Correlation between central venous and mixed venous oxygen saturation in the elective abdominal aortic aneurysm surgery

Ljiljana Šoškić; Mladen Kočica; Dragan Cvetković; Biljana Miličić; Nebojsa Ladjevic; Ivan Palibrk; Milica Karadžić; Miloš  Grujić; Milica Vještica-Mrdak; Arsen Ristić

doi:10.2298/VSP180621131S

Ljiljana Šoškić UC Clinical Centre of Serbia - Clinic for Cardiac Surgery, Department of Anesthesia and Intensive Care, Belgrade
Mladen Kočica Clinical Center of Serbia, Clinic for Cardiac Surgery, Department of Anesthesia and Intensive Care
Dragan Cvetković Clinical Center of Serbia, Clinic for Cardiac Surgery, Department of Anesthesia and Intensive Care
Biljana Miličić University of Belgrade, Faculty of Dentistry, Department of Medical Statistics and Informatics
Nebojsa Ladjevic Clinical Center of Serbia, Clinic for Urology, ‡Department of Anesthesia and Intensive Care, Clinic for Abdominal Surgery
Ivan Palibrk UC Clinical Centre of Serbia - Clinic for Abdominal Surgery, Department of Anesthesia and Intensive Care, Belgrade
Milica Karadžić UC Clinical Centre of Serbia - Clinic for Cardiac Surgery, Department of Anesthesia and Intensive Care, Belgrade
Miloš Grujić UC Clinical Centre of Serbia - Clinic for Cardiac Surgery,Belgrade
Milica Vještica-Mrdak UC Clinical Centre of Serbia - Clinic for Vascular Surgery, Department of Anesthesia and Intensive Care, Belgrade
Arsen Ristić UC Clinical Centre of Serbia - Clinic for Cardiology, Belgrade

DOI: https://doi.org/10.2298/VSP180621131S

Keywords: aorta, abdominal;, aortic aneurysm;, monitoring, physiologic;, oxygen;, oximetry

Abstract

Background/Aim. The concept of utilizing central venous oxygen saturation (ScvO₂) to calculate cardiac index (CI) remains controversial and neither precise nor generally applicable conclusion has been reached yet. We evaluated the relationship between ScvO₂ and mixed venous oxygen saturation (SvO₂) in elective surgery of the abdominal aorta. The adequacy of their interchangeability was tested by comparing cardiac indices (CI) calculated by two methods in patients that underwent major vascular surgery. The aim of this study was to test the correlation between ScvO₂ and SvO₂ in different time frames, in patients undergoing elective abdominal aortic aneurysm (AAA) surgery as well as to determine if the use of ScvO₂ for calculating CI by the modified Fick equation, could be feasible and accurate surrogate for the values obtained by pulmonary artery catheter (PAC). Methods. This prospective observational study included 125 consecutive patients that underwent elective AAA surgery. The ScvO₂and SvO₂ data, as well as CI values, were obtained and compared from samples taken in three different time frames: immediately after induction of general anesthesia (T₀), immediately after admission in the intensive care unit (ICU; T₁), and 8 h after admission in the ICU (T₂). The Fick equation, used for CI estimation from ScvO₂ (CI-F), for the purpose of this study, was simplified according to Walley. Results. There was good linear correlation between ScvO₂ and SvO₂ in all time frames and linear regression study revealed strongest coefficient of determination (R²= 0.661) in T₂ time-frame. There was no correlation between CI-F (i.e. CI calculated from ScvO₂by modified Fick equation) and CI (measured by PAC from SvO₂) in any time-frame. Conclusion. The results of our study confirm that ScvO₂ is a reliable substitute for SvO₂ among patients undergoing elective surgery of the AAA. However, ScvO₂ cannot be used as a surrogate to true SvO₂ in the calculation of CI.

References

Tánczos K, Molnár Z. The oxygen supply-demand balance: a monitoring challenge. Best Pract Res Clin Anaesthesiol 2013; 27(2): 201–7.

Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary ar-tery catheters in high-risk surgical patients. N Engl J Med 2003; 348(1): 5–14.

Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D, et al. The effectiveness of right heart catheteriza-tion in the initial care of critically ill patients. JAMA 1996; 276(11): 889–97.

Ivanov R, Allen J, Calvin JE. The incidence of major morbidity in critically ill patients managed with pulmonary artery cathe-ters: a meta analysis. Crit Care Med 2000; 28(3): 615–9.

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, et al. Pulmonary artery catheters for adult pa-tients in intensive care. Cochrane Database Syst Rev 2013; (2): CD003408.

Reich DL, Mittnacht AJ, London MJ, Kaplan JA. Monitoring of the Heart and Vascular System. In: Kaplan JA, Reich DL, Savino JA, editors. Kaplan’s Cardiac Anesthesia: The Echo Era. 6th ed. St Louis (MO): Elsevier Saunders; 2011. p. 416–51.

Davison JK. Anesthesia for major vascular procedures in the el-derly. Clin Anesth 1986; 4: 931.

Nowood SH, Nelson LD. Continuous monitoring of mixed ve-nous oxygen saturation during aortofemoral bypass grafting. Am Surg 1986; 52(2): 114–5.

