Skip to main content
SpringerLink
Log in

Venöse Sättigung

Zwischen Sauerstoffangebot und -verbrauch

Venous saturation

Between oxygen delivery and consumption

  • Übersichten
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Die venöse Sättigung ist ein physiologischer Parameter und ein wichtiges Maß zur Beurteilung des Verhältnisses zwischen Sauerstoffangebot und Sauerstoffverbrauch sowohl in der Intensivmedizin als auch im perioperativen Setting. Als physiologische Größe hat die gemischt-venöse Sättigung (SvO2) einen hohen Stellenwert in der Intensivmedizin erlangt. Aufgrund der hohen Invasivität der Bestimmung der SvO2 hat sich zur Abschätzung des Gleichgewichts zwischen Sauerstoffangebot und -verbrauch die zentralvenöse Sättigung (ScvO2) etabliert. Einen äquivalenten Ersatz bietet die ScvO2 im Vergleich zur SvO2 jedoch nicht, da Bereiche der unteren Körperhälfte, wie das Splanchnikusgebiet, nur unzureichend miterfasst werden. Allerdings wurde nachgewiesen, dass eine zielorientierte Therapie in der Intensivmedizin, allen voran im septischen sowie hämorrhagischen Schock, mit Hilfe der ScvO2 durchgeführt werden kann. Auch hat die ScvO2 prognostische Aussagekraft über Morbidität und Mortalität. Zu beachten ist hierbei, dass nicht nur niedrige, sondern auch erhöhte venöse Sättigungen mit einem schlechteren Outcome assoziiert sind. Neben der ScvO2 und der SvO2 gewinnt die venös-arterielle pCO2-Differenz (dCO2) zunehmend an Bedeutung. Bei kardiochirurgischen Patienten und bei Patienten mit Sepsis konnte gezeigt werden, dass eine erhöhte dCO2 mit einem schlechteren Outcome einhergeht. Jedoch sind weitere Studien notwendig, um eine Einbindung der dCO2 in den klinischen Alltag zu ermöglichen.

Abstract

Venous saturation is an important parameter to assess the ratio between oxygen delivery and oxygen consumption for both intensive care medicine and during perioperative care. Mixed venous saturation (SvO2) is the most reliable parameter in this setting. Due to the high invasiveness of measuring mixed venous saturation, the less invasive central venous saturation (ScvO2) has been entrenched for determining the balance of oxygen delivery and consumption. However, central venous saturation is inferior compared to mixed venous saturation as it does not cover the lower part of the body, including splanchnic perfusion. Nevertheless, studies have shown that central venous saturation is a reliable marker for goal-directed therapy in intensive care medicine, especially in patients with septic or hemorrhagic shock. Furthermore, central venous saturation has deep impact as a prognostic factor concerning morbidity and mortality. It has to be mentioned that not only decreased venous saturations but also elevated venous saturations are associated with poor outcome. Besides mixed venous and central venous saturation, intensivists and anesthesiologists focus on the central venous-arterial pCO2 difference (dCO2). An elevated dCO2 is associated with poor outcome in patients after cardiac surgery or patients with sepsis. Yet, further investigations have to be performed to implement the dCO2 as a reliable marker in daily routine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Balzer F, Sander M, Simon M, Spies C, Habicher M, Treskatsch S, Mezger V, Schirmer U, Heringlake M, Wernecke KD, Grubitzsch H, von Heymann C (2015) High central venous saturation after cardiac surgery is associated with increased organ failure and long-term mortality: an observational cross-sectional study. Crit Care 19:168 doi:10.1186/s13054-015-0889-6

    Article  PubMed  PubMed Central  Google Scholar 

  2. Baraka A, Baroody M, Haroun S, Nawfal M, Dabbous A, Sibai A, Jamal S, Shamli S (1990) Continuous venous oximetry during cardiopulmonary bypass: influence of temperature changes, perfusion flow, and hematocrit levels. J Cardiothorac Anesth 4:35–38

