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.
Highlights
Current guidelines recommend maintaining central venous oxygen saturation (ScvO2) higher than 70% in patients with severe sepsis and septic shock
The characteristics of patients were collected, including: demographics (age, sex, body mass index (BMI), admission simplified acute physiology score (SAPS) Simplified Acute Physiology Score II (II) [4], and sequential organ failure assessment (SOFA) score) [5]. Variables such as plasma lactate level, plasma creatinine level, daily urine output, ratio of arterial oxygen pressure related to inspired oxygen fraction (PaO2/inspired fraction in oxygen (FiO2)), hemoglobin, heart rate, mean arterial pressure, pulsatile saturation in oxygen (SpO2) and body temperature were recorded contemporary to the ScvO2max value
ICU, intensive care unit; arterial pressure of oxygen (PaO2)/FiO2 ratio, ratio of arterial oxygen pressure related to inspired oxygen fraction; SAPS, simplified acute physiologic score; pulsatile oxygen saturation (SpO2), pulse oxymetry; SvcO2, central venous oxygen saturation; SOFA, Sequential Organ Failure Assessment score
Summary
Current 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. Shock is characterized by either an inadequacy between tissue requirements in oxygen and oxygen delivery or the inadequate use of oxygen. The hemodynamic management of patients in shock aims at improving tissue oxygenation. Central venous blood saturation in oxygen (ScvO2) is a useful tool reflecting the global transport and metabolism of oxygen. International guidelines suggest the need to optimize ScvO2 in the early phase of management of severe sepsis and septic shock [1]. High levels of ScvO2 means either (i) a very high oxygen delivery in excess of tissue requirements and/or (ii) decreased cellular consumption
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