Intensive Care Medicine

, Volume 37, Issue 1, pp 52–59 | Cite as

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

  • Suzanne Perz
  • Thomas Uhlig
  • Matthias Kohl
  • Donald L. Bredle
  • Konrad Reinhart
  • Michael Bauer
  • Andreas Kortgen



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.


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.


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.


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.


ScvO2 Lactate Gastric tonometry Systemic inflammation Organ failure 



Arterio-intestinal pCO2-gradient


Area under the curve


Coronary artery bypass graft


Oxygen delivery


Partial pressure of carbon dioxide


Simplified Acute Physiology Score II


Central venous oxygen saturation


Arterial oxygen saturation


Systemic inflammatory response syndrome


Sepsis-related Organ Failure Assessment


Oxygen uptake

Supplementary material

134_2010_1980_MOESM1_ESM.doc (88 kb)
(DOC 87.5 kb)


  1. 1.
    Ander DS, Jaggi M, Rivers E, Rady My, Levine TB, Barry Levine AB, Masura J, Gryzbowski M (1998) Undetected cardiogenic shock in patients with congestive heart failure presenting to the emergency department. Am J Cardiol 82:888–891CrossRefPubMedGoogle Scholar
  2. 2.
    Rady MY, Rivers EP, Nowak RM (1996) Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med 14:218–225CrossRefPubMedGoogle Scholar
  3. 3.
    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 345:1368–1377CrossRefPubMedGoogle Scholar
  4. 4.
    Kortgen A, Niederprüm P, Bauer M (2006) Implementation of an evidence-based “standard operating procedure” and outcome in septic shock. Crit Care Med 34:943–949CrossRefPubMedGoogle Scholar
  5. 5.
    Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM (1989) Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest 95:1216–1221CrossRefPubMedGoogle Scholar
  6. 6.
    Ladakis C, Myrianthefs P, Karabinis A, Karatzas G, Dosios D, Fildissis G, Gogas J, Baltopoulos G (2001) Central venous and mixed venous oxygen saturation in critically ill patients. Respiration 68:279–285CrossRefPubMedGoogle Scholar
  7. 7.
    Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M (2004) Lack of equivalence between central and mixed venous oxygen saturation. Chest 126:1891–1896CrossRefPubMedGoogle Scholar
  8. 8.
    Bellomo R, Reade MC, Warrillow SJ (2008) The pursuit of a high central venous oxygen saturation in sepsis: growing concerns. Crit Care 12:130CrossRefPubMedGoogle Scholar
  9. 9.
    Bracht H, Hänggi M, Jeker B, Wegmüller N, Porta F, Tüller D, Takala J, Jakob SM (2007) Incidence of low central venous oxygen saturation during unplanned admission in a multidisciplinary intensive care unit: an observational study. Crit Care 11:R2CrossRefPubMedGoogle Scholar
  10. 10.
    Hochman JS (2003) Cardiogenic shock complicating acute myocardial infarction. Expanding the paradigm. Circulation 107:2998–3002CrossRefPubMedGoogle Scholar
  11. 11.
    Tomic V, Russwurm S, Möller E, Claus RA, Blaess M, Brunkhorst F, Bruegel M, Bode K, Bloos F, Wippermann J, Wahlers T, Deigner HP, Thiery J, Reinhart K, Bauer M (2005) Transcriptomic and proteomic patterns of systemic inflammation in on-pump and off-pump coronary artery bypass grafting. Circulation 112:2912–2920PubMedGoogle Scholar
  12. 12.
    Steckel JH (1993) Cross validating regression models in marketing research. Mark Sci 12:412–427CrossRefGoogle Scholar
  13. 13.
    Maillet JM, Le Besnerais P, Cantoni M, Nataf P, Ruffenach A, Lessana A, Brodaty D (2003) Frequency risk factors and outcome of hyperlactatatemia after cardiac surgery. Chest 123:1361–1366CrossRefPubMedGoogle Scholar
  14. 14.
    Pölönen P, Ruokonen E, Hippeläinen M, Pöyhönen M, Takala J (2000) A prospective, randomized study of goal–oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059CrossRefPubMedGoogle Scholar
  15. 15.
    Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, Bennet ED (2001) Base excess and lactate as a prognostic indicators for patients admitted to intensive care. Intensive Care Med 27:74–83CrossRefPubMedGoogle Scholar
  16. 16.
    Kavarana MN, Frumento RJ, Hirsch AL, Oz MC, Lee DC, Bennet-Guerrero E (2003) Gastric hypercarbia and adverse outcome after cardiac surgery. Intensive Care Med 29:742–748PubMedGoogle Scholar
  17. 17.
    Bams JL, Mariani MA, Groeneveld AB (1999) Predicting outcome after cardiac surgery comparison of global hemodynamic and tonometric variables. Br J Anaesth 82:33–37PubMedGoogle Scholar
  18. 18.
    Lebuffe G, Decoene C, Pol A, Prat A, Vallet B (1999) Regional capnometry with air-automated tonometry detects circulatory failure earlier than conventional hemodynamics after cardiac surgery. Anesth Analg 89:1084–1090CrossRefPubMedGoogle Scholar
  19. 19.
    Hameed SM, Cohn SM (2003) Gastric tonometry. The role of mucosal pH measurement in the management of trauma. Chest 123:475S–481SCrossRefPubMedGoogle Scholar
  20. 20.
    Hamilton MA, Mythen MG (2001) Gastric tonometry: were do we stand? Curr Opin Crit Care 7:122–127CrossRefPubMedGoogle Scholar
  21. 21.
    Bakker J (2001) Lactate: may I have your votes please. Intensive Care Med 27:6–11CrossRefPubMedGoogle Scholar
  22. 22.
    Antonelli M, Levy M, Andrews PJD, Chastre J, Hudson LD, Manthous C, Meduri GU, Moreno RP, Putensen C, Stewart T, Torres A (2007) Hemodynamic monitoring in shock and implications for management. International consensus conference, Paris, France, 27–28. April 2006. Intensive Care Med 33:575–590Google Scholar
  23. 23.
    Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennnet ED (2005) Changes in central venous saturation after major surgery, and association with outcome. Crit Care 9:694–699CrossRefGoogle Scholar
  24. 24.
    Ince C, Sinaasappel M (1999) Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 27:1369–1377CrossRefPubMedGoogle Scholar
  25. 25.
    Crouser ED (2004) Mitochondrial dysfunction in septic shock and multiple organ dysfunction syndrome. Mitochondrion 4:729–741CrossRefPubMedGoogle Scholar
  26. 26.
    Burns AM, Keogan M, Donaldson M, Brown DL, Park GR (1997) Effects of inotropes on human leucocyte numbers, neutrophil function and lymphocyte subtypes. Br J Anaesth 78:530–535PubMedGoogle Scholar
  27. 27.
    Levy B (2006) Lactate and the shock state: the metabolic view. Curr Opin Crit Care 12:315–321CrossRefPubMedGoogle Scholar
  28. 28.
    Hatherill M, Salie S, Waggie Z, Lawrenson J, Hewitson J, Reynolds L, Argent A (2007) The lactate: pyruvate ratio following open cardiac surgery in children. Intensive Care Med 33:822–829CrossRefPubMedGoogle Scholar
  29. 29.
    Thackray S, Easthaugh J, Freemantle N, Cleland JG (2002) The effectiveness and relative effectiveness of intravenous inotropic drugs acting through the adrenergic pathway in patients with heart failure—a meta—regression analysis. Eur J Heart Fail 4:515–529CrossRefPubMedGoogle Scholar
  30. 30.
    Follath F, Cleland JG, Just H, Papp JG, Scholz H, Peuhkurinen K, Harjola VP, Mitrovic V, Abdalla M, Sandell EP, Lehtonen L (2002) Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 360:196–202CrossRefPubMedGoogle Scholar
  31. 31.
    Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A (2008) Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome: propensity-adjusted analyses. Anesthesiology 108:979–987CrossRefPubMedGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Suzanne Perz
    • 1
  • Thomas Uhlig
    • 1
  • Matthias Kohl
    • 1
  • Donald L. Bredle
    • 2
  • Konrad Reinhart
    • 1
  • Michael Bauer
    • 1
  • Andreas Kortgen
    • 1
    • 3
  1. 1.Department of Anesthesiology and Critical Care TherapyJena University HospitalJenaGermany
  2. 2.Department of KinesiologyUniversity of WisconsinEau ClaireUSA
  3. 3.Klinik für Anaesthesiologie und IntensivtherapieUniversitätsklinikum JenaJenaGermany

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