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Low and "supranormal" central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study.
MedLine Citation:
PMID:  20689932     Owner:  NLM     Status:  In-Process    
PURPOSE: To characterize incidence of low, normal and "supranormal" central venous oxygen saturation (ScvO(2)) and the relation to markers of tissue hypoxia, course and outcome in cardiac surgery patients.
METHODS: 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 ScvO(2) indicative of impaired tissue oxygenation.
RESULTS: Both low (≤ 60.8%) and supranormal (≥ 77.4%) ScvO(2) were associated with an unfavorable course, while the logistic EuroSCORE for risk adjustment was comparable between groups. Incidences of abnormal ScvO(2) were 13.2% low and 30.7% supranormal. Patients with low ScvO(2) and an uneventful course initially presented with normal lactate levels, whereas patients with supranormal ScvO(2) displayed consistently higher serum lactate levels. High ScvO(2) 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 ScvO(2) (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 ScvO(2) values. In contrast, neither low nor supranormal ScvO(2) was associated with altered gastric pCO(2.)
CONCLUSIONS: High ScvO(2) is an under-recognized warning sign for impaired tissue oxygenation in the peri-operative period. Including values ≥ 77.4% as 'normal' impaired performance of ScvO(2) monitoring to predict a complicated perioperative course.
Suzanne Perz; Thomas Uhlig; Matthias Kohl; Donald L Bredle; Konrad Reinhart; Michael Bauer; Andreas Kortgen
Publication Detail:
Type:  Journal Article     Date:  2010-08-06
Journal Detail:
Title:  Intensive care medicine     Volume:  37     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-9     Citation Subset:  IM    
Department of Anesthesiology and Critical Care Therapy, Jena University Hospital, 07740 Jena, Germany.
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