    Article  CAS  PubMed  Google Scholar 

  3. Castellanos-Ortega A, Suberviola B, Garcia-Astudillo LA, Holanda MS, Ortiz F, Llorca J, Delgado-Rodriguez M (2010) Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study. Crit Care Med 38:1036–1043. doi:10.1097/CCM.0b013e3181d455b6

    Article  PubMed  Google Scholar 

  4. Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M (2004) Lack of equivalence between central and mixed venous oxygen saturation. Chest 126:1891–1896. doi:126/6/1891 [pii];10.1378/chest.126.6.1891

    Article  PubMed  Google Scholar 

  5. Della RG, Pompei L (2011) Goal-directed therapy in anesthesia: any clinical impact or just a fashion? Minerva Anestesiol 77:545–553. doi:R02116155 [pii]

    Google Scholar 

  6. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228. doi:10.1007/s00134-012-2769-8

    Article  CAS  PubMed  Google Scholar 

  7. Donati A, Loggi S, Preiser JC, Orsetti G, Munch C, Gabbanelli V, Pelaia P, Pietropaoli P (2007) Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Chest 132:1817–1824. doi:chest.07-0621 [pii];10.1378/chest.07-0621

    Article  PubMed  Google Scholar 

  8. Du W, Liu DW, Wang XT, Long Y, Chai WZ, Zhou X, Rui X (2013) Combining central venous-to-arterial partial pressure of carbon dioxide difference and central venous oxygen saturation to guide resuscitation in septic shock. J Crit Care 28:1111–1115. doi:10.1016/j.jcrc.2013.07.049

    Article  Google Scholar 

  9. Duke T (1999) Dysoxia and lactate. Arch Dis Child 81:343–350

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Forkmann M, Kolschmann S, Holzhauser L, Ibrahim K, Guenther M, Christoph M, Fuhrmann JT, Boscheri A, Schmeibetaer A, Strasser RH, Wunderlich C (2015) Target temperature management of 33 degrees C exerts beneficial haemodynamic effects after out-of-hospital cardiac arrest. Acta Cardiol 70:451–459

    Article  PubMed  Google Scholar 

  11. Futier E, Robin E, Jabaudon M, Guerin R, Petit A, Bazin JE, Constantin JM, Vallet B (2010) Central venous O(2) saturation and venous-to-arterial CO(2) difference as complementary tools for goal-directed therapy during high-risk surgery. Crit Care 14:R193. doi:cc9310 [pii];10.1186/cc9310

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gotberg M, van der Pals J, Olivecrona GK, Koul S, Erlinge D (2010) Mild hypothermia reduces acute mortality and improves hemodynamic outcome in a cardiogenic shock pig model. Resuscitation 81:1190–1196. doi:10.1016/j.resuscitation.2010.04.033

    Article  PubMed  Google Scholar 

  13. Groeneveld AB (1998) Interpreting the venous-arterial PCO2 difference. Crit Care Med 26:979–980

    Article  CAS  PubMed  Google Scholar 

  14. Habicher M, Von HC, Spies CD, Wernecke KD, Sander M (2015) Central venous-arterial pCO2 difference identifies microcirculatory hypoperfusion in cardiac surgical patients with normal central venous oxygen saturation: a retrospective analysis. J Cardiothorac Vasc Anesth 29(3):646–655. doi:S1053-0770(14)00428-5 [pii];10.1053/j.jvca .2014.09.006

    Article  PubMed  Google Scholar 

  15. Kazarian KK, Del Guercio LR (1980) The use of mixed venous blood gas determinations in traumatic shock. Ann Emerg Med 9:179–182. doi:S0196-0644(80)80002-3 [pii]

    Article  CAS  PubMed  Google Scholar 

  16. Mallat J, Pepy F, Lemyze M, Gasan G, Vangrunderbeeck N, Tronchon L, Vallet B, Thevenin D (2014) Central venous-to-arterial carbon dioxide partial pressure difference in early resuscitation from septic shock: a prospective observational study. Eur J Anaesthesiol 31:371–380. doi:10.1097/EJA.0000000000000064

