Comparison of Central-Venous to Mixed-Venous Oxygen Saturation During Changes in Oxygen Supply/Demand

Reinhart, Konrad; Rudolph, Tobias; Bredle, Donald L.; Hannemann, L.; Cain, S. M.

doi:10.1378/chest.95.6.1216

Cited by 247 publications

(138 citation statements)

References 22 publications

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“…18,25 S v O 2 is probably the best single indicator of the adequacy of oxygen transport, as it represents the amount of oxygen remaining in the systemic venous blood after blood passes through the organs and tissues throughout the body. 26 S v O 2 reflects the balance between oxygen supply and demand and can be a surrogate for cardiac output as a target for goal-oriented hemodynamic therapy.…”

Section: Oxygen Deliverymentioning

confidence: 99%

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cheifetz

2014

Respir Care

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The overall goal of the cardiorespiratory system is to provide the organs and tissues of the body with an adequate supply of oxygen in relation to oxygen consumption. An understanding of the complex physiologic interactions between the respiratory and cardiac systems is essential to optimal patient management. Alterations in intrathoracic pressure are transmitted to the heart and lungs and can dramatically alter cardiovascular performance, with significant differences existing between the physiologic response of the right and left ventricles to changes in intrathoracic pressure. In terms of cardiorespiratory interactions, the clinician should titrate the mean airway pressure to optimize the balance between mean lung volume (ie, arterial oxygenation) and ventricular function (ie, global cardiac output), minimize pulmonary vascular resistance, and routinely monitor cardiorespiratory parameters closely. Oxygen delivery to all organs and tissues of the body should be optimized, but not necessarily maximized. The heart and lungs are, obviously, connected anatomically but also physiologically in a complex relationship.

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Section: Oxygen Deliverymentioning

confidence: 99%

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cheifetz

2014

Respir Care

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“…19,20 Reinhart et al 21 compared mixed venous saturation to saturation in the superior vena cava in an experimental model and demonstrated an excellent correlation (r = 0.97). Lee et al 22 studied 29 stable patients and 15 patients in circulatory shock (septic, hemorrhagic and neurogenic) and detected a good correlation between venous atrial and mixed saturation.…”

Section: Figure 4 -mentioning

confidence: 99%

Indirect calorimetry can be used to measure cardiac output in septic patients?

et al. 2008

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Purpose: The aim of this study was to compare two different cardiac output (CO) monitoring systems based on the thermodilution principle (Thermo-CO) and indirect calorimetry (Fick mixed-CO) in septic patients. Methods: Prospective study in septic patients admitted in an intensive care unit of a university hospital. Nineteen patients aged on average 45.4 ± 21.5 years were enrolled in the study. Four series of hourly measurements by the two techniques were carried out simultaneously. Results: No significant differences were observed between Thermo-CO and Fick mixed-CO (7.0 ± 1.8 L.min -1 and 6.4 ± 1.7 L.min -1. ). Parallel analysis of Fick mixed-CO and Fick atrial-CO was performed introducing a correction factor for the eight atrial samples in order to adjust the values of oxygen saturation obtained from atrial blood (Fick corrected atrial-CO) to those obtained from mixed venous blood. No significant differences could be detected between Fick mixed-CO and Fick corrected atrial-CO. The correlation coefficients of Thermo CO/Fick mixed-CO and Fick mixed-CO/ Fick corrected atrial-CO were 0.84 and 0.94, respectively. Conclusion: We observed that the agreement between the two methods was satisfactory on the basis of the decisions made for treatment. Indirect calorimetry is useful to measure CO in patients with septic shock.Key words: Indirect Calorimetry. Cardiac Output. Septic Shock. Intensive Care Setting. RESUMOObjetivo: O objetivo deste estudo foi comparar as medidas do débito cardíaco (DC) obtidas pela termodiluição (DC-termo) e pela calorimetria indireta (DC-Fick misto) em pacientes com choque séptico. Métodos: Estudo prospectivo em pacientes sépticos internados em unidade de terapia intensiva de um hospital universitário. Foram estudados 19 pacientes (45,4 ± 21,5 anos). Foram realizadas quatro séries de medidas do DC pelos dois métodos, simultaneamente. Resultados: Não houve diferenças significativas entre os valores do DC-termo e DC-Fick misto (7,0 ± 1,8 L.min -1 e 6,4 ± 1,7 L.min -1 , respectivamente). Na avaliação dos oito casos (DC-Fick misto/DC Fick atrial), introduziu-se um fator de correção para aproximar os valores do conteúdo de O 2 atrial (DC-Fick atrial corrigido) com o venoso misto. Não houve diferença significativa do DC-Fick misto e DC-Fick atrial corrigido nos 4 tempos. A correlação foi de 0.84 para o DC-termo/DC-Fick misto e de 0.94 para o DC-Fick misto/DC-Fick atrial corrigido. Conclusão: A calorimetria indireta é um bom método para a medida do DC em pacientes vítimas de choque séptico, sobretudo nos casos onde a monitorização hemodinâmica invasiva não está disponível ou está contra indicada.

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“…In these conditions (due to a blood flow redistribution in the upper parts of the body, decreased splanchnic and renal circulation and increased ERO2) ScVO2 may outmatch SVO2 by up to 20% . (27)(28)(29)(30)(31) The use of individual ScVO2 and ERO2 values as transfusion indicators in these conditions is questionable. In the most common situations in the ICU, when SaO2 is near 100%, ERO2 may be calculated from the SaO2 and SVO2 difference, without a need for VO2 and DO2 measurements.…”

Section: Global Oxygenation Param-eters In Critical Illnessmentioning

confidence: 99%

“…In the most common situations in the ICU, when SaO2 is near 100%, ERO2 may be calculated from the SaO2 and SVO2 difference, without a need for VO2 and DO2 measurements. (31,33,34) When anaemia results in DO2 reduction, ERO2 of 50% represents an indirect indicator of tissue oxygen deficit and may be used as a transfusion trigger. (24) Studies that compared ScVO2 and SVO2 in various clinical situations have still not provided reliable answers on the question of whether or not both of these parameters can be used for the purpose of triggering transfusion therapy.…”

Section: Global Oxygenation Param-eters In Critical Illnessmentioning

confidence: 99%

Indications for blood transfusions in critical illness

Baronica

Tonković²,

Mržljak³

et al. 2015

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Transfusion of blood products should improve tissue oxygenation and reduce negative consequences of anaemia. At the same time, adverse effects of transfusion, such as infections, immunologic reactions and mistransfusion, could be deleterious. Most transfusion guidelines suggest looking at the combination of haemoglobin or haematocrit levels in addition to clinical signs in the decision making process for a blood transfusion. The problem with such indications is that the clinical evaluation may be misleading in severely ill patients and haemoglobin levels that impair oxygen delivery cannot be determined easily. Many studies attempted to establish more convenient parameters, such as oxygen saturation from mixed and central venous blood, tissue oxygen extraction and other methods. Although the results from these studies are conflicting, it appears that global oxygenation parameters are a good indicator for a blood transfusion in some categories of critically ill patients.

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Comparison of Central-Venous to Mixed-Venous Oxygen Saturation During Changes in Oxygen Supply/Demand

Cited by 247 publications

References 22 publications

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Indirect calorimetry can be used to measure cardiac output in septic patients?

Indications for blood transfusions in critical illness

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