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Abstract Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p < 0.05). Results: We studied 28 patients, age 73 ± 7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p = 0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65 ± 10% vs. 74 ± 5%; p = 0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p = 0.043). Post-operative lactate and rSO2 variables were not associated with delirium. Conclusions: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.
Resumo Justificativa: O delírio pós-operatório é uma complicação séria em pacientes submetidos à cirurgia abdominal de grande porte. Ainda não está claro se as variáveis hemodinâmicas e de perfusão no período perioperatório afetam o risco de delírio pós-operatório. O objetivo deste estudo piloto foi avaliar a associação entre perfusão e hemodinâmica no perioperatório com o surgimento de delírio pós-operatório. Métodos: Estudo prospectivo de coorte de adultos com 60 anos ou mais, submetidos à cirurgia eletiva aberta do cólon. As variáveis multimodais de hemodinâmica e perfusão foram monitoradas, inclusive oxigenação venosa central (ScvO2), níveis de lactato e oxigenação cerebral não invasiva (rSO2), de acordo com um protocolo-padrão de anestesia. O teste exato de Fisher ou o teste t de Student foram usados para comparar os pacientes que desenvolveram delírio pós-operatório com aqueles que não desenvolveram p < 0,05. Resultados: Avaliamos 28 pacientes, 73 ± 7 anos, 60,7% do sexo feminino. Dois pacientes desenvolveram delírio pós-operatório (7,1%). Esses dois pacientes tinham menos anos de escolaridade do que aqueles sem delírio pós-operatório (p = 0,031). Nenhuma das variáveis de pressão arterial no perioperatório foi associada à incidência de delírio. Quanto aos parâmetros de perfusão, ScvO2 foi menor no grupo que apresentou delírio pós-operatório do que no grupo que não apresentou delírio, sem atingir significância estatística (65 ± 10% vs. 74 ± 5%; p = 0,08), mas o delta-ScvO2 (a diferença entre as médias no pós-operatório e intraoperatório) foi associado ao delírio (p = 0,043). As variáveis de lactato e rSO2 no pós-operatório não foram associadas ao delírio. Conclusões: Nosso estudo piloto sugere uma associação entre delta-ScvO2 e delírio e uma tendência à diminuição da ScvO2 no pós-operatório de pacientes com delírio. Estudos adicionais são necessários para elucidar essa associação.
Subject(s)
Humans , Male , Female , Aged, 80 and over , Postoperative Complications/epidemiology , Colonic Diseases/surgery , Delirium/epidemiology , Postoperative Complications/etiology , Regional Blood Flow , Digestive System Surgical Procedures , Pilot Projects , Prospective Studies , Colonic Diseases , Colonic Diseases/complications , Delirium/etiology , Hypotension/complicationsABSTRACT
Objective To evaluate the prognostic value of arterial blood lactate clearance based on central venous oxygen saturation and perfusion index in patients with septic shock related myocardial injury after early goal-directed therapy.Methods One hundred and fifty-seven patients with septic shock after early resuscitation were enrolled from August 2013 to July 2016 in ICU at Peking Union Medical College Hospital.Parameters indicating early resuscitation included central venous pressure (CVP) 8-12 mmHg (1 mmHg=0.133 kPa),mean arterial pressure (MAP)＞65 mmHg,central venous oxygen saturation(ScvO2)＞70％ and urine volume (UO) ＞0.Sml · kg-1 · h-1 and arterial blood lactatc (Lac) ＞2 mmoL/L.Patients were divided into group A [ScvO2＞80％ and perfusion index (PI)＞1.4],group B(ScvO2＞80％ and PI＜1.4),group C (ScvO2＜80％ and PI＞1.4),group D(ScvO2＜80％ and Pl＜l.4).Hemodynamic parameters and tissue perfusion indexes at 2 hours(T2),4 hours(T4) and 6 hours(T6) after early resuscitation and troponin Ⅰ which indicated myocardial damage,on day 1 2 3 in ICU were recorded.Results (1)Lac clearance in group C was the quickest,which was 34.57％ (21.44％,44.20％),58.33％ (30.19％,70.79％),71.43％ (53.75％,82.79％) at T2,T4,T6 respectively.(2)The maximal incidence of myocardial damage was in group B(85.0％) and the lowest in group A (45.7％) on day 1 in ICU.Whereas on day 2,group C showed the lowest incidence of myocardial damage (29.3％) and group B the highest(70.0％).On day 3,the proportion of elevated troponin Ⅰ in group B was 70.0％,which was significantly higher than that of group B (29.3％,P＜0.008).(3)Logistic regression analysis suggested that the rate of Lac clearance at T4 in group B was related to the incidence of myocardial damage on day 2 and 3 in ICU.Conclusions The combination of PI and ScvO2 as a resuscitation target in patients with septic shock facilitates Lac clearance as the goal of resuscitation.The rate of arterial Lac clearance based on ScvO2 and PI is correlated with myocardial injury in patients with septic shock after early goal-directed therapy.
