No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin

Abstract

IntroductionControversy remains regarding the relationship between central venous saturation (ScvO2) and mixed venous saturation (SvO2) and their use and interchangeability in patients with sepsis or septic shock. We tested the hypothesis that ScvO2 does not reliably predict SvO2 in sepsis. Additionally we looked at the influence of the source (splanchnic or non-splanchnic) of sepsis on this relationship.MethodsIn this prospective observational two-center study we concurrently determined ScvO2 and SvO2 in a group of 53 patients with severe sepsis during the first 24 hours after admission to the intensive care units in 2 Dutch hospitals. We assessed correlation and agreement of ScvO2 and SvO2, including the difference, i.e. the gradient, between ScvO2 and SvO2 (ScvO2 - SvO2). Additionally, we compared the mean differences between ScvO2 and SvO2 of both splanchnic and non-splanchnic group.ResultsA total of 265 paired blood samples were obtained. ScvO2 overestimated SvO2 by less than 5% with wide limits of agreement. For changes in ScvO2 and SvO2 results were similar. The distribution of the (ScvO2 - SvO2) (< 0 or ≥ 0) was similar in survivors and nonsurvivors. The mean (ScvO2 - SvO2) in the splanchnic group was similar to the mean (ScvO2 - SvO2) in the non-splanchnic group (0.8 ± 3.9% vs. 2.5 ± 6.2%; P = 0.30). O2ER (P = 0.23) and its predictive value for outcome (P = 0.20) were similar in both groups.ConclusionsScvO2 does not reliably predict SvO2 in patients with severe sepsis. The trend of ScvO2 is not superior to the absolute value in this context. A positive difference (ScvO2 - SvO2) is not associated with improved outcome.

Diagnostic accuracy of central venous saturation in estimating mixed venous saturation is proportional to cardiac performance among cardiac surgical patients

“…The wide limits of agreement across all comparisons between ScvO 2 and SvO 2 observed in our study parallel those seen in other publications [18,20,21] and reinforce the notion of a modest mutual association.…”

“…Our data is in line with similar observations in diverse clinical settings [8,17,18,19]. We also specifically investigated the impact of the underlying hemodynamic status on the interchangeability of ScvO 2 and SvO 2 by dichotomizing patients based on a cardiac index cut-off point of 2.0 L/min/m 2 .…”

Agreement between Central and Mixed Venous Oxygen Saturation Following Cardiac Surgery

“…[20], this included critically ill ICU patients [21], and during liver transplantation [22]. On the other hand, other studies presented an unacceptable agreement between both measurements [4,5,23,24].…”

“…There has been considerable debate regarding whether ScvO 2 is a satisfactory substitute for SvO 2 . The previous studies evaluating the relationship between ScvO 2 and SvO 2 showed a significant variation in results because of different study designs and clinical setup which included intensive care patients with either sepsis, heart failure, or shock [4][5][6][7]. Studies involving such relationship during and after cardiac surgery [8][9][10][11][12][13][14][15] also showed contradicting results, this controversy is generating confusion among clinicians and further work is needed to explore this area.…”

Multimodal individualized concept of hemodynamic monitoring

“…However, recent clinical trials, involving mainly septic patients, were unable to show satisfactory agreement between ScvO 2 and SvO 2 . This could in part be explained by modifications of blood flow distribution and oxygen extraction by brain and splanchnic tissues [31].…”