Changes of Central Venous Oxygen Saturation Define Fluid Responsiveness In Patients With Septic Shock: A Prospective Observational Study

• Published in: Journal of critical care Vol. 38; pp. 13 - 19
• Main Authors: Xu, Biao, MD, Yang, Xiaobo, MD, Wang, Chunyao, MD, Jiang, Wei, MD, Weng, Li, MD, Hu, Xiaoyun, MD, Peng, Jinmin, MD, Du, Bin, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017; Elsevier Limited
• Subjects: Acute coronary syndromes; Blood pressure; Cancer; Cardiovascular disease; Catheterization, Central Venous; Catheters; Central venous oxygen saturation; Critical Care; Female; Fluid responsiveness; Fluid Therapy; Fluids; Humans; Hypertension; Male; Metabolism; Middle Aged; Oximetry; Oxygen; Oxygen - blood; Patients; Prospective Studies; Pulmonary arteries; ROC Curve; Sensitivity and Specificity; Sepsis; Septic shock; Shock, Septic - therapy; Ventilators; pulse pressure variation; arterial oxygen saturation; oxygen delivery index; HR; systolic blood pressure; DBP; diastolic blood pressure; oxygen consumption; oxygen delivery; Hb; VO 2; acute physiology and chronic health evaluation; ROC; cardiac index; central venous pressure; systemic vascular resistance index; NA; fraction of inspired oxygen; hemoglobin level; CVP; APACHE; standard deviation; fluid responsiveness; PUMCH; septic shock; PEEP; FiO2; positive end expiratory pressure; analysis of variance test for group and time interaction; AUROC; changes of cardiac index; receiver operating characteristic curve; SaO 2; cardiac output; SD; SVV; stroke volume variation; mixed venous oxygen saturation; ANOVA; PPV; not available; central venous oxygen saturation; Peking Union Medical College Hospital; SBP; heart rate; CI; oxygen consumption index; CO; DO 2I; intensive care units; change of ScvO 2; area under receiver operating characteristics curve; SvO 2; ΔScvO 2; ΔCI; ICU; confidence interval; SVRI; DO 2; VO 2I; Svo2; ΔScvo2; DO2I; DO2; VO2; Central venous oxygen saturation; Fio2; Fluid responsiveness; Septic shock; Sao2; VO2I
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.09.030

A bstract Purpose To evaluate whether the changes of central venous oxygen saturation (ScvO2 ) after fluid challenge can define fluid responsiveness in septic shock patients. Methods In this prospective observational study, septic shock patients with invasive cardiac output monitoring requiring fluid challenge were included. Cardiac index (CI) and ScvO2 were measured before and after fluid challenges. The changes of CI (ΔCI) and the changes of ScvO2 (ΔScvO2 ) were calculated and analyzed using Pearson correlation. Receiver operating characteristics curve (ROC) analysis was used to classify fluid responders and nonresponders. Area under ROC (AUROC) was calculated. Results Forty patients were included, and 18 patients (45%) were fluid responders. In the responders, CI increased from 3.4 ± 1.1 to 4.4 ± 1.0 L/min/m2 and ScvO2 from 69.6 ± 9.8% to 77.1 ± 8.9% (both P < .001) after fluid challenge. In the nonresponders, neither CI nor ScvO2 changed (4.1 ± 1.3 vs. 4.1 ± 1.3 L/min/m2 , 71.0 ± 13.8% vs. 70.6 ± 14.1%, both P > .05). The correlation between ΔScvO2 and ΔCI was significant (r = 0.702, P < .001). The AUROC of ΔScvO2 to define fluid responsiveness was 0.88 (95% confidence interval [CI] 0.76–0.99). A ΔScvO2 threshold value of 5.0% discriminated responders from nonresponders with sensitivity of 0.78 (95%CI 0.52–0.93) and specificity of 0.95 (95%CI 0.75–1.00). Conclusions The changes of ScvO2 correlate with the changes of CI, and the changes of ScvO2 define fluid responsiveness in septic shock patients.