Skip to main content

Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill

Abstract

Objective

To compare the course of continuously measured mixed and central venous O2 saturations in high-risk patients and to evaluate the impact of various factors that might interfere with reflection spectrophotometry.

Design and setting

Prospective, descriptive study in the interdisciplinary ICU of a university hospital.

Patients

32 critically ill patients with triple-lumen central vein catheters, including 29 patients requiring pulmonary artery catheterization.

Interventions

The accuracy of fiberoptic measurements was assessed by comparison to reference co-oximeter results at regular intervals. We examined the effect on measurement accuracy of physiological variables including hematocrit, hemoglobin, pH, temperature, and the administration of various solutions via central venous catheter. Continuous parallel measurements of SvO2 and ScvO2 were performed in patients with each type of catheters over a total observation time of 1097 h.

Results

ScvO2 values were more accurate and stable than in vitro oximeter measurements (r=0.96 from 150 samples, mean difference 0.15%, average drift 0.10%/day) and was not significantly affected by synchronous infusion therapy or by changes in hematocrit, hemoglobin, pH, or temperature. ScvO2 values closely paralleled SvO2, whether measured in vitro (r=0.88 from 150 samples) or in vivo (r=0.81 from 395,128 samples) but averaged about 7±4 saturation percentage higher. ScvO2 changed in parallel in 90% of the 1,498 instances in which SvO2 changed more than 5% (over an average of 43 min).

Conclusions

Continuous fiberoptic measurement of central vein O2 saturation has potential to be a reliable and convenient tool which could rapidly warn of acute change in the oxygen supply/demand ratio of critically ill patients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Goldman RH, Klughaupt M, Metcalf T, Spivak AP, Harrison DC (1968) Measurement of central venous oxygen saturation in patients with myocardial infarction. Circulation 38:941–946

    CAS  PubMed  Google Scholar 

  2. 2.

    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

    CAS  PubMed  Google Scholar 

  3. 3.

    Kasnitz P, Druger GL, Yorra F, Simmons DH (1976) Mixed venous oxygen tension and hyperlactatemia. Survival in severe cardiopulmonary disease. JAMA 236:570–574

    CAS  PubMed  Google Scholar 

  4. 4.

    Krafft P, Steltzer H, Hiesmayr M, Klimscha W, Hammerle AF (1993) Mixed venous oxygen saturation in critically ill septic shock patients. The role of defined events. Chest 103:900–906

    CAS  PubMed  Google Scholar 

  5. 5.

    Edwards JD (1991) Oxygen transport in cardiogenic and septic shock. Crit Care Med 19:658–663

    CAS  PubMed  Google Scholar 

  6. 6.

    Creamer JE, Edwards JD, Nightingale P (1990) Hemodynamic and oxygen transport variables in cardiogenic shock secondary to acute myocardial infarction, and response to treatment. Am J Cardiol 65:1297–1300

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Beale PL, McMichan JC, Marsh HM, Sill JC, Southorn PA (1982) Continuous monitoring of mixed venous oxygen saturation in critically ill patients. Anesth Analg 61:513–517

    PubMed  Google Scholar 

  8. 8.

    Reinhart K, Moser N, Rudolph T, Bredle D, Specht M, Gramm HJ, Goecke J, Eyrich K (1988) Accuracy of two mixed venous saturation catheters during long-term use in critically ill patients. Anesthesiology 69:769–773

    CAS  PubMed  Google Scholar 

  9. 9.

    Robin ED (1985) The cult of the Swan-Ganz catheter. Ann Intern Med 103:445–449

    CAS  PubMed  Google Scholar 

  10. 10.

    Connors AF, Speroff T, Dawson NV, Thomas C, Harrell FE, Wagner D, Desbiens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ Jr, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus WA (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 276:8889–8897

    Google Scholar 

  11. 11.

    Dalen JE, Bone RC (1996) Is it time to pull the pulmonary artery catheter? JAMA 276:916–918

    CAS  PubMed  Google Scholar 

  12. 12.

    Reinhart K, Radermacher P, Sprung CL, Phelan D, Bakker J, Steltzer H (1997) PA catheterization-quo vadis? Do we have to change the current practice with this monitoring device? Intensive Care Med 23:605–609

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274:639–644

    CAS  PubMed  Google Scholar 

  14. 14.

    Wilkinson AR, Phibbs RH, Gregory GA (1979) Continuous in vivo oxygen saturation in newborn infants with pulmonary disease: a new fiberoptic catheter oximeter. Crit Care Med 7:232–236

    CAS  PubMed  Google Scholar 

  15. 15.

    Wilson RF (1978) Get the venous blood too. Am Surg 44:396–400

    CAS  PubMed  Google Scholar 

  16. 16.

    Scheinman MM, Brown MA, Rapaport E (1969) Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients. Circulation 40:165–170

    CAS  PubMed  Google Scholar 

  17. 17.

