Table 2 Studies describing central venous oxygen saturation in clinical settings

Rady and colleagues [1]

n = 36; critically ill patients; ED

Additional therapy is needed after haemodynamic stabilisation to normal blood pressure and heart rate

ScvO₂ can be utilised to guide therapy in this phase

Pope and colleagues [13]

n = 619 registries treated with EGDT; observational study

Groups: ScvO₂ <70%, ScvO₂ 71 to 89%, ScvO₂ >90%

Multivariate analysis: initial high ScvO₂ higher mortali

Also high ScvO₂ values predictive for mortality

Ander and colleagues [35]

Controls n = 17, high lactate group n = 22, low lactate group n = 5; chronic congestive heart failure; ED

ScvO₂ lower in high lactate group than in low lactate group (32 ± 12% vs. 51 ± 13%) and control (60 ± 6%); after treatment

There was a significant decrease of lactate and increase in ScvO₂ in the high lactate group compared with the low lactate group

Once patients with decompensated end-stage congestive heart failure are identified, these patients require aggressive alternative management

Scalea and colleagues [40]

n = 26, trauma patients with suggested blood loss

Despite stable vital signs, 39% of the patients had ScvO₂ <65%; these patients required more transfusions; linear regression analysis demonstrated superiority of ScvO₂ to predict blood loss compared with normally allowed parameters

ScvO₂ is a reliable and sensitive method for detecting blood loss; it is a useful tool in the evaluation of acutely injured patients

Di Filippo and colleagues [41]

n = 121 brain injury after trauma; noncontrolled study

Nonsurvivors showed higher lactate, lower ScvO₂ values; patients with ScvO₂ ≤65% showed higher 28- day mortality, ICU LOS and hospital LOS than patients with ScvO₂ >65%

ScvO₂ <65% in first 24 hours after admission in patients with major trauma and head injury is associated with prolonged hospitalisation and higher mortality

Pearse and colleagues [65]

n = 118, major surgery

After multivariate analysis, lowest CI and lowest ScvO₂ were associated with postoperative complications; optimal ScvO₂ cut-off value for morbidity prediction was 64.4%; in the first hour after surgery, significant reductions in ScvO₂ were observed, without significant changes in CI or oxygen delivery index

Results suggest that oxygen consumption is also an important determinant of ScvO₂; reductions in ScvO₂ are independently associated with postoperative complications

Rivers and colleagues [73]

n = 263; RCT; EGDT vs. controls; severe sepsis, septic shock; ED

EGDT (goal: ScvO₂ ≥70%) showed better survival (absolute 16%), lower lactate; more fluids, red cell transfusion and inotropics

EGDT provides benefits to outcome

Trzeciak and colleagues [74]

n = 16 pre-EGDT; n = 22 EGDT

Less PAC utilisation; more fluids and dobutamine used; similar costs

EGDT endpoint can reliably be achieved

Kortgen and colleagues [75]

n = 30 controls; n = 30 septic shock

Implementation procedure:

septic shock

Implementation: use of dobutamine, insulin, hydrocortisone and activated protein C increased

Amount of fluids and packed blood cells unaffected

Mortality significantly lower after implementation

(27% vs. 53%; P < 0.05).

Implementation of sepsis bundle feasible Survival benefit

Jones and colleagues [76]

n = 79 pre-intervention; n = 77 post-intervention; ED

Controls: more renal failure at baseline

Greater crystalloid volume and vasopressor infusion

Mortality 18 vs. 27%

Implementation resulted in mortality reduction

Micek and colleagues [78]

n = 60 before implementation order set; n = 60 after implementation order set; ED

More appropriate antimicrobial regimen

More fluids, more vasopressors

Less vasopressor by time of transfer to the ICU

Shorter hospital LOS

Lower 28-day mortality

Shapiro and colleagues [80]

n = 51 historical controls; n = 79 septic shock

Patients received more fluids, earlier antibiotics, more vasopressors, tighter glucose control, more frequent assessment of adrenal function, not more packed blood cells

Implementation sepsis protocol feasible No survival benefit

Jones and colleagues [94]

Multicentre, randomised; n = 300 severe sepsis, septic shock

Goals: lactate clearance vs.

ScvO₂

Higher in hospital mortality ScvO₂; nonsignificant difference (predefined -10% threshold)

No significantly different in-hospital mortality between normalisation of lactate clearance compared with normalization ScvO₂