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The relationship between central venous saturation and outcome following high-risk surgery

Introduction

Central venous oxygen saturation (ScvO2) reflects both tissue oxygen delivery and consumption and has been shown experimentally to closely reflect a range of circulatory disturbances. This and related parameters have been used successfully to improve outcome in various patient groups. Despite this fact, there is little or no observational data to link derangements of these parameters to outcome in the high-risk surgical patient.

Methods

Data was collected on high-risk surgical patients for the first eight post-operative hours. Routine monitoring included cardiac output and central venous saturation. Patients were divided into high and low ScvO2 groups according to whether the ScvO2 fell below 65% for two consecutive hourly readings and were followed up for 28 days.

Results

Seventy-nine patients were enrolled. There were eight deaths (10.1%) and 93 morbidity episodes (1.2 episodes per patient). The median age was 67 years (31–86 years). The median APACHE II score was 9 (2–23). Trends in ScvO2 and cardiac index indicated circulatory failure when many routine parameters were normal (e.g. blood pressure, heart rate and serum lactate). A higher incidence of complications in particular septic and cardiac complications, a longer hospital stay and a trend towards increased mortality were found in patients with low ScvO2 (see Table 1).

Table 1 Table 1

Conclusion

Low ScvO2 appears to indicate patients at high risk of complications after surgery. ScvO2 may indicate hypovolaemia at an earlier stage than traditional parameters. ScvO2 may be a suitable haemodynamic goal in surgical patients, as has been shown in severe sepsis.

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Pearse, R., Dawson, D., Fawcett, J. et al. The relationship between central venous saturation and outcome following high-risk surgery. Crit Care 8, P51 (2004). https://doi.org/10.1186/cc2518

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Keywords

  • Severe Sepsis
  • Longe Hospital Stay
  • Circulatory Failure
  • Circulatory Disturbance
  • Central Venous Oxygen Saturation