Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patients

TY - JOUR

T1 - Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patients

AU - Perner, A

AU - Haase, N

AU - Wiis, J

AU - White, J O

AU - Delaney, A

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Background: Simple diagnostic tests are needed to screen septic patients for low cardiac output because intervention is recommended in these patients. We assessed the diagnostic value of central venous oxygen saturation in the superior vena cava (ScvO2) for detecting low cardiac output in patients with septic shock. Methods: We conducted a prospective observational study in three general intensive care units (ICUs) of adult patients with septic shock, who were to have a catheter inserted for thermodilution measurement of cardiac index (CITD). Paired measurements of CITD and central venous oximetry values were obtained when the clinician first measured CITD. Results: We included 56 patients with septic shock and a mean sequential organ failure assessment score of 12 (range 3-20). Baseline CI TD was 3.5 l/min/m2 (1.0-6.2) and ScvO2 of 70% (33-87). The best cut-off of ScvO2 for CITD>2.5 l/min/m2 (n=42) was a value ≥64% with positive and negative predictive values of 91% (95% confidence interval 79-98) and 91% (59-100), respectively. The diagnostic values were not improved by using instead central venous O2 tension or the difference between arterial and central venous O2 saturation. Conclusions: This prospective, observational study found that a ScvO2 measurement of ≥64% indicated CI TD>2.5 l/min/m2 in ICU patients with septic shock.

AB - Background: Simple diagnostic tests are needed to screen septic patients for low cardiac output because intervention is recommended in these patients. We assessed the diagnostic value of central venous oxygen saturation in the superior vena cava (ScvO2) for detecting low cardiac output in patients with septic shock. Methods: We conducted a prospective observational study in three general intensive care units (ICUs) of adult patients with septic shock, who were to have a catheter inserted for thermodilution measurement of cardiac index (CITD). Paired measurements of CITD and central venous oximetry values were obtained when the clinician first measured CITD. Results: We included 56 patients with septic shock and a mean sequential organ failure assessment score of 12 (range 3-20). Baseline CI TD was 3.5 l/min/m2 (1.0-6.2) and ScvO2 of 70% (33-87). The best cut-off of ScvO2 for CITD>2.5 l/min/m2 (n=42) was a value ≥64% with positive and negative predictive values of 91% (95% confidence interval 79-98) and 91% (59-100), respectively. The diagnostic values were not improved by using instead central venous O2 tension or the difference between arterial and central venous O2 saturation. Conclusions: This prospective, observational study found that a ScvO2 measurement of ≥64% indicated CI TD>2.5 l/min/m2 in ICU patients with septic shock.

U2 - 10.1111/j.1399-6576.2009.02086.x

DO - 10.1111/j.1399-6576.2009.02086.x

M3 - Journal article

SN - 0001-5172

VL - 54

SP - 98

EP - 102

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 1

ER -