Continuous central venous oxygen saturation assisted intraoperative hemodynamic management during major abdominal surgery: a randomized, controlled trial

Mikor, A; Trásy, Domonkos; Németh, Márton; Osztroluczki, Angelika; Kocsi, Szilvia; Kovács, Ildikó; Demeter, Gábor; Molnár, Zsolt

doi:10.1186/s12871-015-0064-2

Cited by 25 publications

(16 citation statements)

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“…Physiological mixed venous oxygen saturation ranges between 68% and 77%, and S cv O 2 is considered to be 5% higher [ 29 ]. Indeed, in patients under general anesthesia the S cv O 2 is often higher than 80%, which is due to the reduced oxygen demand and consumption; hence, higher values should be considered as “normal” [ 30 , 31 ]. Furthermore, in our previous experiments, S cv O 2 showed good correlation with oxygen extraction [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

Tánczos

Németh

Trásy

et al. 2015

BioMed Research International

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The aim of this study was to compare stroke volume (SVI) to cardiac index (CI) guided resuscitation in a bleeding-resuscitation experiment. Twenty six pigs were randomized and bled in both groups till baseline SVI (T bsl) dropped by 50% (T 0), followed by resuscitation with crystalloid solution until initial SVI or CI was reached (T 4). Similar amount of blood was shed but animals received significantly less fluid in the CI-group as in the SVI-group: median = 900 (interquartile range: 850–1780) versus 1965 (1584–2165) mL, p = 0.02, respectively. In the SVI-group all variables returned to their baseline values, but in the CI-group animals remained underresuscitated as indicated by SVI, heart rate (HR) and stroke volume variation (SVV), and central venous oxygen saturation (ScvO2) at T 4 as compared to T bsl: SVI = 23.8 ± 5.9 versus 31.4 ± 4.7 mL, HR: 117 ± 35 versus 89 ± 11/min SVV: 17.4 ± 7.6 versus 11.5 ± 5.3%, and ScvO2: 64.1 ± 11.6 versus 79.2 ± 8.1%, p < 0.05, respectively. Our results indicate that CI-based goal-directed resuscitation may result in residual hypovolaemia, as bleeding caused stress induced tachycardia “normalizes” CI, without restoring adequate SVI. As the SVI-guided approach normalized most hemodynamic variables, we recommend using SVI instead of CI as the primary goal of resuscitation during acute bleeding.

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Section: Discussionmentioning

confidence: 99%

Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

Tánczos

Németh

Trásy

et al. 2015

BioMed Research International

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“…ScvO 2 monitorization resulted in more interventions, more fluid boluses and more blood transfusion compared to the conventional group. These intervention resulted in better organ functions, less complication rate, and better 28 days of survival ( 35 ). These results are in accord with the results of an earlier single-center study, where ScvO 2 over 73% directed group had fewer postoperative complications and had shorter length of hospital stay compared to patients in whom hemodynamic stabilization was guided according to MAP and central venous pressure ( 36 ).…”

Section: Parameters For Assessment Of Tissue Metabolismmentioning

confidence: 99%

Monitoring of Tissue Oxygenation: an Everyday Clinical Challenge

Molnár

Németh

2018

Front. Med.

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Purpose of reviewThe aim of this article is to study the overview of pathophysiology and clinical application of central venous oxygen saturation monitoring in critically ill patients and during the perioperative period.Recent findingsThere are several clinical studies and animal experiments evaluating the effects of goal-directed hemodynamic stabilization on critically ill patients. Recent systematic reviews and meta-analyses found that advanced hemodynamic endpoints-targeted management has a positive effect on outcome in high-risk surgical patients. As all interventions aim to improve tissue oxygenation, it is of utmost importance to monitor the balance between oxygen delivery and consumption. For this purpose, central venous blood gas analysis provides an easily available tool in the everyday clinical practice. The adequate interpretation of central venous oxygen saturation renders the need of careful evaluation of several physiological and pathophysiological circumstances. When appropriately evaluated, central venous oxygen saturation can be a valuable component of a multimodal individualized approach, in which components of oxygen delivery are put in the context of the patients’ individual oxygen consumption. In addition to guide therapy, central venous oxygen saturation may also serve as an early warning sign of inadequate oxygen delivery, which would otherwise remain hidden from the attending physician.SummaryWith the incorporation of central venous oxygen saturation in the everyday clinical routine, treatment could be better tailored for the patients’ actual needs; hence, it may also improve outcome.