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Objetivo: determinar si la saturación venosa central de oxigeno inicial (SvCO2) anormal (alta o baja) es un factor predictor de mortalidad en los pacientes con choque séptico que ingresan al área critica de emergencia del hospital "Carlos Andrade Marín". Diseño y lugar: estudio analítico, observacional, prospectivo sobre una cohorte de pacientes que ingresaron al área crítica de emergencia de este hospital. Pacientes: 107 sujetos ingresaron en los meses de junio a septiembre del 2015, con seguimiento para la mortalidad a 28 días. Medidas y resultados: se midió la SvcO2 inicial a través de un catéter venoso central al momento del diagnóstico de choque. La mortalidad a los 28 días fue de 46,2%. Solo los valores de APACHE II (OR:1,11; IC: 1,04 a 1,19 p=< 0,01); la asistencia ventilatoria mecánica (OR:0,19; IC: 0,05 a 0,62, p=<0,01) tuvieron un valor estadístico significativo en regresión logística. APACHE II fue el factor individual más importante, en el modelo CART, el pH arterial y procalcitonina fueron útiles. Conclusiones: la saturación venosa central de O2 inicial (SvcO2) anormal alta o baja no mostró tener utilidad para predecir mortalidad a los 28 días. La medición de la SvcO2 es un método simple que refleja de manera indirecta la oxigenación tisular. El APACHE II es un predictor independiente de mortalidad a 28 días y la ventilación mecánica tuvo una relación inversa con la mortalidad. (AU)
Objective: to determine the central venous saturation of abnormal initial oxygen (SvCO2) (high or low) as a predictor of mortality in patients with septic shock admitted to the emergency area of Carlos Andrade Marín Hospital. Design and location: this is an analytical, observational, prospective study on a cohort of patients admitted to the critical area of emergency of this health unit. Subjects: 107 patients admitted in the months of June to September 2015, with a mortality follow-up of 28-day. Measurements and results: initial SvcO2 was measured by central venous catheter at the time of shock diagnosis. Mortality at 28 days was 46.2%. Only APACHE II values (OR 1.11, CI 1.04-1.19 p = <0.01) and mechanical ventilation (OR 0.19, CI 0.05-0.62, p = 0.01) had significant statistical value in the logistic regression. APACHE II was the most important single factor, in the CART model arterial pH and procalcitonin were useful. Conclusion: Central venous saturation of abnormal or high initial O2 (SvcO2) was not found to be useful in predicting mortality at 28 days of follow-up. Measurement of SvcO2 is a simple method that indirectly reflects tissue oxygenation. The APACHE II is an independent predictor of mortality at 28 days and the use of mechanical ventilation had an inverse relationship with mortality. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Shock, Septic , Blood Physiological Phenomena , Hemic and Immune Systems , Pathologic Processes , Pathological Conditions, Signs and Symptoms , Systemic Inflammatory Response SyndromeABSTRACT
Objective To determine the predictive value of central venous oxygen saturation (ScvO2) in volume response by comparing the relationship between variation of ScvO2 and cardiac output (CO) variability before and after volume expansion in elderly patients with septic shock.Methods Forty-five patients who diagnosed septic shock were enrolled in the study,inserted CVC and were carried out continuous cardiac output monitoring(PICCO) before volume expansion.Every patient was treated by rapid intravenous infusion of 250 mL physiological saline,then take blood gas analysis before and after treated which the blood samples were collected from central venous catheter.The value of ScvO2 and the value of cardiac output was recorded.Degree of variation between two sets of data were tested by Student t-test.The correlation was determined by using Pearson's correlation test.Operating characteristics curve analysis was used to test their ability to distinguish R and NR.Results The mean arterial pressure (MAP)、heart rate(HR)、CO、ScvO2 were demonstrated and have statistical significance (P＜ 0.05) compared with before treated.CO and ScvO2 indexes were positively correlated (P＜0.01) before and after volume expansion.ScvO2 variations after VE were significantly correlated with CO changes after VE (r=0.781,P＜0.01).Conclusion ScvO2 dynamic changes can be used as a criterion for determining the fluid responsiveness.