Edwards JD, Mayall RM. Importance of the sampling site for measurement of mixed oxygen saturation in shock. Crit Care Med 1998; 26(8): 1356–60.

Walley KR. Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med 2011; 184(5): 514–20.

Scheinman MM, Brown MA, Rapaport E. Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients. Circulation 1969; 40(2): 165–72.

Forsyth RP, Hoffbrand BI, Melmon KL. Redistribution of cardiac output during hemorrhage in the unanesthetized monkey. Circ Res 1970; 27(3): 311–20.

Glamann DB, Lange RA, Hillis LD. Incidence and significance of a „step-down“ in oxygen saturation from superior vena cava to pulmonary artery. Am J Cardiol 1991; 68(6): 695–97.

Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, et al. Cardiac filling pressures are not appropriate to predict hemo-dynamic response to volume challenge. Crit Care Med 2007; 35(1): 64–8.

Gašparović H, Gabelica R, Ostojić Z. Kopjar T, Petricevic M, Ivancan V, et al. Diagnostic accuracy of central venous saturation in estimating mixed venous saturation is proportional to cardiac performance among cardiac surgical patients. J Crit Care 2014; 29(5): 828–34.

Faber T. Central venous versus mixed venous oxygen content. Acta Anaesthesiol Scand Suppl 1995; 107: 33–6.

Tahvanainen J, Meretoja O, Nikki P. Can central venous blood replace mixed venous blood samples? Crit Care Med 1982; 10(11): 758–61.

Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds M, Bennett D. Changes in central venous saturation after major surgery, and association with outcome. Crit Care 2005; 9(6): R694–9.

Hu BY, Laine GA, Wang S, Solis RT. Combined central ve-nous oxygen saturation and lactate as markers of occult hy-poperfusion and outcome following cardiac surgery. J Cardio-thorac Vasc Anesth 2012; 26(1): 52–7.

Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed-venous oxygen satu-ration during changes in oxygen supply/demand. Chest 1989; 95(6): 1216–21.

Martin C, Auffray JP, Badetti C, Perrin G, Papazian L, Gouin F. Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients. Intensive Care Med 1992; 18(2): 101–4.

Goto SH, Mazza BF, Freitas FGR, Machado FR. Influence of perfusion status on central and mixed venous oxygen satura-tion in septic patients. Rev Bras Anestesiol 2017; 67(6): 607–14. (Portuguese)

Reinhart K, Kuhn HJ, Hartog C, Bredle DL. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 2004; 30(8): 1572–8.

Goldman RH, Klughaupt M, Metcalf T, Spivack AP, Harrison DC. Measurement of central venous oxygen saturation in patients with myocardial infarction. Circulation 1968; 38(5): 941–6.

Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care 2004; 8(2): R60–5.

Bendjelid K. Cardiac output-ScvO2 relationship during sepsis: A subtle association. J Crit Care 2017; 38: 351–2.

Madsen P, Iversen H, Secher NH. Central venous oxygen satura-tion during hypovolemic shock in humans. Scand J Cin Lab Invest 1993; 53(1): 67–72.

Scalea TM, Holman M, Fuortes M, Baron BJ, Philips TF, Goldstein AS, et al. Central venous blood oxygen saturation: an early, accurate measurement of volume during hemorrhage. J Trau-ma 1988; 28(6): 725–32.

van Beest PA, van Ingen J, Boerma EC, Holman ND, Groen H, Koopmans M, et al. No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin. Crit Care 2010; 14(6): R219.

Pope JV, Jones AE, Gaieski DF, Arnold RC, Trzeciak S, Shapiro NI. Multicenter study of central venous oxygen saturation ScvO2 as a predictor of mortality in patients with sepsis. Ann Emerg Med 2010; 55(1): 40–6.e1.

Lee J, Wright F, Barber R, Stanley L. Central venous oxygen saturation in shock: a study in man. Anesthesiology 1972; 36(5): 472–8.

Rivers E. Mixed versus central venous oxygen saturation may be not numerically equal, but both are still clinically useful. Chest 2006; 129(3): 507–8.

Hutter AM, Jr, Moss AJ. Central venous oxygen saturation. Value of serial determinations in patients with acute myocar-dial infarction. JAMA 1970; 212(2): 299–303.

Muir AL, Kirby BJ, King AJ, Miller HC. Mixed venous oxygen saturation in relation to cardiac output in myocardial infarc-tion. Br Med J 1970; 4(5730): 276–8.

Creamer JE, Edwards JD, Nightingale P. Hemodynamic and oxy-gen transport variables in cardiogenic shock secondary to acute myocardial infarction, and response to treatment. Am J Cardiol 1990; 65(20): 1297–300.

Powelson JA, Maini BS, Bishop RL, Sottile FD. Continuous mon-itoring of mixed venous oxygen saturation during aortic oper-ations. Crit Care Med 1992; 20(3): 332–6.

Kopterides P, Bonovas S, Mavrou I, Kostadima E, Zakynthinos E, Armaganidis A.Venous oxygen saturation and lactate gradient from superior vena cava to pulmonary artery in patients with septic shock. Shock 2009; 31(6): 561–7.