Continuous mixed venous and central venous oxygen saturation in cardiac surgery with cardiopulmonary bypass (original) (raw)
Related papers
Prognostic value of central venous oxygen saturation during anesthesia for cardiac surgery
Sohag Medical Journal, 2020
Background:During cardiac surgery, CPB machine pumps blood instead of the heart affecting blood flow and hence blood perfusion of all tissues. One important marker of blood perfusion is central venous oxygen saturation. Relationship between central venous oxygen saturation and patient morbidity and mortality is an indicator for the reliability of blood lactate as a perfusion marker. Objectives: This study aimed to assess the value of monitoring of central venous oxygen saturation in postoperative prognosis. The primary outcome was ICU length of stay, while the secondary outcomes were both duration of mechanical ventilation and postoperative complications. Methods: In a prospective observational study, 66 patients admitted to Sohag university hospital and Sohag Heart Institute in the period between October 2017 and April 2019 for open cardiac surgery were enrolled. Immediately after induction of anesthesia, the first sample of venous blood gas was obtained from central venous catheter. For measuring of central venous oxygen saturation, the next samples were obtained just before CPB weaning, the next after 24 hours of staying ICU and the last sample were obtained after 48 hours of staying ICU. Results: Central venous oxygen saturation in correlation to ICU length of stay showed patients stayed in the ICU less than 48 hours had significant p-value <0.001 and patients stayed in the ICU more than 48 hours had a non-significant p-value 0.693 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative duration of mechanical ventilation showed patients stayed on mechanical ventilation less than 12 hours had significant p-value 0.004 and patients stayed on mechanical ventilation more than 12 hours had a non-significant p-value 0.724 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative complications showed patients without postoperative complications had significant p-value 0.001 and patients with postoperative complications had a non-significant p-value 0.436 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Conclusion: Measuring ScvO2 at 4 points during and after open-heart surgery showed their prognostic value, regarding results for ScvO2: ICU length of stay, duration of mechanical ventilation and complications.
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.
Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival
Interactive cardiovascular and thoracic surgery, 2013
Long-term survival after cardiac surgery is determined by a number of different risk factors. Central venous oxygen saturation (S(v)O(2)) measures the balance between oxygen delivery and demand. S(v)O(2) levels in the intensive care situation are reported to be associated with patient outcome. The present report explores the connection between S(v)O(2) during cardiopulmonary bypass (CPB) and survival after cardiac surgery. Retrospective analysis of one thousand consecutive cardiac surgical patients was undertaken. S(v)O(2) during CPB was monitored online. Registry data combining specific risk factors with S(v)O(2) were selected for Kaplan-Meier and Cox regression analysis to examine the influence on 30-day and 3-year survivals. Nine-hundred and thirty-two patient records were eligible for analysis. S(v)O(2) below 75% during CPB was associated with significantly shorter 30-day and 3-year survivals. Based on Kaplan-Meier statistics, the survival rate decreased by 3.1% (98.1-95.0), P =...
Journal of Cardiothoracic and Vascular Anesthesia, 2001
Objective: To examine the clinical applicability of substituting central venous oxygen saturation (ScvO 2) for mixed venous oxygen saturation (SmvO 2) in monitoring global tissue oxygenation. Design: Prospective clinical investigation. Setting: University hospital. Participants: Seventy-three adult patients. Interventions: Venous oxygen saturation was recorded, and oxygen saturation difference between SmvO 2 and ScvO 2 (⌬Smvcv) was calculated in 2 groups of patients (group I, sepsis patients [n ؍ 41], and group II, general anesthesia for cardiovascular surgery patients [n ؍ 32]) during initial placement of pulmonary artery catheters. Measurements and Main Results: Patients were classified as follows: class A, patients having a ⌬Smvcv >؊5%; class B, patients having a ⌬Smvcv between ؊5% and ؉5%; and class C, patients having a ⌬Smvcv >؉5 %. Statistically significant differences were observed in cardiac index, oxygen delivery index, and oxygen extraction ratio between class A and B in both groups. Class C of group II showed the worst correlation between SmvO 2 and ScvO 2 and had significantly lower arterial carbon dioxide tension values than class A and B. Conclusion: Pulmonary artery blood sampling should not be replaced with central venous blood. Hypocapnia and increased oxygen extraction ratio seem to be the major factors that worsen the relationship between ScvO 2 and SmvO 2 .