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Objective To explore relationship between the change of serum N terminal brain natriuretic peptide (NT-proBNP) , central venous oxygen saturation (SCVO2 ) and venous-arterial partial pressure of carbon dioxide [P(v-a)CO2 ] levels and prognosis in elderly patients with septic shock .Methods 94 cases of elderly patients with septic shock ,treated from March 2015 to July 2016 in Intensive Care Unit (ICU) of our hospital ,were chosen as the observation group A ,another 80 cases of nonsevere sepsis patients were chosen as the observation group B ,and a total of 56 patients healthy volunteers with the physical examination at the same peri-od of time in our hospital as normal control group .The serum NT-proBNP level was detected by electrochemiluminescence immuno-assay ,and PvCO2 ,PaCO2 and SCVO2 levels were detected by blood gas analyzer .records of patients with central venous blood car-bon dioxide .The NT-proBNP and P (v-a) CO2 levels in the serum of the three groups were compared between the groups of pa-tients in the observation group (SCVO2 ) .Logistic regression analysis was used to analyze the prognostic factors in elderly patients with septic shock ,and the receiver operating characteristic curve (ROC) was used to analyze the predictive value of NT-proBNP ,P (v-a)SCVO2 and SCVO2 levels .Results The serum NT-proBNP level of the observation group A was higher than that in the the observation group B and the control group (P<0 .05) .The SCVO2 level of the A group was lower than that in the B group ,and the P(v-a)CO2 level of the A group was higher than that in the B group ,the difference was statistically significant (P<0 .05) .The age , NT-proBNP ,P(v-a)CO2 ,lactic acid level and APACHE II score in the death group were higher than those in the survival group , and the difference was statistically significant (P< 0 .05) .SCVO2 level in the death group was lower than that in the survival group ,and the difference was statistically significant (P<0 .05) .Logistic multivariate regression analysis showed that NT-proBNP , P(v-a)CO2 and SCVO2 levels were the risk factors for the prognosis of elderly patients with septic shock .ROC curve showed AUC and the sensitivity of P(v-a)CO2 were higher than those of NT-proBNP ,SCVO2 .Conclusion The levels of serum NT-proBNP ,SC-VO2 and P(v-a)CO2 are related to the prognosis of elderly patients with septic shock ,and P(v-a)CO2 has a high value in the prog-nosis of the patients with septic shock ,and has a good clinical value .
