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Curve analysis of tissue oxygen desaturation after a venous occlusion test does not identify the central venous hemoglobin oxygen saturation
Critical Care volume 16, Article number: P257 (2012)
Introduction
We aim to compare the time for the equivalence of tissue oxygen saturation (StO2) with central venous hemoglobin oxygen saturation (ScvO2) measured at depths of 15 and 25 mm.
Methods
Twenty-one critically ill patients were included. The ScvO2 was measured by blood gas analysis. Thenar StO2 was continuously monitored (Model 650 InSpectra Tissue Spectrometer; Hutchinson Technology Inc., MN, USA) in 15 mm (StO2- 15) and 25 mm (StO2- 25) depths. The venous occlusion was performed using an automatic pneumatic device maintaining inflation pressure 10 mmHg above the diastolic pressure. A StO2 desaturation curve was plotted to identify the time for equivalence to ScvO2.
Results
Age: 59 ± 17 years, APACHE II score: 21 ± 7, SOFA score: 7 ± 4, ScvO2: 75 ± 6%, blood lactate: 1.6 ± 1.2 mmol/l, capillary refill time: 9.1 ± 8.1 seconds, body temperature: 36.7 ± 1.1°C. Measurements were performed for up to three consecutive days (total measurements: 43). In four patients the equivalence was not identified. The curve analysis showed that StO2 desaturation time equivalency for ScvO2 was greater for StO2- 15 than for StO2- 25 (88 ± 54 seconds vs. 79 ± 56 seconds, P < 0.01). The Pearson correlation index for equivalence times for StO2- 15 and StO2- 25 was 0.92 (P < 0.001), but Bland-Altman analysis showed a significant difference between the times (mean difference: StO2_25 - StO2- 25: -7.9 ± 37.8 seconds). An arbitrary time of 80 seconds identifies the ScvO2 in 58% of cases.
Conclusion
The analysis of the StO2 desaturation curve does not adequately identify the hemoglobin central venous oxygen saturation.
References
Lima A, et al.: The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients. Crit Care Med 2011, 39: 1649. 10.1097/CCM.0b013e3182186675
Bezemer R, et al.: Assessment of tissue oxygen saturation during a vascular occlusion test using near-infrared spectroscopy: the role of probe spacing and measurement site studied in healthy volunteers. Crit Care 2009,13(Suppl 5):S4..
Lima A, et al.: Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients. Crit Care 2009,13(Suppl 5):S13. 10.1186/cc8011
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Friedman, G., Alan, C., Meregalli, A. et al. Curve analysis of tissue oxygen desaturation after a venous occlusion test does not identify the central venous hemoglobin oxygen saturation. Crit Care 16 (Suppl 1), P257 (2012). https://doi.org/10.1186/cc10864
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DOI: https://doi.org/10.1186/cc10864