High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality

Abstract

IntroductionCurrent guidelines recommend maintaining central venous oxygen saturation (ScvO2) higher than 70% in patients with severe sepsis and septic shock. As high levels of ScvO2 may reflect an inadequate use of oxygen, our aim was to evaluate the relation between maximal ScvO2 levels (ScvO2max) and survival among intensive care unit (ICU) patients with septic shock.MethodsWe retrospectively analyzed data from all admissions to our ICU between January 2008 and December 2009. All septic shock patients in whom the ScvO2 was measured were included. The measures of ScvO2max within the first 72 hours after the onset of shock were collected.ResultsA total of 1,976 patients were screened and 152 (7.7%) patients met the inclusion criteria. The level of ScvO2max was 85% (78 to 89) in the non-survivors, compared with 79% (72 to 87) in the survivors (P = 0.009).ConclusionsOur findings raise concerns about high levels of ScvO2 in patients with septic shock. This may reflect the severity of the shock with an impaired oxygen use. Future strategies may target an optimization of tissue perfusion in this specific subgroup of patients.

Central Venous Oxygen Saturation Under Non-Protocolized Resuscitation Is Not Related to Survival in Severe Sepsis or Septic Shock

“…Septic patients with venous hyperoxia (ScvO 2 990%) in the early stage of severe sepsis (within 6 h) were found to have higher mortality (9). In addition, Textoris and colleagues (10) demonstrated that nonsurvivors, compared with survivors, had higher ScvO 2 in later stages of septic shock (within 72 h). Therefore, results of studies investigating significance of ScvO 2 in survival of sepsis were inconsistent, reflecting complex physiology in ScvO 2 interpretation.…”

“…However, high ScvO 2 may reflect balances of systemic oxygen delivery or consumption, but also may be caused by impaired cellular oxygen consumption (6), arteriovenous shunt, or microcirculatory dysfunction (7). Although previous studies showed prolonged low mixed venous oxygen saturation associated with poor survival (8), two recent studies found that increased ScvO 2 was associated with higher mortality in severe sepsis or septic shock (9,10). Septic patients with venous hyperoxia (ScvO 2 990%) in the early stage of severe sepsis (within 6 h) were found to have higher mortality (9).…”

How I use skeletal muscle Near Infrared Spectroscopy to non-invasively assess hemodynamic status of the critically ill

“…Monitoring ScvO2 is a simpler and cheaper assessment of global DO2 to oxygen consumption ratio, but its use as a treatment goal in patients with severe heart failure with additional sepsis/septic shock is questionable. Higher level of ScvO2 in patients in the latter stages of septic shock was found in the non-survivors (55). These findings raise concerns about high levels of ScvO2 in patients with septic shock.…”

Initial Low Oxygen Extraction Ratio Is Related to Severe Organ Dysfunction and High In-Hospital Mortality in Severe Sepsis and Septic Shock Patients

“…The third limitation is that the low OER for prediction of severe organ failure and mortality was limited to the early period of EGDT, because we calculated OER by using initial SaO 2 and ScvO 2 that was measured within 1 h after ED presentation. Textoris et al reported that high ScvO 2 in the latter stages of septic shock is associated with increased mortality (16). The value of OER for prediction of outcomes may be different according to the stage of sepsis or the measuring point during sepsis treatment.…”