Oxygen consumption and mixed venous oxygen saturation monitoring during orthotopic liver transplantation

Abstract

Mixed venous oxygen saturation$S\bar vO_2$ monitoring has been advocated for some critically ill patients. Patients with end-stage hepatic failure have oxygen consumption rates that are lower than normal. Using the Fick equation, oxygen consumption may be calculated if mixed venous and arterial oxygen tensions (and saturations), hemoglobin, and cardiac output are determined simultaneously. This report describes a unique pattern of changes in$S\bar vO_2$ and oxygen consumption in 7 patients undergoing liver transplantation. A previous study correlated plasma carbohydrate (glucose) levels with early hepatic graft survival. After induction, the 7 patients reported here had low oxygen consumption and high$S\bar vO_2$ values. The oxygen consumption rates decreased to the lowest point during the anhepatic phase and rose above baseline by the end of the case. The$S\bar vO_2$ and oxygen consumption data reported here follow the presence of presumed hepatic metabolic activity (increased CO₂ and ionized calcium). Further research must be completed to determine whether these measurements indicate early hepatic nonfunction.