Relation between mixed venous oxygen saturation and cerebral oxygen saturation measured by absolute and relative near-infrared spectroscopy during off-pump coronary artery bypass grafting (original) (raw)
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Relation between Mixed Venous Oxygen Saturation and Cardiac Index
Chest, 1991
† Cerebral oxygen saturation might provide better non-invasive monitor of tissue perfusion than mixed venous oxygen saturation. † Simultaneous measurements of cerebral oxygen saturation using two near-infrared spectroscopy monitors (INVOS w and Foresight w) were compared in cardiac surgery. † Cerebral oxygen saturation appears to provide a more responsive monitor of tissue perfusion than mixed venous saturation. Background. We hypothesized that previously reported contradictory results regarding the equivalence of mixed venous (Smv O 2) and cerebral (rS c O 2) oxygen saturation might be related to time delay issues and to measurement technology. In order to explore these two factors, we designed a prospective clinical study comparing Smv O 2 with relative (INVOS w) and absolute (Foresight w) rS c O 2 measurements. Methods. Forty-two consenting patients undergoing elective off-pump coronary artery bypass grafting were included. Two INVOS and two Foresight sensors continuously registered rS c O 2. Smv O 2 was measured continuously via a pulmonary artery catheter. Data were assessed by within-and between-group comparisons and correlation analysis. Results. A similar time delay of 19 (4) and 18 (4) s was found for Smv O 2 compared with rS c O 2 measurements by Foresight and INVOS, respectively, during haemodynamic changes. After adjusting for this time delay, the correlation between Smv O 2 and rS c O 2 increased from r¼0.25 to 0.75 (P,0.001) for Foresight, and from r¼0.28 to 0.73 (P,0.001) for INVOS. Comparison of Foresight and INVOS revealed significant differences in absolute rS c O 2 values (range 58-89% for Foresight and 28-95% for INVOS). Changes in rS c O 2 in response to acute haemodynamic alterations were significantly more pronounced with INVOS compared with Foresight (P,0.001). Conclusions. Considering the important time delay with Smv O 2 , rS c O 2 seems to reflect more appropriately acute haemodynamic alterations. This might suggest its use as a valid alternative to invasive monitoring of tissue oxygen saturation. Relative and absolute rS c O 2 measurements demonstrated significant differences in measured rS c O 2 values and in the magnitude of rS c O 2 changes during haemodynamic alterations.
Critical Care, 2009
To assess potential metabolic and microcirculatory alterations in critically ill patients, near-infrared spectroscopy (NIRS) has been used, in combination with a vascular occlusion test (VOT), for the non-invasive measurement of tissue oxygen saturation (StO 2 ), oxygen consumption, and microvascular reperfusion and reactivity. The methodologies for assessing StO 2 during a VOT, however, are very inconsistent in the literature and, consequently, results vary from study to study, making data comparison difficult and potentially inadequate. Two major aspects concerning the inconsistent methodology are measurement site and probe spacing. To address these issues, we investigated the effects of probe spacing and measurement site using 15 mm and 25 mm probe spacings on the thenar and the forearm in healthy volunteers and quantified baseline, ischemic, reperfusion, and hyperemic VOT-derived StO 2 variables.
Central venous oxygen saturation monitoring
British Journal of Cardiac Nursing, 2009
It has been established that mixed venous oxygen saturation (SvO2) reflects the balance between systemic oxygen deliver y and consumption. Literature indicates that it is a valuable clinical indicator and has good prognostic value early in patient course. This article aims to establish the usefulness of SvO2 as a clinical indicator. A secondary aim was to determine whether central venous oxygen saturation (ScvO2) and SvO2 are interchangeable. Of particular relevance to cardiac nurses is the link between decreased SvO2 and cardiac failure in patients with myocardial infarction, and with decline in myocardial function, clinical shock and arrhythmias. While absolute values ScvO2 and SvO2 are not interchangeable, ScvO2 and SvO2are equivalent in terms of clinical course. Additionally, ScvO2 monitoring is a safer and less costly alternative to SvO2 monitoring. It can be concluded that continuous ScvO2 monitoring should potentially be undertaken in patients at risk of haemodynamic instability. KEY WORDS Oxygen saturation; monitoring; blood gases. KEY POINTS • Venous oxygen saturation has been advocated as an indirect index of tissue oxygenation. • It is generally accepted that venous oxygen saturation reveals a discrepancy between oxygen supply and oxygen demand thus indicating global tissue hypoxia. • Mixed venous oxygen saturation monitoring can detect tissue ischaemia at an early stage, and thus is a valuable indicator of clinical course. • Central venous oxygen saturation and mixed venous oxygen saturation are interchangeable in the course of clinical decision making.
