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Tissular perfusion influence on central, mixed and atrial venous oxygen saturations
Critical Care volume 17, Article number: P56 (2013)
Even though there has been quite a discussion on whether venous oxygen saturations are useful to guide treatment during initial resuscitation of sepsis, using mixed and central venous oxygen saturations as goals is still advised in the Surviving Sepsis Campaign under strong recommendation but a low level of evidence (1C). According to these guidelines, SvO2 <65% or SvcO2 <70% demands treatment. In addition, there is no consensus whether these variables are interchangeable. The objective of this study was to evaluate the influence of tissular perfusion on the correlation between the central venous (SvcO2), the mixed venous (SvO2) and the atrial oxygen saturations (SvaO2) by the analysis of arterial lactate.
A prospective observational study; the populations from three ICUs of the Hospital São Paulo were evaluated from October 2011 to November 2012 and patients diagnosed with severe sepsis or septic shock monitored by pulmonary artery catheter (PAC) were included. Hyperlactatemia was defined as an arterial lactate value >28 mg/dl and the correct location of the PAC was confirmed by chest radiography and pulmonary artery pressure tracings. For the statistical analysis, samples were allocated into two groups: normal lactate levels (Group 1) and hyperlactatemia (Group 2). Results were expressed in mean ± standard deviation or median (25 to 75% percentiles) or percentages.
Twenty-one patients were included; altogether, 65 paired blood samples were obtained (Table 1). A higher correlation between the venous oxygen saturations was found in the hyperlactatemia group (Table 2). APACHE II and SOFA scores were higher among these individuals (Table 1). SvcO2 and SvO2 were shown not to be acceptable surrogates by the analysis of the Bland-Altman plots, but bias and limits of agreement were narrower in Group 1 (Figures 1, 2 and 3).
In patients with hyperlactatemia, a global tissular perfusion marker, venous oxygen saturations presented a higher correlation and narrower bias and limits of agreement, suggesting, perhaps, that under high arterial lactate levels there is a generalized hypoperfusion that reflects not only on the SvO2, but also on the SvcO2. There was no agreement between those variables either.
Dellinger RP, Levy MM, Rhodes A, et al.: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83af
Van Beest , et al.: No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin. Crit Care 2010, 14: R219. 10.1186/cc9348
Varpula M, Karlsson S, Ruokonen E, Pettilä V: Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock. Intensive Care Med 2006, 32: 1336-1343. 10.1007/s00134-006-0270-y
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Goto, S., Mazza, B. & Machado, F. Tissular perfusion influence on central, mixed and atrial venous oxygen saturations. Crit Care 17, P56 (2013). https://doi.org/10.1186/cc12672
- Lactate Level
- Pulmonary Artery Catheter
- Survive Sepsis Campaign
- Sofa Score
- Arterial Lactate