High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients

Dimitrios Velissaris,Jean Louis Vincent,Daniel De Backer,Sabino Scolletta,Charalampos Pierrakos

doi:10.1186/10326

Dimitrios Velissaris, Jean Louis Vincent + Show 3 more

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Journal: Critical Care	Publication Date: Jan 1, 2011
Citations: 47	License type: CC BY 2.0

Affiliation: Université Libre de Bruxelles

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IntroductionThe aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. We also sought to define whether fluid responsiveness would be less likely in the presence of a high SvO2 (>70%).MethodsThis observational study was conducted in a 32-bed university hospital medicosurgical ICU. The hemodynamic response to a fluid challenge was evaluated in 65 critically ill patients with severe sepsis. Patients were divided into two groups (responders and nonresponders) according to their cardiac index (CI) response to the challenge (>10% or <10%).ResultsOf the 65 patients, 34 (52%) were fluid responders. Baseline SvO2, CI, heart rate (HR) and mean arterial pressure (MAP) were not statistically different between groups. The responders had lower pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) at baseline than the nonresponders. After the fluid challenge, there were no differences between the two groups in MAP, CVP, PAOP or HR. There was no correlation between changes in CI or stroke volume index and baseline SvO2. Receiver operating characteristic analysis showed that SvO2 was not a predictor of fluid responsiveness.ConclusionsThe response of septic patients to a fluid challenge is independent of baseline SvO2. The presence of a high SvO2 does not necessarily exclude the need for further fluid administration.

Highlights

The aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels
Further fluids may be administered in the presence of a normal or high SvO2 level to further increase the cardiac index (CI), but whether a fluid challenge is still worth trying when SvO2 or central venous oxygen saturation (ScvO2) has reached 70% has not been well defined
The results of our study suggest that SvO2 and, in particular, high SvO2 levels cannot serve as predictors of fluid responsiveness in critically ill septic patients, as 52% of septic patients with SvO2 >70% responded to fluids by increasing their CI values >10%

Summary

Introduction

The aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. Patients with severe sepsis and septic shock typically have decreased vascular tone, with a high cardiac index (CI), low systemic vascular resistance and elevated mixed venous oxygen saturation (SvO2). The wellknown study by Rivers et al [4] indicated that targeting a mixed central venous oxygen saturation (ScvO2) level greater than 70% during early resuscitation of patients with severe sepsis may improve outcomes. A normal or high SvO2 level suggests an adequate CI for tissue energy demands, but may not always indicate adequate fluid resuscitation. Further fluids may be administered in the presence of a normal or high SvO2 level to further increase the CI, but whether a fluid challenge is still worth trying when SvO2 or ScvO2 has reached 70% has not been well defined

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