Saudi Journal of Anaesthesia, 2010
extent the cardiopulmonary system meets the metabolic demands of the various tissues and to provide an index of tissue oxygenation. [3] Furthermore, it allows calculation of tissue oxygen consumption, oxygen extraction ratio, and the degree of pulmonary venous admixture. [4] However, SvO 2 A B S T R A C T Objective: To examine the validity of central venous oxygen saturation (ScvO 2) as a numerical substitution of mixed venous oxygen saturation (SvO 2) in adult patients undergoing normothermic on pump beating coronary artery bypass grafting (CABG).
Central Venous Saturation: A Prognostic Tool in Cardiac Surgery patients
Journal of Intensive Care Medicine, 2010
Background: Central venous oxygen saturation (ScvO 2 ) is a valuable prognostic marker in sepsis. However, its value in cardiac surgery has not been assessed yet. This study aimed at evaluating ScvO 2 as a tool for predicting short-term organ dysfunction (OD) after cardiac surgery. Methods: A prospective cohort including cardiac surgery patients submitted to a goal-oriented therapy to maintain ScvO 2 above 70% was studied. Postoperative blood samples collected at 30 minutes (T1), 6 hours (T2), and 24 hours (T3) for ScvO 2 measurement were selected to further analysis. Two groups were formed according to the absence (G0) or presence (G1) of OD defined as a Sequential Organ Failure Assessment (SOFA) score !5 on the third postoperative day. A logistic regression analysis was performed to identify the variables independently associated with OD on the third postoperative day. Results: From the 246 patients included, 54 (22%) developed OD and were defined as G1. The mortality rates in G0 and G1 were 1.6% and 31.5%, respectively (P < .001). In the comparative analysis between G0 and G1, the ScvO 2 values were remarkably lower in G1 at T1 (66.2 + 9.2 vs 62.3 + 11.6; P ¼ .009), T2 (69.6 + 5.9 vs 63.5 + 9.4; P .001), and T3 (69.6 + 5.6 vs 64.6 + 6.4; P .001). The variables independently associated with OD in the final logistic regression model were Cleveland score (95% CI: 1.13-1.44; OR: 1.27; P < .001), lactate at T3 (95% CI:1.21-3.15; OR 1.95; P ¼ .006), BE at T3 (95% CI:0.69-0.93; OR 0.80; P ¼ .005); ScvO 2 at T2 (95% CI:0.86-0.96; OR 0.91; P ¼ .002), and ScvO 2 at T3 (95% CI:0.83-0.95; OR 0.89; P ¼ .002). Conclusion: Postoperative ScvO 2 can be a valuable tool to predict OD after major cardiac surgeries. Its kinetics should be carefully followed in that setting.
Journal of cardiothoracic and vascular anesthesia, 2015
Parameters such as central venous oxygen saturation (ScvO2) are used increasingly to monitor adequate hemodynamic treatment. However, it still remains challenging to identify patients with assumed adequate circulatory status quantified by ScvO2 who suffer from macro- and microcirculatory hypoperfusion. The authors hypothesized that central venous-arterial pCO2 difference (dCO2) could serve as an additional parameter to evaluate the adequacy of perfusion in cardiac surgery patients. Retrospective data analysis of a prospective interventional study. University medical center. Patients undergoing surgery with cardiopulmonary bypass. The dCO2 was measured postoperatively. The patients with an ScvO2≥70% were divided into 2 groups, the high-dCO2 group (≥8 mmHg) and the low-dCO2 group (<8 mmHg). Sixty patients were included in this analysis. Twenty-five patients had ScvO2≥70%, 4 patients were assigned to the high-dCO2 group. Patients of the high-dCO2 group had significantly longer inten...