Study on correlation between mixed SvO2, P(v-a)CO2 and LAC with APACHEⅡ score, SOFA score and disease condition / 重庆医学

Objective To investigate the correlation between mixed venous oxygen saturation(SVO2),mixed venous-arterial partial pressure of carbon dioxide[P(v-a)CO2] and blood lactate(LAC) with the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and Sequential Organ Failure Assessment (SOFA) score,and to investigate the value of SVO2,P(v-a)CO2,LAC in assessing the disease condition.Methods A total of 104 patients with heart operation in the Chengdu Municipal Third People's Hospital from December 2011 to March 2015 were collected and divide into survival group and non-survival group according to the prognosis.The correlation between SvO2,P(v-a)CO2 and LAC with the APACHE Ⅱ score and SOFA score was analyzed by using the Pearman correlation analysis.The correlation between SvO2,P(v-a)CO2 and LAC with the disease condition was also analyzed.The Receiver Operating Characteristic (ROC) curvewas utilized to evaluating the accuracy of SvO2,P(v-a)CO2 and LAC for assessing the prognosis.Results Compared with the survival group,the difference of P(v-a)CO2,LAC,APACHE Ⅱ scores in the non-survival group had statistical significance(P＜0.05).SOFA score was 11.22 vs.7.35 (t=-3.433,P＜0.01),all were significantly increased,but SvO2 was significantly decreased(0.65 vs.0.71,t=2.794,P＜0.05).The values of SvO2 and LAC were significantly correlated with SOFA score (r=-0.268,P=0.006;r=0.200,P =0.041).But P(v-a) CO2 had no correlation with SOFA score(r=0.190,P=0.054).The values of SvO2,P(v-a)CO2 and LAC were correlated with APACHE Ⅱ score(r=-0.3,76,P=0.000;r=0.282,P=0.004;r=0.264,P =0.007).The values of SvO2,P (v-a) CO2 and LAC were correlated with prognosis (r=0.308,P=0.001;r=-0.248,P=0.011;r=-0.400,P=0.000).The areas under ROC curve of SvO2,P(v-a)CO2 and LAC corresponding practical mortality all were less than 0.70.Conclusion SvO2,P(v-a)CO2 and LAC have a certain correlation with the APACHE Ⅱ score,SOFA score and severity of disease condition,but which can not serve as the evaluation indicators of prognosis.

Values of mixed venous oxygen saturation and difference of mixed venous-arterial partial pressure of carbon dioxide in monitoring of oxygen metabolism and treatment after open-heart operation / 中华危重病急救医学