    Article  PubMed  Google Scholar 

  17. 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 18:101–104

    Article  CAS  PubMed  Google Scholar 

  18. Collaborative Study Group on Perioperative ScvO2 Monitoring (2006) Multicentre study on peri- and postoperative central venous oxygen saturation in high-risk surgical patients. Crit Care 10:R158. doi:cc5094 [pii];10.1186/cc5094

    Article  PubMed Central  Google Scholar 

  19. Morris CG, Low J (2008) Metabolic acidosis in the critically ill: part 2. Causes and treatment. Anaesthesia 63:396–411. doi:10.1111/j.1365-2044.2007.05371.x

    Article  CAS  PubMed  Google Scholar 

  20. Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311. doi:10.1056/NEJMoa1500896

    Article  CAS  PubMed  Google Scholar 

  21. Ospina-Tascon GA, Bautista-Rincon DF, Umana M, Tafur JD, Gutierrez A, Garcia AF, Bermudez W, Granados M, Arango-Davila C, Hernandez G (2013) Persistently high venous-to-arterial carbon dioxide differences during early resuscitation are associated with poor outcomes in septic shock. Crit Care 17(6):R294 doi:cc13160 [pii];10.1186/cc13160

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ospina-Tascon GA, Umana M, Bermudez W, Bautista-Rincon DF, Hernandez G, Bruhn A, Granados M, Salazar B, Arango-Davila C, De BD (2015) Combination of arterial lactate levels and venous-arterial CO to arterial-venous O content difference ratio as markers of resuscitation in patients with septic shock. Intensive Care Med 41(5):796–805. doi:10.1007/s00134-015-3720-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Peake SL, Bailey M, Bellomo R, Cameron PA, Cross A, Delaney A, Finfer S, Higgins A, Jones DA, Myburgh JA, Syres GA, Webb SA, Williams P (2009) Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study. Resuscitation 80(7):811–818. doi:S0300-9572(09)00120-8 [pii];10.1016/j.resuscitation.2009.03.008

    Article  PubMed  Google Scholar 

  24. Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506. doi:10.1056/NEJMoa1404380

    Article  CAS  PubMed  Google Scholar 

  25. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED (2005) Changes in central venous saturation after major surgery, and association with outcome. Crit Care 9:R694–R699. doi:cc3888 [pii];10.1186/cc3888

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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 90:1052–1059

    Article  CAS  PubMed  Google Scholar 

  27. Pope JV, Jones AE, Gaieski DF, Arnold RC, Trzeciak S, Shapiro NI (2010) Multicenter study of central venous oxygen saturation (ScvO(2)) as a predictor of mortality in patients with sepsis. Ann Emerg Med 55(1):40–46. doi:S0196-0644(09)01440-1 [pii];10.1016/j.annemergmed.2009.08.014

    Article  PubMed  Google Scholar 

  28. Ranucci M, Castelvecchio S, Ditta A, Brozzi S, Boncilli A, Baryshnikova E (2011) Transfusions during cardiopulmonary bypass: better when triggered by venous oxygen saturation and oxygen extraction rate. Perfusion 26:327–333. doi:0267659111407539 [pii];10.1177/0267659111407539

    Article  CAS  PubMed  Google Scholar 

  29. 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 345:1368–1377. doi:10.1056/NEJMoa010307

    Article  CAS  PubMed  Google Scholar 

  30. Sander M, Spies CD, Foer A, Weymann L, Braun J, Volk T, Grubitzsch H, Von HC (2007) Agreement of central venous saturation and mixed venous saturation in cardiac surgery patients. Intensive Care Med 33:1719–1725. doi:10.1007/s00134-007-0684-1

    Article  PubMed  Google Scholar 

  31. Scalea TM, Holman M, Fuortes M, Baron BJ, Phillips TF, Goldstein AS, Sclafani SJ, Shaftan GW (1988) Central venous blood oxygen saturation: an early, accurate measurement of volume during hemorrhage. J Trauma 28(6):725–732

