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Herz

, Volume 44, Issue 1, pp 76–81 | Cite as

Predictive value of ScvO2 monitoring for pericardial tamponade after cardiac surgery

  • S. Saha
  • H. Baraki
  • I. Kutschka
  • J. HademEmail author
Original articles
  • 463 Downloads

Abstract

Background

We examined the predictive value of central venous oxygen saturation (ScvO2) changes regarding the occurrence of pericardial tamponade following cardiac surgery.

Methods

We retrospectively identified 66 consecutive patients in whom ScvO2 and arterial lactate levels were analyzed during an 8‑h time interval preceding pericardiotomy due to pericardial tamponade (PT), and at equivalent time points in 30 control patients (C) who had an uncomplicated course.

Results

The median age of the patients was 74 years (interquartile range, 63–78). Three percent of procedures were re-operations. There were no differences between the baseline values of PT and C patients. Pericardiotomy was performed on average 1 day (0–3.5) after cardiac surgery. PT patients displayed a significant decline (p < 0.001) to lower ScvO2 levels (p < 0.001) and a significant increase (p = 0.005) to higher arterial lactate levels (p = 0.019) during the 8 h preceding pericardiotomy, whereas C patients did not (p = 0.440 and p = 0.279, respectively). PT was associated with a longer hospital stay (p = 0.04) and a higher in-hospital mortality (p = 0.008). An ScvO2 decline below 60% (p = 0.018), a delta ScvO2 decline greater than 5% (p = 0.001), and a delta lactate increase greater than 0.18 mmol/l (p = 0.002) during the 8 h preceding pericardiotomy were independently associated with PT. None of these parameters predicted in-hospital mortality.

Conclusion

Deteriorations in ScvO2 might serve as an early marker of PT following cardiac surgery.

Keywords

Hemodynamics Oxygen consumption Pericardiotomy Reoperation Hospital mortality 

Prädiktiver Wert des SzvO2-Monitorings bezüglich einer Perikardtamponade nach Herzoperation

Zusammenfassung

Hintergrund

Die Autoren untersuchten die prädiktive Aussagekraft von Veränderungen der zentralvenösen Sauerstoffsättigung (SzvO2) bezüglich des postoperativen Auftretens einer Perikardtamponade nach herzchirurgischen Eingriffen.

Methoden

Es wurden 66 konsekutive Patienten mit postoperativer Perikardtamponade (PT) im Hinblick auf Veränderungen der SzvO2 und arteriellen Laktatlevel innerhalb eines 8‑stündigen Intervalls vor Perikardiotomie untersucht. Als Vergleichsgruppe dienten 30 Patienten mit komplikationslosem Verlauf (C).

Ergebnisse

Das mediane Alter lag bei 74 (Interquartilsspanne 63–78) Jahren. In 3% der Fälle handelte es sich um eine Reoperation. Es fanden sich keine Gruppenunterschiede bzgl. der Basisparameter. Eine Perikardiotomie erfolgte im Mittel einen Tag (0–3,5) nach herzchirurgischem Primäreingriff. Patienten der PT-Gruppe zeigten hierbei einen signifikanten Abfall (p < 0,001) hin zu niedrigeren SzvO2 (p < 0,001) und einen signifikanten Anstieg (p = 0,005) hin zu höheren arteriellen Laktatspiegeln (p = 0,019) während des 8‑stündigen Zeitintervalls vor Perikardiotomie. C‑Patienten hingegen wiesen keine signifikanten Veränderungen auf (p = 0,440 bzw. p = 0,279). Die PT-Gruppenzugehörigkeit ging mit einem längeren Krankenhausaufenthalt (p = 0,04) und einer höheren Mortalität im Krankenhaus einher (p = 0,008). Ein Abfall der SzvO2 unter 60 % (p = 0,018) sowie eine Reduktion der SzvO2 um >5 % (p = 0,001) und ein Laktatanstieg um >0,18 mmol/l (p = 0,002) während des genannten 8‑h-Intervalls waren ebenfalls mit einer postoperativen Perikardiotomie assoziiert. Die krankenhausinterne Mortalität wurde jedoch durch keinen dieser Parameter vorhergesagt.

Schlussfolgerung

Ein Abfall der SzvO2 könnte als frühpostoperativer Marker einer Perikardtamponade nach herzchirurgischen Eingriffen dienen.

Schlüsselwörter

Hämodynamik Sauerstoffverbrauch Perikardiotomie Reoperation Krankenhausmortalität 

Notes

Compliance with ethical guidelines

Conflict of interest

S. Saha, H. Baraki, I. Kutschka, and J. Hadem declare that they have no competing interests.

All patients consented to the cardiac surgery, postoperative treatment and data acquisition performed as part of routine patient care. All procedures described in this study were in accordance with the institutional research committee, national data safety regulations, and the 1964 Helsinki declaration and its last amendment by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013. Informed patient consent was not required by the institutional research committee for this retrospective, noninterventional study.

Supplementary material

59_2017_4629_MOESM1_ESM.jpg (56 kb)
Supplementary Fig. 1: Kaplan–Meier survival curves (proportion of patients alive against time [days]) of 30 control versus 66 pericardial tamponade (PT) patients regarding decline of ScvO2 < 60% (a), postoperative acute kidney injury (AKI) (b), and re-thoracotomy for PT (c). Green curves indicate presence and blue curves indicate absence of the aforementioned criterion

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryUniversity Clinic, Otto-von-Guericke-UniversitätMagdeburgGermany

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