Low and “supranormal” central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study
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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.
KeywordsScvO2 Lactate Gastric tonometry Systemic inflammation Organ failure
Area under the curve
Coronary artery bypass graft
Partial pressure of carbon dioxide
- SAPS II
Simplified Acute Physiology Score II
Central venous oxygen saturation
Arterial oxygen saturation
Systemic inflammatory response syndrome
Sepsis-related Organ Failure Assessment
- 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
- 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
- 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