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Background: Compromised ventricular function complicates the postoperative course after open heart surgery. Incidence of low-output syndrome (LOS) after cardiopulmonary bypass(CPB) is 30%. Vaso active therapy is required for weaning from bypass. Levosimendan is one of the new class of inodilator useful in refractory cardiac failure. Objective: The aim of this randomized control trial is to detect whether prophylactic levosimendan infusion is superior to milrinone in preserving better tissue perfusion, in decreasing complications related to low output syndromes and better hemodynamic control and to evaluate the efficacy of intravenous levosimendan infusion in decreasing the use of high dose of conventional inotropes and consequent prolonged hospitalization in open heart surgery patients with preoperative compromised ventricular function. Methods: Thirty consecutive patients with compromised cardiac function belongs to American Society of Anesthesiologists(ASA) physical status III who underwent open-heart surgery with CBP were randomly divided into two groups. Gr-L received levosimendan (loading dose of 12 μg/kg over 10 mins followed by infusion dose of (0.1 μg/kg /min ) and Gr-M received milrinone loading dose of 50 μg/kg over 10 mins followed by infusion dose of (0.5 μg/kg/ min )after anesthesia induction. Hemodynamic profile, mixed or central venous oxygen saturation (SVO2, SCVO2) which are surrogate markers for cardiac output, tissue perfusion were recorded, and blood obtained for troponin level. Results: SVO2 and SCVO2 were significantly higher in Gr L versus Gr M. Postoperative troponin- I concentrations, need of other inotropes incidence of arrhythmia, re-intubation, Intensive care unit(ICU) stay and hospital stay were significantly decreased in Gr L. Conclusion: Prophylactic levosimendan infusion maintains better hemodynamic control, tissue perfusion, myocardial protection and lesser complications in patients with compromised ventricular function.
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Background: Lactate and central venous oxygen saturation (ScVO2) are well known biomarkers for adequacy of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient’s nutritional status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2 and endothelin before induction may be predictive of mortality in pediatric cardiac surgery. Methods: We conducted a prospective observational study of 150 pediatric (6 months to 12 years) patients who were posted for intracardiac repair for tetralogy of fallot and measured lactate, ScVO2 and endothelin before induction (T1), 20 minutes after protamine administration (T2) and 24 hours after admission to ICU (T3). Results: Preinduction lactate and endothelin levels were found to predict mortality in patients of tetralogy of fallot with an odds ratio of 6.020 (95% CI 2.111-17.168) and 1.292(95% CI 1.091-1.531) respectively. In the ROC curve analysis for lactate at T1, the AUC was 0.713 (95% CI 0.526–0.899 P = 0.019). At the cutoff value of 1.750mmol/lt, the sensitivity and specificity for the prediction of mortality was 63.6% and 65.5%, respectively. For endothelin at T1, the AUC was 0.699 (95% CI 0.516–0.883, P = 0.028) and the cutoff value was ≤2.50 (sensitivity, 63.6%; specificity, 58.3 %). ScVO2 (odds ratio 0.85) at all three time intervals, suggested that improving ScVO2 can lead to 15% reduction in mortality. Conclusions: Lactate, ScVO2 and endothelin all showed association with mortality with lactate having the maximum prediction. Lactate was found to be an independent, reliable and cost-effective measure of prediction of mortality in patients with tetralogy of fallot.
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Objective To investigate the application value of the ratio of lactic acid(LAC)divided by central venous oxygen saturation (ScvO2 ) to judge the illness severity and prognosis in shock patients. Methods Sixty-four shock patients were divided into two groups:survival group (n=35) and death group (n=29) based on death in 28-d admission. The gender, age, LAC/ScvO2, LAC, 6 h-lactate clearance rate (6 h-LCR), ScvO2 and acute physiology and chronic health Ⅱ(APACHEⅡ) score were compared between two groups. The correlation of LAC/ScvO2 with APACHEⅡscore was analysised in two groups. The receiver operating characteristic (ROC) curve was used to analyse the values of LAC/ScvO 2, LAC, 6 h-LCR, ScvO2 and APACHEⅡscore in the treatment and prognosis of shock. Results There were significant differences in LAC, ScvO2, 6h-LCR and APACHEⅡbetween two groups. There was a lower LAC/ScvO2 in survival group compared with that of death group (P<0.01). LAC/ScvO2 was positively correlated with APACHEⅡscore (rs=0.706,P<0.01). The sensitivity and speciality of LAC/ScvO2 were the highest compared with those of LAC, ScvO2, 6 h-LCR and APACHEⅡ score, the best threshold was 13.92. Conclusion LAC/ScvO2 is a better indicator for shock patients to evaluate the severity degree and prognosis.