Journal of Cardiothoracic and Vascular Anesthesia, 2007
Objective: Cerebral near-infrared spectroscopy (NIRS) was evaluated for use in monitoring global oxygenation in adult patients after cardiac surgery. Design: Prospective, randomized clinical monitoring study. Setting: Intensive care unit for cardiac surgery; university hospital. Participants: The study included 35 patients scheduled for cardiac surgery with insertion of a pulmonary artery catheter; patients with known cerebral-vascular perfusion disturbances were excluded. Interventions: Noninvasive cerebral NIRS oxygen saturation (rSO 2) and conventional intensive care monitoring parameters were assessed. Measurements and Main Results: Simple regression analysis was used to assess the correlation of rSO 2 to hemody-namic parameters. There was fair-to-moderate intersubject correlation to hemoglobin concentration (r ؍ 0.45, p < 0.0001) and mixed venous oxygen saturation (SmvO 2) (r ؍ 0.33, p < 0.0001). Sensitivity and specificity of rSO 2 to detect substantial (>1 standard deviation) changes in mixed venous oxygen saturation were 94% and 81%, respectively. Conclusions: Cerebral NIRS in adult patients might not be the tool to replace mixed venous oxygen monitoring. Further work has to be done to assess its potential to reflect intraindividual trends.
CHEST Journal, 1989
Because central venous O saturation (superior vena cava, Scvo,) can be monitored with less patient risk than mixed venous O saturation (pulmonary artery, S O), we exammed the correlations between S O and ScvO2 over a broad range of cardiorespiratory conditions, including hypoxia, hemorrhage, and resuscitation in anesthetized dogs. The correlation coefficient (r) between Si O2 and ScvO, in 179 simultaneously drawn blood samples from 22 dogs was 0.97. !n another nine dogs, the two sites were continuously and simultaneously monitored with fiberoptic catheters; r was
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society, 2020
Objective: In the study, the regional cerebral oxygen saturation (rSO 2) of patients with and without carotid artery stenosis was monitored to see whether or not NIRS can be used routinely in CABG operations. Methods: Eighty patients undergoing CABG were divided into two groups. Following the preoperative colour Doppler ultrasonography, the patients with internal carotid artery stenosis or with stable plaque were included in Group I (n=40), while the patients having no internal carotid artery stenosis were included in Group II (n=40). Pulse rates, systolic and diastolic blood pressures, mean arterial blood pressures, nasopharyngeal temperatures, haematocrit, PaO 2 , PaCO 2 , SpO 2 , BIS, right, and left rSO 2 values, and relative changes in rSO 2 from baseline of the two groups were compared. Results: The male/female ratios in both groups were 27/13. The mean age was 60.82±9.63 (39-79) years in Group I and 59.95±9.54 (41-80) years in Group II. No differences were observed in terms of demographic data, preoperative laboratory and bispectral index (BIS) values, and time of operation and CPB. In addition, no differences were observed between the arterial blood gas values or the right and left rSO 2 values of the groups at all measurement time points (p=0.309 and p=0.114, respectively). In both groups, the decrease in rSO 2 values was not higher than 20% at all measurement time points. However, the relative changes in rSO 2 from baseline in Group I were statistically different compared to those in Group II (right p=0.031, left p<0.001). No stroke occurred in the groups postoperatively. Conclusion: In patients undergoing CABG, brain perfusion reduces when a CPB pump is put into operation, and the monitoring of intraoperative cerebral perfusion with NIRS is crucial. In patients with carotid artery stenosis, relative changes in rSO 2 from baseline are higher.
Journal of Clinical Monitoring and Computing, 2008
Objective. Continuous assessment of central venous oxygen saturation (S cevox O 2) with the CeVOX device (Pulsion Medical Systems, Munich, Germany) was evaluated against central venous oxygen saturation (S cv O 2) determined by co-oximetry. Methods. In 20 cardiac surgical patients, a CeVOX fiberoptic probe was introduced into a standard central venous catheter placed in the right internal jugular vein and advanced 2-3 cm beyond the catheter tip. After in vivo calibration of the probe, S cevox O 2 , S cv O 2 , mixed venous oxygen saturation (S mv O 2) haemoglobin (Hb), body temperature, heart rate, central venous and mean arterial pressure, and cardiac index were assessed simultaneously at 30 min intervals during surgery and at 60 min intervals during recovery in the intensive care unit. Agreement between S cevox O 2 , and S cv O 2 was determined by Bland-Altman analysis. Simple regression analysis was used to assess the correlation of S cevox O 2 , and S cv O 2 to Hb, body temperature and haemodynamic parameters. Results. Values of S cevox O 2 and S cv O 2 (84 data pairs during surgery and 106 in the intensive care unit) ranged between 45-89% and 43-90%, respectively. Mean bias and limits of agreement of S cevox O 2 and S cv O 2 were-0.9 ()7.9/+6.1)% during surgery and)1.2 ()10.5/ +8.1)% in the intensive care unit. In 37.9% of all measured data pairs, the difference between S cevox O 2 and S cv O 2 was beyond clinically acceptable limits (‡1 s.d.). Mean bias was significantly influenced by cardiac index. Sensitivity and specificity of S cevox O 2 to detect substantial (‡1 s.d.) changes in S cv O 2 were 89 and 82%, respectively. Conclusions. In adult patients during and after cardiac surgery, the current version of the CeVOX device might not be the tool to replace S cv O 2 determined by co-oxymetry, although sensitivity and specificity of S cevox O 2 to predict substantial changes in S cv O 2 were acceptable.