Objective To explore the clinic values of early goal directed treatment (EGDT)with the target of mixed venous oxygen saturation (SvO2)and difference of mixed venous-arterial partial pressure of carbon dioxide (Pv-aCO2) in monitoring of oxygen metabolism and treatment for patients post open-heart operation. Methods A prospective study was conducted. The adult patients admitted to Third People's Hospital of Chengdu from December 2011 to March 2014 with SvO22 mmol/L when admitted in intensive care unit(ICU)were selected on whom elective open-heart operation and pulmonary artery catheter examination were done. All patients received EGDT with the target of SvO2≥0.65 and Pv-aCO2<6 mmHg (1 mmHg=0.133 kPa)and were divided into three groups by the values of SvO2 and Pv-aCO2 at 6-hour after ICU admission:A group with SvO2≥0.65 and Pv-aCO2<6 mmHg,B group with SvO2≥0.65 and Pv-aCO2≥6 mmHg,and C group with SvO2<0.65. Then the changes and prognosis of the patients in different groups were observed. Results 103 cases were included,44 in A group,31 in B group and 28 in C group. The acute physiology and chronic health evaluationⅡ (APACHEⅡ)score in group A were significantly lower than that in group B or C at 6,24,48 and 72 hours (T6,T24,T48,T72)of ICU admission (T6:11.4±5.8 vs. 13.9±5.4,13.7±6.4;T24:8.8±3.7 vs. 10.8±4.8,11.8±5.4;T48:8.7±4.1 vs. 9.6 ±4.2,10.2 ±5.1;T72:7.5 ±3.4 vs. 8.6 ±2.9,9.2 ±4.2,all P<0.05),and the sequential organ failure assessment (SOFA)showed the same tendency (T6:6.5±4.3 vs. 8.0±3.8,9.1±4.5;T24:6.6±3.6 vs. 8.6±3.9, 8.5±3.3;T48:5.2±3.4 vs. 7.0±3.6,7.6±5.1;T72:4.6±2.4 vs. 5.8±2.5,6.8±3.5,all P<0.05). The values of blood lactic acid (mmol/L)in group A and B were significant lower than that in group C at T6,T24,T48 and T72 (T6:1.60 ±0.95,2.20 ±1.02 vs. 2.55 ±1.39;T24:2.26 ±1.26,2.70 ±1.36 vs. 3.34 ±2.36;T48:2.01 ±1.15, 2.17 ±1.51 vs. 2.42 ±1.63;T72:1.62 ±1.14,1.64 ±0.75 vs. 2.11 ±1.29,all P<0.05). The time of machine ventilation(days)in group A or B was significantly shorter than that in group C(2.8±2.0,3.6±2.3 vs. 5.0±3.1,both P<0.05). ICU day (days)in group A was significant shorter than that in group C (4.6±2.5 vs. 6.5±3.7,P<0.05). The 7-day mortalities after operation in three groups were significantly different. Compared with group A (2.3%),the odds ratio (OR)in group B (22.6%)was 12.5 (P<0.05),group C (25.0%)14.3 (P<0.05). The morbidity and 28-day mortality in three groups were not significantly different. Pv-aCO2 negatively correlated with cardiac index(CI, r=-0.685,P=0.000),but not correlated with blood lactic acid(r=0.187,P=0.080). Conclusions EGDT with the target of SvO2≥0.65 and Pv-aCO2<6 mmHg improved the general condition and tissue hypoxia,shortened the time of machine ventilation and duration of hospitalization in ICU,and decrease the 7-day mortality.

The clinical significance of central venous oxygen saturation monitoring in the patients after cardiac operation / 中国医师进修杂志

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.

A Study on the Monitoring of Bupivacaine-induced Cardiac Depression in Dogs: A Comparison between Continuous Mixed Venous Oxygen Saturation and Mean Arterial Blood Pressure / 대한마취과학회지

BACKGROUND: Bupivacaine induces cardiac depression, which is resistant to treatment. Therefore early recognition of its development is important so that the injection of bupivacaine can be discontinued promptly. We compared the efficacy of continuous mixed venous oxygen saturation (cSvO2) monitoring with that of the mean arterial blood pressure (MBP) monitoring in terms of the prediction of cardiac output (CO) changes in anesthetized dogs with bupivacaine-induced cardiovascular depression. METHODS: Bupivacaine was infused to pentobarbital-anesthetized mongrel dogs (n = 8) at a rate of 0.5 mg/kg/min until the MBP decreased to 40 mmHg or less (end of bupivacaine infusion; BIE). We defined the early period as the interval from baseline till 30 minutes after the bupivacaine infusion and the late period as that after the 30 minutes till BIE. We monitored cSvO2 with a fiberoptic pulmonary artery catheter. The MBP and CO were measured every ten minutes after the initiation of the bupivacaine infusion. Arterial blood gas analysis, mixed venous gas analysis, measurement of serum electrolyte concentrations and serum bupivacaine concentrations were performed simultaneously. The relationship between CO versus cSvO2 or versus MBP was compared retrospectively by regression analysis. RESULTS: The Pearson's correlation coefficients between CO and cSvO2 were 0.782 (r2 = 0.6111, P 0.05) in the early period and 0.799 (r2 = 0.6381, P < 0.01) in the late period. CONCLUSIONS: cSvO2 is superior to MBP for the prediction of CO changes in bupivacaine-induced cardiac depression in dogs, especially in the early period. We might expect a profound reduction of CO when MBP begins to decrease in the late period.