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Introduction: Educational programs in pediatric life support endorse a capillary refill time > 2 s as an indicator of shock. In the emergency room, a barrier to the implementation of an early goal directed therapy, aiming at central venous oxygen saturation (ScvO2) ≥ 70% is the insertion of central venous catheter (CVC). Objective: To establish the predictive value of capillary refill time > 2 s to detect ScvO2 < 70% in children admitted to Intensive Care Units. Patients and Method: Prospective study. We included 48 children admitted in the first 24 hours in ICU with superior vena cava CVC. Simultaneously, we measured ScvO2 and capillary refill time in the heel of upper extremity or toe. Results: There were 75 paired measurements ScvO2 (75,9 ± 8,4%) and capillary refill capillary (1,9 ± 1,0 s). We found an inverse correlation between capillary refill time and ScvO2 (r - 0,58 ). The ROC curve analysis revealed an excellent ability for the capillary fill time > 2 s to predict ScvO2 < 70% (AUC 0,94) (95% CI 0,87-0,98). Conclusions: A prolonged capillary refill time > 2 s, is a predictor of ScvO2 < 70% in children admitted to ICU, which supports the current recommendations. This finding may be relevant in emergency units where the use of CVC is limited and ScvO2 is not available.
Introducción: Programas educativos de reanimación pediátrica establecen que un tiempo de llene capilar > 2 s es un indicador de shock. En unidades de emergencia, una barrera para la implementación de una reanimación precoz guiada por metas, teniendo como objetivo una saturación venosa central de oxígeno (ScvO2) ≥ 70%, es la inserción de un catéter venoso central (CVC). Objetivo: Determinar el valor predictivo de un tiempo de llene capilar > 2 s en la detección de ScvO2 < 70% en niños ingresados a la Unidad de Cuidados Intensivos. Pacientes y Método: Estudio prospectivo. Se incluyeron 48 niños ingresados en las primeras 24 h en UCI con CVC en la vena cava superior. De manera simultánea se determinaron ScvO2 y tiempo de llene capilar en talón o dedo de extremidad superior. Resultados: Se obtuvieron 75 mediciones pareadas de ScvO2 (75,9 ± 8,4%) y llene capilar (1,9 ± 1,0 s), observándose una correlación inversa entre llene capilar y ScvO2 (r = -0,58). El análisis de la curva ROC reveló una excelente capacidad del tiempo de llene capilar > 2 s para predecir una ScvO2 < 70% (AUC = 0,94, IC 95% = 0,87-0,98). Conclusiones: La prolongación del tiempo de llene capilar > 2 s es predictor de ScvO2 < 70% en niños críticamente enfermos. Este hallazgo apoya las recomendaciones actuales y podría ser relevante en unidades de emergencia donde el uso de CVC es limitado y la ScvO2 no está disponible.
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Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Catheterization, Central Venous/methods , Oxygen/blood , Shock, Septic/blood , Capillaries/physiology , Intensive Care Units , Predictive Value of Tests , Prospective Studies , Time Factors , Vena Cava, SuperiorABSTRACT
Objective To explore the value of early arterial blood lactate clearance rate and central venous oxygen saturation (ScvO2 ) monitoring in patients with severe pneumonia .Methods A total of 56 patients with severe pneumonia treated during the period from January 2012 to December 2013 were reviewed retrospectively .The arterial blood lactate concentration and ScvO2 were determined immediately after admission to hospital and 6 hours after admission to calculate the 6‐hour lactate clearance rate .APACHE II score was evaluated at the same time .The patients were divided into three groups according to APACHE II score:10 to ＜20 (group A) ,20 to ＜30 (group B) ,≥30 (group C) .The three groups were compared in terms of early arterial blood lactate clearance rate and ScvO2 and estimate their association with the prognosis of patients .Results The initial arterial blood lactate concentration did not show significant difference between the three groups (P>0 .05) .The early lactate clearance rate and ScvO2 at 6 hours in group C were significantly lower than in group B .The values in group B were significantly lower than in group A (P＜0 .05) .The mortality rate in group C was significantly higher than in group B ,and the mortality rate in group B was significantly higher than in group A (P＜0 .05) .The APACHE II score of the dead patients was higher than that of the suevivors ,but early lactate clearance rate and ScvO2 level were lower than those of the survivors (P＜0 .05) .APACHE II score was negatively correlated to early lactate clearance rate (r=0 .661 ,P＜0 .01) and early ScvO2 level (r=0 .579 , P＜ 0 .01) .Conclusions Early lactate clearance rate and ScvO2 level are good indicators to reflect the severity of disease and predict the outcome in the patients with severe pneumonia .
