Central venous oxygen saturation is a good indicator of altered oxygen balance in isovolemic anemia

Kocsi, Szilvia; Demeter, Gábor; Fogas, J.; Érces, Dániel; Kaszaki, József; Molnár, Zsolt

doi:10.1111/j.1399-6576.2011.02622.x

Cited by 24 publications

(26 citation statements)

References 25 publications

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“…The current experiment complements our previously published data on the relationship of ScvO 2 and isovolemic anemia [12]. Vietnamese mini pigs (n = 13) weighing 24±3 kg were anaesthetized and mechanically ventilated in pressure control mode.…”

Section: Methodsmentioning

confidence: 71%

“… cv CO 2 -gap: central venous-to-arterial carbon dioxide difference; v CO 2 -gap: mixed venous-to-arterial carbon dioxide difference; P (cv-a) CO 2 /C (a-cv) O 2 : the central venous-to-arterial pCO 2 difference divided by the difference of the arterio-venous oxygen content; P (v-a) CO 2 /C (a-v) O 2 : the mixed venous-to-arterial pCO 2 difference divided by the difference of the arterio-venous oxygen content; ScvO 2 : central venous oxygen saturation; SvO 2 : mixed venous oxygen saturation; DO 2 : oxygen delivery; VO 2 : oxygen consumption; VO 2 /DO 2 : oxygen extraction ratio; ERO 2 : simplified oxygen extraction ratio; PaCO 2 : arterial partial pressure of carbon dioxide; PaO 2 : arterial partial pressure of oxygen * p<.05 as compared to baseline, § p<.05 significant difference between mixed venous and central venous blood with Friedman and Wilcoxon tests, # Data published earlier [12].…”

Section: Resultsmentioning

confidence: 96%

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Central Venous-To-Arterial CO2-Gap May Increase in Severe Isovolemic Anemia

et al. 2014

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Despite blood transfusions are administered to restore adequate tissue oxygenation, transfusion guidelines consider only hemoglobin as trigger value, which gives little information about the balance between oxygen delivery and consumption. Central venous oxygen saturation is an alternative, however its changes reflect systemic metabolism and fail to detect regional hypoxia. A complementary parameter to ScvO2 may be central venous-to-arterial carbon dioxide difference (CO2-gap). Our aim was to investigate the change of alternative transfusion trigger values in experimental isovolemic anemia. After splenectomy, anesthetized Vietnamese mini pigs (n = 13, weight range: 18–30 kg) underwent controlled bleeding in five stages (T1–T5). During each stage approximately 10% of the estimated starting total blood volume was removed and immediately replaced with an equal volume of colloid. Hemodynamic measurements and blood gas analysis were then performed. Each stage of bleeding resulted in a significant fall in hemoglobin, the O2-extraction increased significantly from T3 and ScvO2 showed a similar pattern and dropped below the physiological threshold of 70% at T4. By T4 CO2-gap increased significantly and well correlated with VO2/DO2 and ScvO2. To our knowledge, this is the first study to show that anemia caused altered oxygen extraction may have an effect on CO2-gap.

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Section: Methodsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 96%

Central Venous-To-Arterial CO2-Gap May Increase in Severe Isovolemic Anemia

et al. 2014

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“…These results were reinforced by a retrospective analysis of a prospective observational study in which ScvO 2 was found to be a good indicator of transfusion [14]. The results of our recent animal study on isovolaemic haemodilution gave further evidence that anaemia-induced change in oxygen balance can be monitored by ScvO 2 [15]. We found a strong, negative correlation between VO 2 /DO 2 and ScvO 2 (r = −0.71, p < 0.001).…”

Section: Central Venous Oxygen Saturation (Scvo 2 ) As a Transfusion mentioning

confidence: 84%

ScvO2 as an Alternative Transfusion Trigger

Kocsi

Tánczos

Molnár

2014

Transfusion in the Intensive Care Unit

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Blood transfusion is often a life-saving but risky intervention. Restrictive transfusion protocols have recently been developed with a post-transfusion target haemoglobin level of 7-10 g/dL. Whether only haemoglobin level is enough to guide our transfusion practice is questionable; hence, the same level of anaemia may be harmless in sedated, haemodynamically stable patients, while it requires urgent treatment in unstable patients or when oxygen demand is increased. Therefore, it is not the haemoglobin level per se that determines the severity of anaemia but the imbalance between oxygen delivery and consumption. One of the simple surrogates to estimate the balance of the oxygen extraction ratio is central venous oxygen saturation. In this chapter, the role of central venous oxygen saturation as an alternative transfusion trigger in addition to haemoglobin will be discussed.

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“…Strict definition of mixed venous saturation includes caval and coronary sinus venous return. However, central venous oxygen saturation suggests an oxygen imbalance [11] and correlates with mixed venous oxygen saturations [12,13]. Central venous and arterial blood gases were drawn simultaneously to calculate the estimated avO 2 diff.…”

Section: Methodsmentioning

confidence: 99%