    Lee J, Wright F, Barber R, Stanley L (1972) Central venous oxygen saturation in shock: a study in man. Anesthesiology 36:472–478

    CAS  PubMed  Google Scholar 

  18. 18.

    Meier-Hellmann A, Reinhart K, Bredle DL, Specht M, Spies CD, Hannemann L (1997) Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 25:399–404

    CAS  PubMed  Google Scholar 

  19. 19.

    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

    PubMed  Google Scholar 

  20. 20.

    Rivers EP, Ander DS, Powell D (2001) Central venous oxygen saturation monitoring in the critically ill patient. Curr Opin Crit Care 7:204–211

    Article  CAS  Google Scholar 

  21. 21.

    Reinhart K, Rudolph T, Bredle DL, Hannemann L (1989) Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest 95:1216–1221

    CAS  PubMed  Google Scholar 

  22. 22.

    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

    CAS  PubMed  Google Scholar 

  23. 23.

    Wever R (1959) Untersuchungen zur Extinktion von strömendem Blut. Pflugers Arch 259:97–109

    Google Scholar 

  24. 24.

    Landsman ML, Knop N, Kwant G, Mook GA, Zijlstra WG (1978) A fiberoptic reflection oximeter. Pflugers Arch 373:273–282

    CAS  PubMed  Google Scholar 

  25. 25.

    Bland JM, Altman DG (1986) Statistical methods for assessing aggreement between two methods of clinical measurement. Lancet 8:307–310

    Google Scholar 

  26. 26.

    Birman H, Haq A, Hew E, Aberman A (1984) Continuous monitoring of mixed venous oxygen saturation in hemodynamically unstable patients. Chest 86:753–756

    CAS  PubMed  Google Scholar 

  27. 27.

    De Sepibus G, Kehrli B, Ehrengruber H, Weber JW, Stocker F, Gurtner HP (1975) Die Schätzung der gemischtvenösen O2-Sättigung bei der oxymetrischen Bestimmung von Herzminutenvolumen und Shuntgröße. Schweiz Med Wochenschr 105:1445–1447

    PubMed  Google Scholar 

  28. 28.

    Weber H, Grimm T, Albert J (1980) Die Sauerstoffsättigung des Blutes in der Hohlvene, im rechten Herzen und in der Pulmonalarterie und Vergleich der Formeln zur Bestimmung des gemischt venösen Blutes bei gesunden Säuglingen und Kindern. Z Kardiol 69:504–507

    CAS  PubMed  Google Scholar 

  29. 29.

    Meier-Hellmann A, Specht M, Hannemann L, Hassel H, Bredle DL, Reinhart K (1996) Splanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis. Intensive Care Med 22:1354–1359

    CAS  PubMed  Google Scholar 

  30. 30.

    Dahn MS, Lange MP, Jacobs LA (1988) Central mixed and splanchnic venous oxygen saturation monitoring. Intensive Care Med 14:373–378

    CAS  PubMed  Google Scholar 

  31. 31.

    Wilmore DW, Goodwin CW, Aulick LH, Powanda MC, Mason AD Jr, Pruitt BA Jr (1980) Effect of injury and infection on visceral metabolism and circulation. Ann Surg 192:491–504

    CAS  PubMed  Google Scholar 

  32. 32.

    Edwards JD, Mayall RM (1998) Importance of the sampling site for measurement of mixed venous oxygen saturation in shock. Crit Care Med 26:1356–1360

    CAS  PubMed  Google Scholar 

  33. 33.

    Ladakis C, Myrianthefs P, Karabinis A, Karatzas G, Dosios T, Fildissis G, Gogas J, Baltopoulos G (2001) Central venous and mixed venous oxygen saturation in critically ill patients. Respiration 68:279–285

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Tahvanainen J, Meretoja O, Nikki P (1982) Can central venous blood replace mixed venous blood samples? Crit Care Med 10:758–761

    CAS  PubMed  Google Scholar 

  35. 35.

    Wendt M, Hachenberg T, Albert A, Janzen R (1990) Mixed venous versus central venous oxygen saturation in intensive medicine. Anasth Intensivther Notfallmed 25:102–106

    CAS  PubMed  Google Scholar 

  36. 36.

    Rady MY, Rivers EP, Nowak RM (1996) Resuscitation of the critically ill in the ED: response of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med 14:218–225

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Konrad Reinhart.

Additional information

Funding and support for this research were provided by Baxter Healthcare Corp.;K.R. has been a consultant for Baxter Healthcare Corp.

Electronic Supplementary Material

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Reinhart, K., Kuhn, HJ., Hartog, C. et al. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 30, 1572–1578 (2004). https://doi.org/10.1007/s00134-004-2337-y

Download citation

Keywords

  • Central venous oxygen saturation
  • Mixed venous oxygen saturation
  • Fiberoptic
  • Oximetry