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Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients

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Abstract

Objective

Blood O2 saturation and lactate concentration gradients from superior vena cava (SVC) to pulmonary artery (PA) occur in critically ill patients. These gradients (ΔSO2 and Δ[Lac]) may be positive or negative. We tested the hypothesis that positive ΔSO2 and Δ[Lac] are associated with improved survival in critically ill patients.

Design and setting

Multinational, prospective observational study conducted in six medical and surgical ICUs.

Patients

Consecutive sample of 106 adults requiring insertion of a pulmonary artery catheter (PAC). Average age was 59.5 ± 15.5 years, APACHE II score was 15.5 ± 6.7 (mean ± SD). Main outcome measure was 28-day mortality.

Interventions

None.

Measurements and results

We drew blood samples from the proximal and distal ports of PACs every 6 h from the time of PAC insertion (Initial measurement) until its removal (Final measurement). Samples were analyzed for SO2, [Lac], glucose concentration and blood gases. Hemodynamic measurements were obtained after blood samples. We monitored patients for 30.9 ± 11.0 h. Overall mortality rate was 25.5%. More survivors had mean and final ΔSO2 ≥ 0 and Δ[Lac] ≥ 0 than decedents (p < 0.01; p < 0.05 respectively). On the average, ΔSO2 and Δ[Lac] were positive in survivors and negative in decedents. Survival odds ratios for final measurements of ΔSO2 ≥ 0 and Δ[Lac] ≥ 0 were 19.22 and 7.70, respectively (p < 0.05).

Conclusions

A strong association exists between positive ΔSO2 and Δ[Lac] and survival in critically ill patients. Whether therapy aimed at increasing ΔSO2 and Δ[Lac] results in improved ICU survival remains to be determined.

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Acknowledgments

Funds to conduct this research were provided by internal research grants from the various participating institutions and by a Research Grant from The Richard B. and Lynne V. Cheney Cardiovascular Institute. The authors thank Dr. Subrata Kundu and Mr. Hiro Hikawa, Department of Statistics, The George Washington University for their assistance in data analysis.

Dr. Gutierrez holds a patent application on a method related to the subject matter of the study. No other author has conflicts of interest to declare.

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Authors and Affiliations

  1. Pulmonary and Critical Care Medicine Division, The George Washington University Medical Center, 2150 Pennsylvania Ave., N.W, Washington, DC, 20037, USA

    Guillermo Gutierrez & Vinayak Jha

  2. Fundacion Favaloro, Buenos Aires, Argentina

    Pablo Comignani & Yanina Arzani

  3. Hospital Escuela Corrientes, Corrientes, Argentina

    Luis Huespe, Silvio Lazzeri, Lombardo Sosa, Carlos Mizdraji & Alejandra Ojeda

  4. Centro de Tratamiento Intensivo, Hospital de Clinicas, Montevideo, Uruguay

    F. Javier Hurtado, Daniela Suarez & Gonzalo Lacuesta

  5. Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina

    Arnaldo Dubin & Daniela Olmos

  6. Centro Cardiologico del Sanatorio Americano, Montevideo, Uruguay

    Juan Riva & Wolf Kohn

Authors
  1. Guillermo Gutierrez
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  2. Pablo Comignani
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  3. Luis Huespe
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  9. Lombardo Sosa
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  10. Juan Riva
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  11. Wolf Kohn
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  12. Daniela Suarez
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  13. Gonzalo Lacuesta
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  14. Daniela Olmos
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  15. Carlos Mizdraji
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  16. Alejandra Ojeda
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Corresponding author

Correspondence to Guillermo Gutierrez.

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Gutierrez, G., Comignani, P., Huespe, L. et al. Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients. Intensive Care Med 34, 1662–1668 (2008). https://doi.org/10.1007/s00134-008-1128-2

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  • DOI: https://doi.org/10.1007/s00134-008-1128-2

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