Tissue oxygenation does not predict central venous oxygenation in emergency department patients with severe sepsis and septic shock

Napoli, A.M.; Machan, J.T.; Forcada, A.; Corl, K.; Gardiner, F.

Academic Emergency Medicine Official Journal of the Society for Academic Emergency Medicine 17(4): 349-352

2010


ISSN/ISBN: 1069-6563
PMID: 20370772
DOI: 10.1111/j.1553-2712.2010.00701.x
Accession: 056592610

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Abstract
This study sought to determine whether tissue oxygenation (StO(2)) could be used as a surrogate for central venous oxygenation (ScVO(2)) in early goal-directed therapy (EGDT). The study enrolled a prospective convenience sample of patients aged > or =18 years with sepsis and systolic blood pressure <90 mm Hg after 2 L of normal saline or lactate >4 mmol, who received a continuous central venous oximetry catheter. StO(2) and ScVO(2) were measured at 15-minute intervals. Data were analyzed using a random coefficients model, correlations, and Bland-Altman plots. There were 284 measurements in 40 patients. While a statistically significant relationship existed between StO(2) and ScVO(2) (F(1,37) = 10.23, p = 0.002), StO(2) appears to systematically overestimate at lower ScVO(2) and underestimate at higher ScVO(2). This was reflected in the fixed effect slope of 0.49 (95% confidence interval [CI] = 0.266 to 0.720) and intercept of 34 (95% CI = 14.681 to 50.830), which were significantly different from 1 and 0, respectively. The initial point correlation (r = 0.5) was fair, but there was poor overall agreement (bias = 4.3, limits of agreement = -20.8 to 29.4). Correlation between StO(2) and ScVO(2) was fair. The two measures trend in the same direction, but clinical use of StO(2) in lieu of ScVO(2) is unsubstantiated due to large and systematic biases. However, these biases may reflect real physiologic states. Further research may investigate if these measures could be used in concert as prognostic indicators.

Tissue oxygenation does not predict central venous oxygenation in emergency department patients with severe sepsis and septic shock