than normals (0%, p < 0.001). Lactate was comparably increased in patients that ultimately died, irrespective whether they had low or supranormal ScvO2 values. In contrast, neither low nor supranormal ScvO2 was associated with altered gastric pCO2.

Conclusions

High ScvO2 is an under-recognized warning sign for impaired tissue oxygenation in the peri-operative period. Including values ≥77.4% as ‘normal’ impaired performance of ScvO2 monitoring to predict a complicated perioperative course.

Keywords

ScvO2 Lactate Gastric tonometry Systemic inflammation Organ failure