European Journal of Anaesthesiology, 2010
Background and objective The present study compares the accuracy of a new continuous venous oxygenation monitoring system (PediaSat Oximetry Catheter) with laboratory blood oximetry in paediatric surgical patients. Methods Children and adolescents undergoing cardiac, orthopaedic or craniofacial surgery with major blood loss were included. A 4.5 Fr two-lumen or 5.5 Fr three-lumen central venous oximetry catheter (S PediaSat cvO 2) was inserted preoperatively into the superior vena cava. After in-vivo calibration of the PediaSat system, repeated blood samples were obtained from the distal port of the venous catheter and oximetrically analysed for haemoglobin and central venous oxygen saturation (S CO-OX cvO 2). Central venous oxygen saturation values measured by the PediaSat (S PediaSat cvO 2) were compared with co-oximetry (S CO-OX cvO 2) values from the simultaneously taken blood samples by Bland-Altman and simple regression analyses. Results Overall, 142 data pairs from 27 patients, aged from 0.6 to 19.0 years (median 5.3 years) were analysed. S PediaSat cvO 2 and S CO-OX cvO 2 values ranged from 57 to 98% and from 57.1 to 95.8%, respectively. Correlation between S PediaSat cvO 2 and S CO-OX cvO 2 was poor with r 2 equal to 0.28 (P < 0.0001). S PediaSat cvO 2 overestimated S CO-OX cvO 2 (mean bias R2.6%), but limits of agreement (AE2 SD of bias) were unacceptably high (À14.4/R19.6%). Sensitivity and specificity of S PediaSat cvO 2 to indicate a fall or rise of S CO-OX cvO 2 between two subsequent measurements were only 0.42 and 0.24, respectively. Conclusion In paediatric and adolescent patients undergoing major surgery, the PediaSat system did not reliably reflect S CO-OX cvO 2 values and cannot replace repeated invasive ScvO 2 assessments in the clinically relevant range of ScvO 2 .
Journal of Clinical Monitoring and Computing
Near infrared spectroscopy (NIRS) has been used to evaluate regional cerebral tissue oxygen saturation (ScO 2) during the last decades. Perioperative management algorithms advocate to maintain ScO 2 , by maintaining or increasing cardiac output (CO), e.g. with fluid infusion. We hypothesized that ScO 2 would increase in responders to a standardized fluid challenge (FC) and that the relative changes in CO and ScO 2 would correlate. This study is a retrospective substudy of the FLuid Responsiveness Prediction Using Extra Systoles (FLEX) trial. In the FLEX trial, patients were administered two standardized FCs (5 mL/kg ideal body weight each) during cardiac surgery. NIRS monitoring was used during the intraoperative period and CO was monitored continuously. Patients were considered responders if stroke volume increased more than 10% following FC. Datasets from 29 non-responders and 27 responders to FC were available for analysis. Relative changes of ScO 2 did not change significantly in non-responders (mean difference − 0.3% ± 2.3%, p = 0.534) or in fluid responders (mean difference 1.6% ± 4.6%, p = 0.088). Relative changes in CO and ScO 2 correlated significantly, p = 0.027. Increasing CO by fluid did not change cerebral oxygenation. Despite this, relative changes in CO correlated to relative changes in ScO 2. However, the clinical impact of the present observations is unclear, and the results must be interpreted with caution. Trial registration: http://Clini calTr ial.gov identifier for main study (FLuid Responsiveness Prediction Using Extra Systoles-FLEX): NCT03002129.
The Open Respiratory Medicine Journal, 2022
Background: Central venous oxygen saturation (ScvO 2) is an essential test readily performed both by medical and nursing personnel in a critical care setting. It gives information on the patient's oxygen supply, oxygen consumption, and cardiac output. It plays an important role in early goal-directed treatment. Objectives: This study was planned to assess the effect of different fractions of inspired oxygen (FiO 2) levels on central venous oxygen saturation for consideration during the evaluation of central venous oxygen saturation. Methods: This interventional cross-over study enrolled 60 critically ill, nonmechanically ventilated patients. Blood samples were repeatedly drawn from the distal end of the central venous catheter for blood gas analysis after administration of 30%, 40%, and 50% FIO 2 respectively. Results: The results showed that increasing FiO 2 from 30% to 40% resulted in a mean increase in ScvO 2 of 6.2%. While increasing FiO 2 from 40% to 50% resulted in a mean increase in ScvO 2 of 3.2%. A significant increase in ScvO 2 with changes in FiO 2 levelwas recorded among patients in shock or patients with pneumonia (from 30% to 50%, p=0.002 in shock patients and from 30% to 40%, p=0.02 in patients with pneumonia). Conclusion: Increasing FiO 2 resulted in a substantial rise in ScvO 2. ScvO 2 changes in response to a therapeutic challenge should be interpreted at constant FiO 2 level, especially in patients with pneumonia.