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

We have compared in vivo oxygen saturation recordings obtained from the Oximetrix 3 with in vitro measurements using the Instrumentation Laboratories 282 Co-Oximeter. The small mean difference (0.85%) and close limits of agreement (—4% to 6%) are close enough for clinical purposes, provided in vivo calibration is performed after insertion of the fibreoptic catheter and repeated at least every 12 h. Continuous monitoring of jugular bulb oxygen saturation during intensive care of brain injured patients is now possible using fibreoptic technology. This technique may be of value in detecting global ischaemia, and as a predictor and monitor of cerebral perfusion pressure therapy.

Jugular bulb cannulation: description of a cannulation technique and validation of a new continuous monitor.

Shock is defined as global tissue hypoxia secondary to an imbalance between systemic oxygen delivery and oxygen demand. Venous oxygen saturations represent this relationship between oxygen delivery and oxygen demand and can therefore be used as an additional parameter to detect an impaired cardiorespiratory reserve. Before appropriate use of venous oxygen saturations, however, one should be aware of the physiology. Although venous oxygen saturation has been the subject of research for many years, increasing interest arose especially in the past decade for its use as a therapeutic goal in critically ill patients and during the perioperative period. Also, there has been debate on differnces between mixed and central venous oxygen saturation and their interchangeability. Both mixed and central venous oxygen saturation are clinically useful but both variables should be used with insightful knowledge and caution. In general, low values warn the clinician about cardiocirculatory or metabolic impairment and should urge further diagnostics and appropriate action, whereas normal or high values do not rule out persistent tissue hypoxia. The use of venous oxygen saturations seems especially useful in the early phase of disease or injury. Whether venous oxygen saturations should be measured continuously remains unclear. Especially, continuous measurement of central venous oxygen saturation as part of the treatment protocol has been shown a valuable strategy in the emergency department and in cardiac surgery. In clinical practice, venous oxygen saturations should always be used in combination with vital signs and other relevant endpoints.

/pdf/clinical-review-use-of-venous-oxygen-saturations-as-a-goal-a-xsdgfcqb0w.pdf

Clinical review: use of venous oxygen saturations as a goal - a yet unfinished puzzle

Mixed Venous Oxygen Saturation in Critically Ill Septic Shock Patients* The Role of Defined Events

ObjectivesTo determine if oxyhemoglobin saturation in blood samples taken from the superior vena cava or right atrium can be substituted for oxyhemoglobin saturation in blood taken from the proximal pulmonary artery (SvO2) in patients in shock.DesignProspective clinical investigation.SettingMixed su

Importance of the sampling site for measurement of mixed venous oxygen saturation in shock.

A prospective study was performed to evaluate the efficacy of continuous venous oximetry to supplement traditional hemodynamic monitoring in 39 critically ill surgical patients. There was no statistically significant difference in SvO2 between the continuous in vivo values and in vitro values (0.694 +/- 0.095 vs. 0.698 +/- 0.108). There was no statistically significant correlation between continuously measured SvO2 and PaO2 (r = 0.09, p greater than 0.5), SaO2 (r = 0.08, p greater than 0.5), or oxygen consumption (r = 0.46, p greater than 0.5). There was a slight but statistically significant correlation between continuously measured SvO2 and cardiac output (r = 0.40, p less than 0.025) and oxygen delivery (r = 0.49, p less than 0.005). There was a highly significant correlation between continuously measured SvO2 and oxygen utilization coefficient (r = -0.96, p less than 0.001). Continuously measured SvO2 is a reliable predictor of SvO2 measured intermittently by in vitro methods. In critically ill surgical patients, SvO2 does not correlate highly with the individual determinants of oxygen transport but rather correlates with the oxygen utilization coefficient and therefore reflects the overall balance between oxygen consumption and delivery.

Continuous venous oximetry in surgical patients.

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Continuous venous oximetry in surgical patients.