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Comparative Study
. 2010;14(6):R219.
doi: 10.1186/cc9348. Epub 2010 Nov 29.

No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin

Paul A van Beest  1 , Jan van Ingen, E Christiaan Boerma, Nicole D Holman, Henk Groen, Matty Koopmans, Peter E Spronk, Michael A Kuiper
Affiliations
Comparative Study

No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin

Paul A van Beest et al. Crit Care. 2010.

Abstract

Introduction: Controversy remains regarding the relationship between central venous saturation (ScvO(2)) and mixed venous saturation (SvO(2)) and their use and interchangeability in patients with sepsis or septic shock. We tested the hypothesis that ScvO(2) does not reliably predict SvO(2) in sepsis. Additionally we looked at the influence of the source (splanchnic or non-splanchnic) of sepsis on this relationship.

Methods: In this prospective observational two-center study we concurrently determined ScvO(2) and SvO(2) in a group of 53 patients with severe sepsis during the first 24 hours after admission to the intensive care units in 2 Dutch hospitals. We assessed correlation and agreement of ScvO(2) and SvO(2), including the difference, i.e. the gradient, between ScvO(2) and SvO(2) (ScvO(2) - SvO(2)). Additionally, we compared the mean differences between ScvO(2) and SvO(2) of both splanchnic and non-splanchnic group.

Results: A total of 265 paired blood samples were obtained. ScvO(2) overestimated SvO(2) by less than 5% with wide limits of agreement. For changes in ScvO(2) and SvO(2) results were similar. The distribution of the (ScvO(2) - SvO(2)) (< 0 or ≥ 0) was similar in survivors and nonsurvivors. The mean (ScvO(2) - SvO(2)) in the splanchnic group was similar to the mean (ScvO(2) - SvO(2)) in the non-splanchnic group (0.8 ± 3.9% vs. 2.5 ± 6.2%; P = 0.30). O(2)ER (P = 0.23) and its predictive value for outcome (P = 0.20) were similar in both groups.

Conclusions: ScvO(2) does not reliably predict SvO(2) in patients with severe sepsis. The trend of ScvO(2) is not superior to the absolute value in this context. A positive difference (ScvO(2) - SvO(2)) is not associated with improved outcome.

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Figures

Figure 1
Figure 1
Bland and Altman plot showing the agreement between (a) ScvO2 and SvO2 (bias 1.7, 95% limits of agreement from -12.1 to 15.5) and in (b) changes in ScvO2 and SvO2 (bias 0.6, 95% limits of agreement from -13.4 to 14.6). ScvO2, central venous saturation; SvO2, mixed venous saturation.
Figure 2
Figure 2
Mean mixed venous saturation (SvO2) and central venous saturation (ScvO2) values at different time points. ScvO2 is consistently higher than SvO2 without statistical difference (paired t test; all P > 0.05).
Figure 3
Figure 3
Number of paired measurements resulting either in an (ScvO2 - SvO2) of at least 0 (dark bars) or in an (ScvO2 - SvO2) of less than 0 (light bars). There was no significantly different distribution of (ScvO2 - SvO2) between survivors and non-survivors in (a) the total population (P = 0.13), (b) the splanchnic group (P = 0.23), or (c) the non-splanchnic group (P = 0.13). The χ2 test was used to establish significance between the number of survivors and non-survivors. ScvO2, central venous saturation; SvO2, mixed venous saturation.
Figure 4
Figure 4
Receiver operating characteristic curves of oxygen extraction ratio for the splanchnic and non-splanchnic groups. The area under the curve (AUC) in the splanchnic group was not significantly larger than AUC in the non-splanchnic group (0.67 versus 0.55; P = 0.20).
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