Abstract
Hemodynamic monitoring has become a real challenge in the intensive care unit. As an integrative parameter for oxygen supply/demand, venous oxygen saturation (SvO2) provided by pulmonary artery catheterization is one of the most popular parameters to assess the adequacy of cardiac output. However, technical limitations and potential iatrogenic complications constitute important limits for a widespread use. Regular central venous catheters coupled with a fiberoptic lumen for central venous oxygen saturation (ScvO2) monitoring have been proposed as a surrogate for SvO2 monitoring. The purpose of the present article is to review the physiological backgrounds of circulation, the pathophysiology of circulatory failure and subsequent venous oxygen saturation alterations, and finally the merits and the limits of the use of ScvO2 in different clinical situations.
Highlights
Hemodynamic monitoring has become a common practice in the intensive care unit
Venous blood saturation of oxygen (SvO2), which takes into account venous coronary blood, is usually lower than the ScvO2
Any major increase in myocardial oxygen consumption could lead to a critical myocardial oxygen extraction that would have no impact on ScvO2 monitoring
Summary
Most industrial efforts have concentrated on providing devices for cardiac output monitoring. As cardiac output is an adaptive parameter, it is always difficult to judge whether a given value at a given time for a given patient is appropriate or not. Considering that O2 supply to the tissue is the basic objective, intensivists have been trying to find out an integrative parameter that would be more suitable to globally assess hemodynamic status of their patients. As a surrogate for evaluating O2 demand/supply adequacy, central oxygen venous saturation (ScvO2) has become a popular parameter. As explained for the dummies, oxygen venous saturation is interpreted as a bank statement at the end of the month: “if the balance is negative, you can consider two explanations: you spend too much money or you earn not enough.”. As explained for the dummies, oxygen venous saturation is interpreted as a bank statement at the end of the month: “if the balance is negative, you can consider two explanations: you spend too much money or you earn not enough.” The aim of the present paper is precisely to critically analyze the physiological basements for such an interpretation, the data that support its use in clinical practice, and the limits that should be kept in mind while using such a parameter at the bedside
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