Original articleCombined Central Venous Oxygen Saturation and Lactate as Markers of Occult Hypoperfusion and Outcome Following Cardiac Surgery
Section snippets
Methods
This prospective, observational study was approved by the hospital's institutional review board for human research and written informed consent was obtained for each patient.
Eligible adult patients who were to undergo coronary artery bypass grafting (CABG) and/or valve surgery using cardiopulmonary bypass (CPB) from October 2007 through June 2008 at a 912-bed academic tertiary care hospital were assessed for enrollment based on inclusion and exclusion criteria of the study. Inclusion criteria
Results
Of the 129 screened patients, 60 patients fulfilled eligibility requirements (17 women, 43 men). Thirty-one patients had CABG surgery, 17 had valve surgery, and 12 patients underwent both surgeries. One death occurred during the study period. Patients' mean age was 65 ± 11 years.
Discussion
The unyielding imbalance between oxygen demand and oxygen supply is an initiator for the cascade of events leading to multiple organ failure.1, 2, 3, 4 Prompt amelioration of this hypoperfused state is, therefore, key. Conventional indicators of perfusion, such as blood pressure or UO, have been proved repeatedly to be inaccurate.5, 6, 7 Therefore, the need for a tool to assess hypoperfusion accurately is paramount in curbing the incidence of organ dysfunction in these patients.
SvO2, ScvO2, and
Conclusions
The incidence of occult hypoperfusion after cardiac surgery was remarkably high, and the use of ScvO2 and lactate facilitated rapid identification of these patients. Although admission ScvO2 and lactate were not independently associated with increased morbidity, patients who developed severe GTH (ScvO2 <70% and lactate ≥4 mmol/L) had significantly prolonged ICU stays. This trial supports the use of ScvO2 and lactate in combination to identify patients with hypoperfusion otherwise undetected by
Acknowledgments
The authors acknowledge the contributions of Nic Bartell for database development, Michael Dore and Ian Jarrett for obtaining laboratory data, and Kimberly Putney for careful review of the manuscript. The authors thank the patients, families, nurses, and cardiovascular surgeons at St Luke's Episcopal Hospital, whose cooperation and participation made this study possible.
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This research was supported in part by the Roderick D. MacDonald Research Fund.