Research

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

Paul A van Beest^1*, Jan van Ingen², E Christiaan Boerma³, Nicole D Holman², Henk Groen⁴, Matty Koopmans³, Peter E Spronk^5,6 and Michael A Kuiper^3,6

• * Corresponding author: Paul A van Beest p.van.beest@anest.umcg.nl

Author Affiliations

¹ Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands

² Department of Intensive Care Medicine, Martini Hospital, Van Swietenplein 1, Groningen, 9700 RM, The Netherlands

³ Department of Intensive Care Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8901 BR, The Netherlands

⁴ Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands

⁵ Department of Intensive Care Medicine, Gelre Hospital Apeldoorn, Albert Schweitzerlaan 31, Apeldoorn, 7300 DS, The Netherlands

⁶ Department of Intensive Care Medicine L.E.I.C.A, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

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Critical Care 2010, 14:R219 doi:10.1186/cc9348

See related letter by Jha and Gutierrez, http://ccforum.com/content/15/3/436

Published: 29 November 2010

Abstract

Introduction

Controversy remains regarding the relationship between central venous saturation (ScvO₂) and mixed venous saturation (SvO₂) and their use and interchangeability in patients with sepsis or septic shock. We tested the hypothesis that ScvO₂ does not reliably predict SvO₂ 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 ScvO₂ and SvO₂ 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 ScvO₂ and SvO₂, including the difference, i.e. the gradient, between ScvO₂ and SvO₂ (ScvO₂ - SvO₂). Additionally, we compared the mean differences between ScvO₂ and SvO₂ of both splanchnic and non-splanchnic group.

Results

A total of 265 paired blood samples were obtained. ScvO₂ overestimated SvO₂ by less than 5% with wide limits of agreement. For changes in ScvO₂ and SvO₂ results were similar. The distribution of the (ScvO₂ - SvO₂) (< 0 or ≥ 0) was similar in survivors and nonsurvivors. The mean (ScvO₂ - SvO₂) in the splanchnic group was similar to the mean (ScvO₂ - SvO₂) in the non-splanchnic group (0.8 ± 3.9% vs. 2.5 ± 6.2%; P = 0.30). O₂ER (P = 0.23) and its predictive value for outcome (P = 0.20) were similar in both groups.

Conclusions

ScvO₂ does not reliably predict SvO₂ in patients with severe sepsis. The trend of ScvO₂ is not superior to the absolute value in this context. A positive difference (ScvO₂ - SvO₂) is not associated with improved outcome.