Research

The incidence of low venous oxygen saturation on admission to the intensive care unit: a multi-center observational study in The Netherlands

Paul A van Beest^1,2 , Jorrit J Hofstra³ , Marcus J Schultz^3,4 , E C Boerma¹ , Peter E Spronk^3,4,5 and Michael A Kuiper^1,3,4

¹  Medical Center Leeuwarden, Leeuwarden, The Netherlands

²  University Medical Center Groningen, Groningen, The Netherlands

³  Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

⁴  HERMES Critical Care Group, The Netherlands

⁵  Gelre Hospitals, location Lucas, Apeldoorn, The Netherlands

author email corresponding author email

Critical Care 2008, 12:R33doi:10.1186/cc6811

Published:	4 March 2008

See related commentary by Bellomo et al., http://ccforum.com/content/12/2/130

Abstract

Background

Low mixed or central venous saturation (S(c)vO₂) can reveal global tissue hypoxia and therefore can predict poor prognosis in critically ill patients. Early goal directed therapy (EGDT), aiming at an ScvO₂ ≥ 70%, has been shown to be a valuable strategy in patients with sepsis or septic shock and is incorporated in the Surviving Sepsis Campaign guidelines.

Methods

In this prospective observational multi-center study, we determined central venous pressure (CVP), hematocrit, pH, lactate and ScvO₂ or SvO₂ in a heterogeneous group of critically ill patients early after admission to the intensive care units (ICUs) in three Dutch hospitals.

Results

Data of 340 acutely admitted critically ill patients were collected. The mean SvO₂ value was > 65% and the mean ScvO₂ value was > 70%. With mean CVP of 10.3 ± 5.5 mmHg, lactate plasma levels of 3.6 ± 3.6 and acute physiology, age and chronic health evaluation (APACHE II) scores of 21.5 ± 8.3, the in-hospital mortality of the total heterogeneous population was 32.0%. A subgroup of septic patients (n = 125) showed a CVP of 9.8 ± 5.4 mmHg, mean ScvO₂ values of 74.0 ± 10.2%, where only 1% in this subgroup revealed a ScvO₂ value < 50%, and lactate plasma levels of 2.7 ± 2.2 mmol/l with APACHE II scores 20.9 ± 7.3. Hospital mortality of this subgroup was 26%.

Conclusion

The incidence of low ScvO₂ values for acutely admitted critically ill patients is low in Dutch ICUs. This is especially true for patients with sepsis/septic shock.