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Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.
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Objective To investigate the clinical significance of central venous oxygen saturation (ScvO2) monitoring in the patients after cardiac operation.Methods Fifty patients after cardiac operation were randomly selected into this study.After the patients entered ICU 2 h,ScvO2,mixed venous oxygen saturation (S(v)vO2),lactate (Lac) were detected at the same time and oxygen extraction rate (O2ER) was calculated.Fifty patients were divided into three groups according to the level of ScvO2,group A (ScvO2 ＜0.65,23 patients),group B (ScvO2 0.65-0.75,18 patients),group C (ScvO2 ＞ 0.75,9 patients).The correlation among ScvO2,S(v)vO2,O2ER were analyzed.The correlation between ScvO2 and Lac in each group were calculated.The level of Lac in three groups were compared.The incidence rate of complications,ventilator time and ICU stay time were compared.Results The level of ScvO2,S（v）O2,O2ER,Lac in 50patients were 0.656 ±0.086,0.639 ±0.081,0.356 ±0.084,(2.6 ± 1.3) mmol/L.The level of ScvO2 had significantly positive correlation with S(v)O2 (r =0.688,P ＜ 0.01),and had significantly negative correlation with O2ER (r =-0.640,P ＜0.01).In group A,the level of Lac had significantly negative correlation with ScvO2 (r =-0.772,P ＜ 0.01).In group C,the level of Lac had significantly positive correlation with ScvO2 (r =0.717,P ＜ 0.05).In group B,the level of Lac had no significant correlation with ScvO2 (r =-0.358,P ＞0.05).The level of Lac in group A and group C was significantly higher than that in group B [(2.0 ± 0.9),(4.8 ±2.1) mmol/L vs.(1.6 ±0.5) mmol/L] (P ＜0.05 or ＜0.01).The incidence rate of hyoxemia,low cardiac output syndrome and renal functional lesion in group A were significantly higher than those in group B (P ＜ 0.05).The incidence rate of liver functional lesion and renal functional lesion in group C were significantly higher than those in group B (P ＜ 0.05).The ventilator time and ICU stay time in group A andgroup C were significantly longer than those in group B (P ＜ 0.05).Conclusions ScvO2 is an ideal index to judge oxygen equilibrium in early period after cardiac operation.The lower and supranormal ScvO2 both suggest tissue hypoxia,resulting in increased postoperative complications and prolonged treatment.
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ObjectiveTo study central venous oxygen saturation (ScyO2) in controlled hemorrhagic shock rabbits resuscitation process as a transfusion trigger and traditional transfusion trigger of comparison.MethodsSelection New Zealand pure line of rabbit 32 only,simple randonly divided into 4 groups,groups A and B for the observation group,groups C and D as control group,groups of eight only.A,B,C,D four groups respectively by ScvO2 ≤70％,ScvO2 ≤75％,hemoglobin (Hb)≥8g/dl,blood loss for the whole blood volume≥30％ as transfusion trigger.From right femoral artery bloodletting 10 minute inside,made the MAP to about (40 ± 5 )mmHg,and maintained the blood pressure 60 minutes,established controlled hemorrhagic shock rabbits of animal model.And then started to resuscitate,with colloid and crystalloid infusion according to the proportion 1∶2,infusion rate of about 10 ～ 15ml/( kg · h),according to the blood pressure and heart rate,and proper adjustment according to the different requirements of each group conducted a blood transfusion.Monitoring based value,shock,shock treatment 30 minutes,60 minutes,120 minutes,180 minutes all time points,and various indexes of blood loss,blood transfusions,crystalloid and colloid fluid volume and so on.ResultsIn shock treatment observation group A late blood pressure,pH,BE,HCO3-,O2ER etc compared with the other three groups had obvious statistical differences ( P ＜ 0.05 ),group B with C and D two groups at the same time points each monitoring were no significant differences ( P ＞0.05 ).The volume of transfusion group C was most,compared with the other three groups were significant difference ( P ＜ 0.05 ),group D of blood transfusions than A,B two groups (P ＜ 0.05 ),groups A and B infused colloid fluid,crystal fluid volume than groups C and D ( P ＜ 0.05 ),each group blood lossed without significant difference.ConclusionScvO2 for controlled hemorrhagic shock rabbit resuscitation monitoring can guide controlled hemorrhagic shock rabbit of blood transfusions,according to ScvO2 ≤75％ transfusion with traditional according to Hb or blood loss transfusion trigger comparison,can achieve the same resuscitation effect,and can more accurately and individualized guide transfusion,reduce unnecessary blood transfusions,save resources.