Correlation between Mixed Venous Oxygen Saturation and Cardiac Index in Coronary Arterty Bypass Grafting Patients / 临床麻醉学杂志

Objective:Cardiac index(CI) and mixed venous oxygen saturation SvO2 were studied in 85 patients undergoing coronary artery bypass grafting(CABG). Methods: Measurement of CI and SvO2 was carried out with a fiberoptic ballon-tip thermodilation pulmonary artery catheter. Fentanyl-based anesthesia was applied in all patients. Hemodynamic parame-ters were obtained prior to anesthesia induction as the baseline, after endotracheal intubation, after stemotomy, after weaning of cardiopulmonary bypass, at 6 and 24h after operation. Results: CI and SvO2 increased or was not changed at all time intervals, compared with the baselines. The changes of SvO2 correlated well with those of CI. Conclusion: The results suggest that continuous monitoring of SvO2 may be useful to predicting alteration in CI in patients undergoing CABG.

Correlation of Mixed Venous and Central Venous Oxygen Saturation and Comparison between Venous-Oxygen Saturation and Cardiac Index / 대한마취과학회지

BACKGROUND: Although mixed venous oxygen saturation(SvO2) has been established as a useful measure of whole body oxygenation, SvO2 must be measured through a pulmonary artery(PA) catheter. We performed this study to evaluate whether central venous oxygen saturation(ScvO2) could substitute for SvO2, and whether SvO2 reflects cardiac output. METHODS: Twenty five patients were studied. Thirteen patients(GA Group) had PA catheters inserted during general anesthesia, and twelve(ICU Group) patients in the intensive care unit had PA catheters inserted for management of critical illnesses. In each patient, blood samples for SvO2 and ScvO2 were drawn separately from the PA and CVP ports of a PA catheter, and cadiac index(CI) was measured. RESULTS: Mean ScvO2 was significantly higher than SvO2 in both group, but the differences of SvO2 and ScvO2 were only about 2.5%. Correlations of SvO2 and ScvO2 were very high in GA and ICU Groups(r=0.92, 0.95, respectively). SvO2 was weakly related to CI in GA Group(r=0.64), and in ICU Group(r=0.50) CONCLUSIONS: We conclude that ScvO2 can be a useful estimate of SvO2, but SvO2 does not reliably reflect cardiac index.

The Assessment of Change in Total Oxygenation by Continuous Monitoring of Mixed Venous Oxygen Saturation during Canine Orthotopic Liver Transplantation / 대한마취과학회지

There are many hemodynamic and physiologic changes during liver transplantation much more than other surgical interventions. The oxygen delivery and oxygen consumption are af- fected by depressed hemodynamic and metabolic status during the operation. At the lower levels of oxygen present in venous blood, a linear relationship exists between saturation and tension. The use of fiberoptic oximetry system in conventional pulmonary artery flotation catheters has made the bedside application of this relationship of practical value in the continuous assessment of mixed venous oxygen saturation. This study was performed to determine changes in SvO2 and other variables of oxygen kinetics during canine OLT and study the correlation between SvO2 and cardiac output, SvO2 and oxygen consumption and oxygen utilization ratio. The continuous rnixed venous oxygen saturation and cardiac output by SO2/CO computer were monitored and the oxygen delivery, oxygen consumption and oxygen utilization ratio were calculated by arterial and venous blood gas analysis and modified Fick's equation during orthotopic liver transplantation in 20 dogs. The results were as follow as ; 1. There was no significant difference in tissue oxygen extraction between preoperative control and anhepatic phase, while cardiac output were decreased during anhepatic phase. 2. By utilizing centrifugal pump(venovenous bypass) oxygen delivery and oxygen utilization ratio were well maintained even though suppressed the change of oxygen delivery and oxygen consumption during anhepatic phase. 3. There was a significant decrease in SvO2 immediately after declamping the suprahepatic vena cava, whereas the oxygen utilization rate and oxygen consumption following reperfusion were significantly increased than just prior to reperfusion of transplanted liver. 4. A Statistically significant correlation was found between SvO2 and cardiac output, oxygen consumption in all surgical stages except reperfusion(CO;r=0.478, p<0.001, VO2,r=-0. 272, p=0.004), but their correlations were relatively poor. However, there was highly significant correlation among SvO2 and oxygen utilization ratio in all surgical stages(O2UR; r=- 0.834, P<0.001). In conclusion, continuous monitoring mixed venous oxygen via a fiberoptic pulmonary catheter could be used as the index for evaluation of hemodynamics and oxygen kinetics during canine OLT, but further research should be performed to determine whether these measurements indicate viability of the grafted liver.