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2023, Number 8

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Med Crit 2023; 37 (8)

A 50-year legacy: central venous saturation of oxygen its usefulness in addressing septic shock

Flores RÁ, López FJ, Cortés RJS, Huanca PJM

Language: Spanish
References: 36
Page: 630-637
PDF size: 293.26 Kb.


ABSTRACT

Introduction: septic shock is a frequent entity in critical areas, during the approach we will face decision making, which in a large percentage of cases we will be condemned and make mistakes, clinical determination can be the first step, tissue perfusion markers global, such as SvcO2 described in the 70s, will provide us with early recognition of a state of inadequate perfusion, interventions must be objective to improve the course, prognosis and outcome in the intensive care unit. Objective: to analyze the association between central venous oxygen saturation (SvcO2) as a risk factor for mortality outcomes in a sample of 120 patients diagnosed with septic shock in the intensive care unit. Material and methods: type of analytical, cross-sectional, observational and retrospective study. Results: shock was classified as normodynamic (SvcO2 < 80%) (n = 9) and hyperdynamic (SvcO2 ≥ 80%) (n = 111). Perfusion indices were evaluated by a multivariate analysis (lactate (p = 0.13) 5.6 ± 1.1, delta CO2 (p = 0.92) 9.2 ± 3.8, mitochondrial index (p ≤ 0.001) 1.99 ± 0.40; overall mortality 59.2% (n = 71) of the patients with normodynamic septic shock, 40% had an outcome due to death, while, in the septic shock group of hyperdynamic patients, it was 59% (p = 0.046). Central venous oxygen; for every 1 above 80% the risk associated with death increases 16 times more compared to less than 80%. Conclusions: the alteration of microcirculatory blood flow and the presence of anaerobiosis are common in patients with septic shock and are associated with an increase in mortality. The evaluation of central venous oxygen saturation and tissue perfusion indices could be a feasible route.


REFERENCES

  1. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369:1726-1734.

  2. Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795-1815.

  3. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi: 10.1001/jama.2016.0287.

  4. Bertullo M, Carbone N, Brandes M, et al. Epidemiología, diagnóstico y tratamiento de la sepsis severa en Uruguay: un estudio multicéntrico prospectivo. Rev Med Urug. 2016;32(3):178-189.

  5. Angus D, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840-851. Available in: http://dx.doi.org/10.1056/NEJMra1208623

  6. Spronk PE, Zandstra DF, Ince C. Bench-to-bedside review: sepsis is a disease of the microcirculation. Crit Care. 2004;8(6):462-468. Available in: http://dx.doi.org/10.1186/cc2894

  7. Ince C, Sinaasappel M. Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med. 1999;27(7):1369-1377.

  8. Klijn E, Den Uil CA, Bakker J, Ince C. The heterogeneity of the microcirculation in critical illness. Clin Chest Med. 2008;29(4):643-654. Available in: http://dx.doi.org/10.1016/j.ccm.2008.06.008

  9. Singer M. Cellular dysfunction in sepsis. Clin Chest Med. 2008;29(4):655-660. Available in: http://dx.doi.org/10.1016/j.ccm.2008.06.003

  10. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303:739-746. Available in: http://dx.doi.org/10.1001/jama.2010.158

  11. Ducrocq N, Kimmoun A, Levy B. Lactate or ScvO2 as an endpoint in resuscitation shock states. Minerva Anestesiol. 2013;79(9):1049-1058.

  12. Rivers E, Nguyen B, Havstad S, et al. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377. Available in: http://dx.doi.org/10.1056/NEJMoa010307

  13. Rivers EP, Katranji M, Jaehne KA, et al. Early interventions in severe sepsis and septic shock: a review of the evidence one decade later. Minerva Anestesiol. 2012;78(6):712-24.

  14. Dellinger RP, Carlet JM, Masur H, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Intens Care Med. 2004;30:536-555. Available in: http://dx.doi.org/10.1007/s00134-004-2210-z

  15. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guide-lines for management of severe sepsis and septic shock, 2012. Intens Care Med. 2013;39:165-228. Available in: http://dx.doi.org/10.1007/s00134-012-2769-8

  16. ProCESS, Investigators; Yealy DM, Kellum JA, et al. A randomized trial of protocolbased care for early septic shock. N Engl J Med. 2014;370(18):1683-1693. Available in: http://dx.doi.org/10.1056/NEJMoa1401602

  17. ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496-1506. Available in: http://dx.doi.org/10.1056/NEJMoa1404380

  18. Mouncey PR, Osborn TM, Power GS, et al; ProMISe Trial Investigators. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301-1311. Available in: http://dx.doi.org/10.1056/NEJMoa1500896

  19. Gattinoni L, Pesenti A, Matthay M. Understanding blood gas analysis. Intensive Care Med. 2018;44(1):91-93. doi: 10.1007/s00134-017-4824-y.

  20. Velissaris D, Pierrakos C, Scolletta S, Backer D, Vincent JL. High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients. Crit Care. 2011;15:R177.

  21. Moller MH, Cecconi M. Venous-to-arterial carbon dioxide difference: an experimental model or a bedside clinical tool? Intensive Care Med. 2016;42:287-289.

  22. Reinhart K, Kuhn HJ, Hartog C, Bredle DL. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med. 2004;30:1572-1578.

  23. Evans DC, Doraiswamy VA, Prosciak MP, et al. Complications associated with pulmonary artery catheters: a comprehensive clinical review. Scand J Surg. 2009;98:199-208.

  24. Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed venous oxygen saturation during changes in oxygen supply/demand. Chest. 1989;95:1216-1221.

  25. Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol. 2003;14:527-534.

  26. Sánchez DJ, Monares ZE, Rivera SG, Clasificación clínica de la perfusión tisular en pacientes con choque séptico basada en la saturación venosa central de oxígeno (SvcO2) y la diferencia venoarterial de dióxido de carbono entre el contenido arteriovenoso de oxígeno (ΔP(v-a)CO2/C(a-v)O2). Med Crit. 2016;30(5):283-289.

  27. Reinhart K, Kuhn HJ, Hartog C, et al. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med. 2004;30:1572-1578.

  28. Ronco JJ, Fenwick JC, Tweeddale MG, et al. Identification of critical oxygen delivery for anaerobic metabolism in critically ill septic and non septic humans. JAMA. 1993;270:1724-1730.

  29. Carrillo-Esper R, Núñez-Bacarreza JJ, Carrillo-Córdova JR Saturación venosa central. Conceptos actuales. Rev Mex Anest. 2007;30(3):165-171.

  30. Kremzar B, Spec-Marn A, Kompan L, Cerovi? O. Normal values of SvO2 as therapeutic goal in patients with multiple injuries. Intensive Care Med. 1997;23(1):65-70.

  31. Gattinoni L, Pesenti A, Matthay M. Understanding blood gas analysis. Intensive Care Med. 2018;44(1):91-93.

  32. Textoris J, Fouché L, Wiramus S, et al. High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality. Crit Care. 2011;15(4):R176.

  33. Kanoore Edul VS, Ince C, Dubin A. What is microcirculatory shock? Curr Opin Crit Care. 2015;21(3):245-252. doi: 10.1097/MCC.0000000000000196. PMID: 25827583.

  34. Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37:1670-1677.

  35. Lamia B, Monet X, Teboul JL. Meaning of arterio-venous pCO2 difference in circulatory shock. Minerva Anestesiol. 2006;72:597-604.

  36. Mesquida J, Saludes P, Gruartmoner G, et al. Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock. Crit Care. 2015;19:126.




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