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Journal of Cardiothoracic Surgery

, 8:189

First Online: 22 September 2013Received: 02 April 2013Accepted: 17 September 2013

Abstract

BackgroundIt is unclear if and how SvO2 can serve as an indicator of fluid responsiveness in patients after cardiac or major vascular surgery.

MethodsThis was a substudy of a randomized single-blinded clinical trial reported earlier on critically ill patients with clinical hypovolemia after cardiac or major vascular surgery. Colloid fluid loading was done for 90 min, guided by changes in pulmonary artery occlusion pressure PAOP or central venous pressure CVP. Fluid responsiveness was defined as ≥15% increase in cardiac index CI. Hemodynamics, including transpulmonary dilution-derived global end-diastolic volume index GEDVI and global ejection fraction GEF, were measured and blood samples taken.

ResultsWhereas baseline SvO2 >70% in 68% of patients did not differ, the SvO2 increased in patients responding to fluid loading ≥15% in CI in n = 26 versus those not responding n = 11; P = 0.03. The increase in GEDVI was also greater in responders P = 0.005. The area under the receiver operating characteristic curve for fluid responsiveness of changes in SvO2 was 0.73 P = 0.007, with an optimal cutoff of 2%, and of those in GEDVI 0.82 P < 0.001, while the areas did not differ. However, the value of SvO2 increases to reflect CI increases with fluid loading was greatest when GEF was ≤20% in 53% of patients.

ConclusionsAn increase in SvO2 ≥2%, irrespective of a relatively high baseline value, can thus be used as a monitor of fluid responsiveness in clinically hypovolemic patients after cardiac or major vascular surgery, particularly in those with systolic cardiac dysfunction. Fluid responsiveness concurs with increased tissue O2 delivery.

KeywordsFluid responsiveness Mixed venous oxygen saturation Pulmonary artery catheter Global end-diastolic volume index Transpulmonary thermodilution AbbreviationsICUIntensive care unit

DO2IO2 delivery index

VO2IO2 consumption index

CICardiac index

SVIStroke volume index

GEDVIGlobal end-diastolic volume index

GEFGlobal ejection fraction

PAOPPulmonary artery occlusion pressure

CVPCentral venous pressure

MAPMean arterial pressure

MPAPMean pulmonary artery pressure

HRHeart rate

SaO2O2 saturation in arterial blood

HbHemoglobin

SvO2O2 saturation in mixed venous blood

ScvO2O2 saturation in central venous blood

PEEPPositive end-expiratory pressure

BSABody surface area

AVRAortic valve replacement

CABGCoronary artery bypass grafting

ASDAtrial septal defect

HESHydroxyethyl starch

AUCArea under the curve

ROCReceiver operating characteristic

Sens.Sensitivity

Spec.Specificity

PPVPositive predictive value

NPVNegative predictive value

RResponder

NRNon-responder.

Electronic supplementary materialThe online version of this article doi:10.1186-1749-8090-8-189 contains supplementary material, which is available to authorized users.

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Autor: Arjan N Kuiper - Ronald J Trof - AB Johan Groeneveld

Fuente: https://link.springer.com/



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