medigraphic.com
ISSN 2448-8909 (Print)

2015, Number 3

<< Back Next >>

Med Crit 2015; 29 (3)

Central venous O2 saturation difference as pronostic marker of diastolic dysfunction and weaning failure

Martínez MM, Cendejas GM, Brito ZOR

Language: Spanish
References: 32
Page: 145-151
PDF size: 209.58 Kb.


ABSTRACT

Mechanical ventilation is associated with complications and should be discontinued as soon as possible. Some patients fail to weaning despite having extubation criteria, other predictors must be studied, such as central venous oxygen saturation (SvcO2).
Objective: To determine the delta SvcO2 (D-ScvO2) as a predictor of diastolic dysfunction and failure of ventilator weaning.
Material and methods: Clinical research, design: Test predicts. Conducted from March to August 2013 in ICU patients with mechanical ventilation for more than 48 hours and criteria for spontaneous breath test. Central gas analysis was performed at baseline and two hours later for measuring venous D-SvcO2. In patients with unsuccessful weaning B-type natriuretic peptide (BNP) was measured.
Results: In the group of patients with successful weaning, the average was 2.73 ± 1.28% and in patients with unsuccessful weaning was 6.33 ± 1.37% (p = 0.001.) With a sensitivity to the D-SvcO2 96.3% and specificity of 100%.
Conclusions: We consider the D-SvcO2 during weaning of mechanical ventilation as a new and independent prognostic marker for the success or failure of extubation.


REFERENCES

  1. Epstein S, Tobin M. Principles and practice of mechanical ventilation. 2nd ed. New York: McGraw Hill; 2006, pp. 877-802.

  2. Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. J Am Med Assoc. 2002;287:345-355.

  3. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033-1056.

  4. Chelluri L, Im KA, Belle SH, et al. Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med. 2004;32:61-69.

  5. Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ. Modes of mecánica ventilation and weaning: a national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest. 1994;106(4):1188-1193.

  6. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335(25):1864-1869.

  7. Esteban A, Alia I, Tobin MJ, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med. 1999;159:512-518.

  8. Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. Clinical characteristics, respiratory function parameters, and outcome of two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998;158:1855-1862.

  9. Meade MO, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest. 2001;120:400S-424S.

  10. Conti G, Montini L, Pennisi MA, et al. A prospective, blinded evaluation of indexes proposed to predict weaning from mechanical ventilation. Intensive Care Med. 2004;30:830-838.

  11. Jubran A, Tobin MJ. Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med. 1997;155:906-915.

  12. Epstein SK. Decision to extubate. Intensive Care Med. 2002;28(5):535-546.

  13. Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992;116:540-543.

  14. Ishaaya AM, Nathan SD, Belman MJ. Work of breathing after extubation. Chest. 1995;107:204-209.

  15. Tobin MJ. 1999 Donald F. Egan Scientific Lecture: weaning from mechanical ventilation; what have we learned? Respir Care. 2000;45:417-431.

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

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

  18. 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.

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

  20. Polonen P, Ruokonen E, Hippelainen M, Pöyhönen M, Takala J. A prospective randomized study of goal oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg. 2000;90:1052-1059.

  21. Kremzar B, Spec-Marn A, Kompan L, Cerovi’c O. Normal values of SvO2 as therapeutic goal in patients with multiple injuries. Intensive Care Med. 1997;23:65-60.

  22. Lamia B, Monnet X, Teboul JL. Weaning induced cardiac dysfunction. Yearbook of Intensive Care and Emergency Medicine: Springer, 2005, pp. 239-245.

  23. Reuse C, Vincent JL, Pinsky M. Measurements of right ventricular volumes during fluid challenge. Chest. 1990;98:1450-1454.

  24. Paulus S, Lehot JJ, Bastien O, Piriou V, George M, Estanove S. Enoximone and acute left ventricular failure during weaning from mechanical ventilation after cardiac surgery. Crit Care Med. 1994;22:74-70.

  25. Chatila W, Ani S, Cuaglianone D, Jacob B, Amoateng-Adjepong Y, Manthous CA. Cardiac ischemia during weaning from mechanical ventilation. Chest. 1996;109:577-583.

  26. Chien JY, Lin MS, Huang YC, Chien YF, Yu CJ, Yang PC. Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit Care Med. 2008;36:1421-1426.

  27. Koglin J, Pehlivanli S, Schwaiblmair M, Vogeser M, Cremer P, von Scheidt W. Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure. J Am Coll Cardiol. 2001;38:1934-1941.

  28. Jubran A, Mathru M, Dries D, Tobin MJ. Continuous monitoring of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med. 1998;158:1763-1769.

  29. Noll ML, Byers JF. Usefulness of measures of SVO2, SPO2, vital signs, and derived dual oximetry parameters as indicators of arterial blood gas variables during weaning of cardiac surgery patients from mechanical ventilation. Heart Lung. 1995;24:220-227.

  30. Teixeira C, da Silva NB, Savi A, et al. Central venous saturation is a predictor of reintubation in difficult to wean patients. Crit Care Med. 2010;38:491-496.

  31. Cason CL, De Salvo SK, Ray WT. Changes in oxygen saturation during weaning from short term ventilator support after coronary bypass graft surgery. Heart Lung. 1994;23:368-375.

  32. Dahlström U. Can natriuretic peptides be used for the diagnosis of diastolic heart failure? Euro J Heart Fail. 2004;6(3):281-287.




2020     |     www.medigraphic.com