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BACKGROUND: This study was performed to analyze the effects of differences between initial and follow up amounts of central venous oxygen saturation (Scvo2), lactate, anion gap (AG), and corrected anion gap (CAG). METHODS: Patients with systolic blood pressure that was lower than 90 mmHg participated in this study. Along with Arterial Blood Gas Analysis (ABGA), the amounts of electrolytes, albumin, and Scvo2 were initially checked and then re-checked four hours later. The patients were divided into two groups, which were survived and expired, and the differences in initial and final values were compared in both groups. RESULTS: Out of a total of 36 patients, 29 patients survived and 7 patients died. The data showed almost no difference in mean age, mean arterial pressure, heart rate, respiratory rate, and body temperature between two groups. Comparing the initial amount, there was a statistically significant variation in lactate. Comparing the final values, lactate, AG, and CAG varied significantly. However, for both groups, the differences between the initial and final values were not significant. The area under curve (AUC) of follow up lactate and follow up CAG was 0.89 and 0.88. AUC of ED-APACHEII and original ICU APACHEII was 0.74 and 0.96. CONCLUSIONS: There was no prognostic effect of Scvo2, lactate, AG, and CAG in hypotensive patients. The initial and final values of lactate and CAG were good prognostic factors for the expired group.
Subject(s)
Humans , Acid-Base Equilibrium , Area Under Curve , Arterial Pressure , Blood Gas Analysis , Blood Pressure , Body Temperature , Electrolytes , Emergencies , Follow-Up Studies , Heart Rate , Hypotension , Lactic Acid , Oxygen , Respiratory RateABSTRACT
PURPOSE: Mixed venous oxygen saturation (Smvo2) and other hemodynamic parameters are highly useful in the monitoring of critically ill patients, but the measurement of S m v o2 requires catheterization of the pulmonary artery. In contrast, central venous oxygen saturation (Scvo2) can be easily obtained with a central venous catheter, which is less invasive. To assess if Scvo2 could be a useful value in the treatment of critically ill patients, we evaluated the agreement and the relationship between Scvo2 and Smvo2. Furthermore, the correlations of Scvo2 with other additional parameters were investigated. METHODS: During 18 months, 83 patients in the intensive care unit (ICU) of Ajou university hospital were included. S c v o2, Smvo2, the cardiac index (CI), the oxygen extraction ratio (OER), the oxygen uptake (Vo2), and the oxygen delivery (Do2) were obtained by using a pulmonary artery catheter. RESULTS: There was a difference between Scvo2 and Smvo2 (76.32 +/- 7.86 vs 73.79 +/- 6.31, p < 0.001). The relationship between the two measures showed a meaningful correlation (r=0.700, p < 0.01). Scvo2 also had correlations with the CI (r =0.326, p < 0.05), the OER (r =-0.467, p < 0.01), the Vo2 (r =-0.393, p < 0.01), and the Do2 (r =0.422, p < 0.01). CONCLUSION: Although the Scvo2 value cannot replace the S m v o2 value, it shows a relation with Smvo2 and other parameters. Thus, Scvo2 is suggested as a hemodynamic value for use with critically ill patients.