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“…The total sample size was <100 participants for 33 studies (Bahlmann et al, 2019;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Cecconi et al, 2011;Colantonio et al, 2015;El Sharkawy et al, 2013;Funk et al, 2015;Han et al, 2016;Jammer et al, 2015;Joosten et al, 2019;Kaufmann et al, 2018;Kim et al, 2018;Kumar et al, 2016;Lobo et al, 2000;Mayer et al, 2010;Mikor et al, 2015;Mythen & Webb, 1995;Peng et al, 2014;Reisinger et al, 2017;Scheeren et al, 2013;Senagore et al, 2009;Shoemaker et al, 1988;Sinclair et al, 1997;Ueno et al, 1998;Van der Linden et al, 2010;Venn et al, 2002;Weinberg et al, 2017;Weinberg et al, 2019;Wu et al, 2017;Yin et al, 2018;Zakhaleva et al, 2013;Zeng et al, 2014;Zhang et al, 2013) (50%) and the majority (77%) were conducted in a single centre setting (Bartha et al, 2013;Bender et al, 1997;Benes et al, 2010;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Boyd et al, 1993;Cecconi et al, 2011;…”

Section: Resultsmentioning

confidence: 99%

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

et al. 2020

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Background Perioperative goal-directed haemodynamic therapy (GDHT), defined as the administration of fluids with or without inotropes or vasoactive agents against explicit measured goals to augment blood flow, has been evaluated in many randomised controlled trials (RCTs) over the past four decades. Reported post-operative pulmonary complications commonly include chest infection or pneumonia, atelectasis, acute respiratory distress syndrome or acute lung injury, aspiration pneumonitis, pulmonary embolism, and pulmonary oedema. Despite the substantial clinical literature in this area, it remains unclear whether their incidence is reduced by GDHT. This systematic review aims to determine the effect of GDHT on the respiratory outcomes listed above, in surgical patients. Methods We searched the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, and clinical trial registries up until January 2020. We included all RCTs reporting pulmonary outcomes. The primary outcome was post-operative pulmonary complications and secondary outcomes were specific pulmonary complications and intra-operative fluid input. Data synthesis was performed on Review Manager and heterogeneity was assessed using I2 statistics. Results We identified 66 studies with 9548 participants reporting pulmonary complications. GDHT resulted in a significant reduction in total pulmonary complications (OR 0.74, 95% CI 0.59 to 0.92). The incidence of pulmonary infections, reported in 45 studies with 6969 participants, was significantly lower in the GDHT group (OR 0.72, CI 0.60 to 0.86). Pulmonary oedema was recorded in 23 studies with 3205 participants and was less common in the GDHT group (OR 0.47, CI 0.30 to 0.73). There were no differences in the incidences of pulmonary embolism or acute respiratory distress syndrome. Sub-group analyses demonstrated: (i) benefit from GDHT in general/abdominal/mixed and cardiothoracic surgery but not in orthopaedic or vascular surgery; and (ii) benefit from fluids with inotropes and/or vasopressors in combination but not from fluids alone. Overall, the GDHT group received more colloid (+280 ml) and less crystalloid (−375 ml) solutions than the control group. Due to clinical and statistical heterogeneity, we downgraded this evidence to moderate. Conclusions This systematic review and meta-analysis suggests that the use of GDHT using fluids with inotropes and/or vasopressors, but not fluids alone, reduces the development of post-operative pulmonary infections and pulmonary oedema in general, abdominal and cardiothoracic surgical patients. This evidence was graded as moderate. PROSPERO registry reference: CRD42020170361

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Continuous central venous oxygen saturation assisted intraoperative hemodynamic management during major abdominal surgery: a randomized, controlled trial

Cited by 25 publications

References 44 publications

Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

Monitoring of Tissue Oxygenation: an Everyday Clinical Challenge

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

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