Abstract
The aim of this article is to study the overview of pathophysiology and clinical application of central venous oxygen saturation monitoring in critically ill patients and during the perioperative period. There are several clinical studies and animal experiments evaluating the effects of goal-directed hemodynamic stabilization on critically ill patients. Recent systematic reviews and meta-analyses found that advanced hemodynamic endpoints-targeted management has a positive effect on outcome in high-risk surgical patients. As all interventions aim to improve tissue oxygenation, it is of utmost importance to monitor the balance between oxygen delivery and consumption. For this purpose, central venous blood gas analysis provides an easily available tool in the everyday clinical practice. The adequate interpretation of central venous oxygen saturation renders the need of careful evaluation of several physiological and pathophysiological circumstances. When appropriately evaluated, central venous oxygen saturation can be a valuable component of a multimodal individualized approach, in which components of oxygen delivery are put in the context of the patients' individual oxygen consumption. In addition to guide therapy, central venous oxygen saturation may also serve as an early warning sign of inadequate oxygen delivery, which would otherwise remain hidden from the attending physician. With the incorporation of central venous oxygen saturation in the everyday clinical routine, treatment could be better tailored for the patients' actual needs; hence, it may also improve outcome.
Highlights
Interventions to improve oxygen delivery and decrease oxygen consumption are the cornerstone of resuscitation in the critically ill patients and during the perioperative period of high-risk patients
The multimodal concept in hemodynamic monitoring enables us to appreciate that each patient is different, the so-called normal values, which are more or less appropriate for a given population may be inadequate for the given patient
In our recent animal experiment on isovolemic anemia, we have found that anemia-induced change in VO2/DO2 showed significant correlation with changes of ScvO2 [33]; ScvO2 may be used as a “physiologic transfusion trigger” in otherwise hemodynamically stable patients
Summary
Interventions to improve oxygen delivery and decrease oxygen consumption are the cornerstone of resuscitation in the critically ill patients and during the perioperative period of high-risk patients. The use of appropriate indices, which are able to detect the imbalance between oxygen delivery (DO2) and consumption (VO2), is mandatory for adequate management [2]. Conventional parameters such as heart rate, mean arterial blood pressure, mental status, and urine output are robust warning signs of inadequate tissue perfusion, but for fine tuning of therapy detailed hemodynamic monitoring is warranted [3]. To monitor changes in tissue oxygenation, central or mixed venous blood gas measurements can give more detailed information, which should be incorporated into a multimodal approach that can lead to a better, individualized, patient-centered care. The goal of this review is to highlight the importance of central venous oxygen saturation in this multimodal, individualized hemodynamic management in the context of the pathophysiological background and the results of recent clinical and experimental studies
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