    Article  CAS  PubMed  Google Scholar 

  32. Silva JM Jr, Oliveira AM, Segura JL, Ribeiro MH, Sposito CN, Toledo DO, Rezende E, Malbouisson LM (2011) A large venous-arterial PCO(2) is associated with poor outcomes in surgical patients. Anesthesiol Res Pract 2011. doi:10.1155/2011/759792

    PubMed  PubMed Central  Google Scholar 

  33. Soussi MS, Jebali MA, Le MY, Nasri M, Zouari B, Chenik S, Ferjani M (2012) Central venous saturation is not an alternative to mixed venous saturation during cardiopulmonary bypass in coronary artery surgery patients. Perfusion 27:300–306. doi:0267659112442902 [pii];10.1177/0267659112442902

    Article  CAS  PubMed  Google Scholar 

  34. Takami Y, Masumoto H (2005) Mixed venous-arterial CO2 tension gradient after cardiopulmonary bypass. Asian Cardiovasc 13:255–260. doi:13/3/255

    Article  Google Scholar 

  35. Tappy L, Chiolero R (2007) Substrate utilization in sepsis and multiple organ failure. Crit Care Med 35:S531–534. doi:10.1097/01.CCM.0000278062.28122.A4

    Article  PubMed  Google Scholar 

  36. Teixeira C, da Silva NB, Savi A, Vieira SR, Nasi LA, Friedman G, Oliveira RP, Cremonese RV, Tonietto TF, Bressel MA, Maccari JG, Wickert R, Borges LG (2010) Central venous saturation is a predictor of reintubation in difficult-to-wean patients. Crit Care Med 38:491–496. doi:10.1097/CCM.0b013e3181bc81ec

    Article  PubMed  Google Scholar 

  37. Textoris J, Fouche L, Wiramus S, Antonini F, Tho S, Martin C, Leone M (2011) High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality. Crit Care 15:R176 doi:cc10325 [pii];10.1186/cc10325

    Article  PubMed  PubMed Central  Google Scholar 

  38. Vallee F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, Samii K, Fourcade O, Genestal M (2008) Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock? Intensive Care Med 34:2218–2225. doi:10.1007/s00134-008-1199-0

    Article  PubMed  Google Scholar 

  39. van Beest PA, van der Schors A, Liefers H, Coenen LG, Braam RL, Habib N, Braber A, Scheeren TW, Kuiper MA, Spronk PE (2012) Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation. Crit Care Med 40:3196–3201. doi:10.1097/CCM.0b013e3182657591 [doi];00003246-201212000-00011

    Article  PubMed  Google Scholar 

  40. van Beest PA, van IJ, Boerma EC, Holman ND, Groen H, Koopmans M, Spronk PE, Kuiper MA (2010) No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin. Crit Care 14:R219 doi:cc9348 [pii];10.1186/cc9348

    Article  PubMed  PubMed Central  Google Scholar 

  41. van BP, Wietasch G, Scheeren T, Spronk P, Kuiper M (2011) Clinical review: use of venous oxygen saturations as a goal – a yet unfinished puzzle. Crit Care 15:232 doi:cc10351 [pii];10.1186/cc10351

    Article  Google Scholar 

  42. Varpula M, Karlsson S, Ruokonen E, Pettila V (2006) Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock. Intensive Care Med 32:1336–1343. doi:10.1007/s00134-006-0270-y

    Article  PubMed  Google Scholar 

  43. Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693. doi:10.1056/NEJMoa1401602

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    V. Mezger,  F. Balzer &  M. Habicher

  2. Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland

    M. Sander

Authors
  1. V. Mezger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Balzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Habicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Sander
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Mezger.

Ethics declarations

Interessenkonflikt

V. Mezger, F. Balzer, M. Habicher und M. Sander geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Buerke, Siegen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mezger, V., Balzer, F., Habicher, M. et al. Venöse Sättigung. Med Klin Intensivmed Notfmed 112, 492–498 (2017). https://doi.org/10.1007/s00063-016-0145-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-016-0145-0

Schlüsselwörter

Keywords

Search

Navigation