Document Detail


Lack of equivalence between central and mixed venous oxygen saturation.
MedLine Citation:
PMID:  15596689     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: We compared paired samples of central venous O(2) saturation (Scvo(2)) and mixed venous O(2) saturation (Svo(2)) to test the hypothesis that Scvo(2) is equivalent to Svo(2). We also compared O(2) consumption (Vo(2)) computed with Scvo(2) (Vo(2)cv) to that computed with Svo(2) (Vo(2)v). DESIGN: Prospective, sequential, observational study. SETTING: Combined medical-surgical ICU. PATIENTS: Fifty-three individuals > 18 years of age of either sex who required a pulmonary artery catheter (PAC) to guide fluid therapy. Subjects were identified as postsurgical (32 patients) or medical (21 patients) according to their ICU admission diagnosis. INTERVENTIONS: A PAC was inserted through the internal jugular or subclavian veins. Care was taken to place the PAC proximal port approximately 3 cm above the tricuspid valve. Blood samples were drawn from the proximal and distal ports in random order. An arterial blood sample also was drawn. MEASUREMENTS: Cardiac output in triplicate, systemic pressure, and central pressure. We analyzed blood samples for hemoglobin concentration and O(2) saturation (So(2)). Data were compared by correlation analysis and by the method of Bland and Altman. RESULTS: Svo(2) was consistently lower than Scvo(2) (p < 0.0001), with a mean (+/-SD) bias of -5.2 +/- 5.1%. Similar differences in Scvo(2) and Svo(2) were present within each subgroup (p < 0.001). A lower Svo(2) resulted in Vo(2)v values that were higher than the Vo(2)cv values for all patients in the study (mean Vo(2)v, 236.7 +/- 103.4 mL/min; mean Vo(2)cv, 191.1 +/- 84.0 mL/min; p < 0.001) as well as for patients within each subgroup (p < 0.001). CONCLUSIONS: Measurements of Scvo(2) and Svo(2) were not equivalent in this sample of critically ill patients. Moreover, substituting Scvo(2) for Svo(2) in the calculation of Vo(2) produced unacceptably large errors. The decrease in So(2) between Scvo(2) to Svo(2) may result from the mixing of atrial and coronary sinus blood. As such, this difference may be a marker of myocardial O(2) consumption.
Authors:
Lakhmir S Chawla; Hasan Zia; Guillermo Gutierrez; Nevin M Katz; Michael G Seneff; Muhammed Shah
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Chest     Volume:  126     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-14     Completed Date:  2005-01-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1891-6     Citation Subset:  AIM; IM    
Affiliation:
The George Washington University MFA, 2150 Pennsylvania Ave NW, Suite 5-404, Washington, DC 20037, USA.
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MeSH Terms
Descriptor/Qualifier:
Catheterization, Swan-Ganz
Critical Illness
Female
Heart Atria
Hemoglobins / analysis
Humans
Intensive Care Units
Male
Middle Aged
Oximetry / methods
Oxygen / blood*
Oxygen Consumption*
Veins
Venae Cavae
Chemical
Reg. No./Substance:
0/Hemoglobins; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Chest. 2005 Aug;128(2):1073-4; author reply 1074-5   [PMID:  16100219 ]
Chest. 2006 Mar;129(3):507-8   [PMID:  16537845 ]

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