TY - JOUR
T1 - EXPLORING the ROLE of CENTRAL VENOUS OXYGEN SATURATION in the EVALUATION and MANAGEMENT of SEVERE HYPOXEMIA in MECHANICALLY VENTILATED PATIENTS
AU - Kanj, Amjad N.
AU - Rovati, Lucrezia
AU - Castillo Zambrano, Claudia
AU - Marquez, Alberto
AU - Robbins, Kellie
AU - Cortes Puentes, Gustavo
AU - Gallo De Moraes, Alice
AU - Gajic, Ognjen
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background: Although central venous oxygen saturation (ScvO2) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low ScvO2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. Methods: Retrospective review of data from adult intensive care unit patients with hypoxemia who required invasive mechanical ventilation for over 24 h and had at least one ScvO2 measured within 6 h of a PaO2/FiO2 ratio <200. Results: Of 442 mechanically ventilated patients with severe hypoxemia, 249 (56%) had an ScvO2 <70%. When compared with patients with ScvO2 ≥70%, those with low ScvO2 had worse systemic oxygenation and hemodynamic parameters and were more likely to receive red blood cell transfusions (31.7% vs. 18.1%, P = 0.001), epinephrine (27.3% vs. 16.6%, P = 0.007), and inodilators. Outcomes such as median intensive care unit length of stay (7.5 vs. 8.3 days, P = 0.337) and hospital mortality (39.8% vs. 35.7%, P = 0.389) were not different between groups. When stratified by the central venous-to-arterial CO2 difference (ΔPCO2), patients with a low ScvO2 and normal ΔPCO2 had lower median PaO2 and hemoglobin levels and received more red blood cell transfusions, whereas those with an increased ΔPCO2 had a lower pulse pressure and cardiac index and were more likely to receive epinephrine and milrinone. Conclusion: Low ScvO2 is frequently observed in mechanically ventilated patients with severe hypoxemia, and these patients receive different interventions. Clinicians often use therapies targeting systemic oxygen delivery to correct low ScvO2. Prospective research is needed to identify patients with severe hypoxemia that might benefit from interventions targeting systemic oxygen delivery.
AB - Background: Although central venous oxygen saturation (ScvO2) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low ScvO2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. Methods: Retrospective review of data from adult intensive care unit patients with hypoxemia who required invasive mechanical ventilation for over 24 h and had at least one ScvO2 measured within 6 h of a PaO2/FiO2 ratio <200. Results: Of 442 mechanically ventilated patients with severe hypoxemia, 249 (56%) had an ScvO2 <70%. When compared with patients with ScvO2 ≥70%, those with low ScvO2 had worse systemic oxygenation and hemodynamic parameters and were more likely to receive red blood cell transfusions (31.7% vs. 18.1%, P = 0.001), epinephrine (27.3% vs. 16.6%, P = 0.007), and inodilators. Outcomes such as median intensive care unit length of stay (7.5 vs. 8.3 days, P = 0.337) and hospital mortality (39.8% vs. 35.7%, P = 0.389) were not different between groups. When stratified by the central venous-to-arterial CO2 difference (ΔPCO2), patients with a low ScvO2 and normal ΔPCO2 had lower median PaO2 and hemoglobin levels and received more red blood cell transfusions, whereas those with an increased ΔPCO2 had a lower pulse pressure and cardiac index and were more likely to receive epinephrine and milrinone. Conclusion: Low ScvO2 is frequently observed in mechanically ventilated patients with severe hypoxemia, and these patients receive different interventions. Clinicians often use therapies targeting systemic oxygen delivery to correct low ScvO2. Prospective research is needed to identify patients with severe hypoxemia that might benefit from interventions targeting systemic oxygen delivery.
KW - Central venous oxygen saturation
KW - ScvO
KW - circulatory shock
KW - hypoxemia
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UR - http://www.scopus.com/inward/citedby.url?scp=85176495366&partnerID=8YFLogxK
U2 - 10.1097/SHK.0000000000002219
DO - 10.1097/SHK.0000000000002219
M3 - Article
C2 - 37695634
AN - SCOPUS:85176495366
SN - 1073-2322
VL - 60
SP - 646
EP - 651
JO - Shock
JF - Shock
IS - 5
ER -