EXPLORING THE ROLE OF CENTRAL VENOUS OXYGEN SATURATION IN THE EVALUATION AND MANAGEMENT OF SEVERE HYPOXEMIA IN MECHANICALLY VENTILATED PATIENTS
Background: Although central venous oxygen saturation (ScvO 2 ) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low Scv...
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| Veröffentlicht in: | Shock (Augusta, Ga.) Ga.), 2023-11, Vol.60 (5), p.646-651 |
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| creator | Kanj, Amjad N Rovati, Lucrezia Zambrano, Claudia Castillo Marquez, Alberto Robbins, Kellie Puentes, Gustavo Cortes De Moraes, Alice Gallo Gajic, Ognjen |
| description | Background: Although central venous oxygen saturation (ScvO 2 ) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low ScvO 2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. Methods: Retrospective review of data from adult intensive care unit patients with hypoxemia who required invasive mechanical ventilation for over 24 h and had at least one ScvO 2 measured within 6 h of a PaO 2 /FiO 2 ratio |
| doi_str_mv | 10.1097/SHK.0000000000002219 |
| format | Article |
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The aim of this study was to assess the incidence of low ScvO 2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. Methods: Retrospective review of data from adult intensive care unit patients with hypoxemia who required invasive mechanical ventilation for over 24 h and had at least one ScvO 2 measured within 6 h of a PaO 2 /FiO 2 ratio <200. Results: Of 442 mechanically ventilated patients with severe hypoxemia, 249 (56%) had an ScvO 2 <70%. When compared with patients with ScvO 2 ≥70%, those with low ScvO 2 had worse systemic oxygenation and hemodynamic parameters and were more likely to receive red blood cell transfusions (31.7% vs. 18.1%, P = 0.001), epinephrine (27.3% vs. 16.6%, P = 0.007), and inodilators. Outcomes such as median intensive care unit length of stay (7.5 vs. 8.3 days, P = 0.337) and hospital mortality (39.8% vs. 35.7%, P = 0.389) were not different between groups. When stratified by the central venous-to-arterial CO 2 difference (∆PCO 2 ), patients with a low ScvO 2 and normal ∆PCO 2 had lower median PaO 2 and hemoglobin levels and received more red blood cell transfusions, whereas those with an increased ∆PCO 2 had a lower pulse pressure and cardiac index and were more likely to receive epinephrine and milrinone. Conclusion: Low ScvO 2 is frequently observed in mechanically ventilated patients with severe hypoxemia, and these patients receive different interventions. Clinicians often use therapies targeting systemic oxygen delivery to correct low ScvO 2 . Prospective research is needed to identify patients with severe hypoxemia that might benefit from interventions targeting systemic oxygen delivery.</description><identifier>ISSN: 1073-2322</identifier><identifier>EISSN: 1540-0514</identifier><identifier>DOI: 10.1097/SHK.0000000000002219</identifier><identifier>PMID: 37695634</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Epinephrine ; Humans ; Hypoxia - therapy ; Oxygen - therapeutic use ; Oxygen Saturation ; Prospective Studies ; Respiration, Artificial</subject><ispartof>Shock (Augusta, Ga.), 2023-11, Vol.60 (5), p.646-651</ispartof><rights>Copyright © 2023 by the Shock Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c307t-ffd50241bc55a08a5af1354f1783c56067e3e40c0773e1133e823273580d04563</citedby><cites>FETCH-LOGICAL-c307t-ffd50241bc55a08a5af1354f1783c56067e3e40c0773e1133e823273580d04563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37695634$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kanj, Amjad N</creatorcontrib><creatorcontrib>Rovati, Lucrezia</creatorcontrib><creatorcontrib>Zambrano, Claudia Castillo</creatorcontrib><creatorcontrib>Marquez, Alberto</creatorcontrib><creatorcontrib>Robbins, Kellie</creatorcontrib><creatorcontrib>Puentes, Gustavo Cortes</creatorcontrib><creatorcontrib>De Moraes, Alice Gallo</creatorcontrib><creatorcontrib>Gajic, Ognjen</creatorcontrib><title>EXPLORING THE ROLE OF CENTRAL VENOUS OXYGEN SATURATION IN THE EVALUATION AND MANAGEMENT OF SEVERE HYPOXEMIA IN MECHANICALLY VENTILATED PATIENTS</title><title>Shock (Augusta, Ga.)</title><addtitle>Shock</addtitle><description>Background: Although central venous oxygen saturation (ScvO 2 ) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low ScvO 2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. Methods: Retrospective review of data from adult intensive care unit patients with hypoxemia who required invasive mechanical ventilation for over 24 h and had at least one ScvO 2 measured within 6 h of a PaO 2 /FiO 2 ratio <200. Results: Of 442 mechanically ventilated patients with severe hypoxemia, 249 (56%) had an ScvO 2 <70%. When compared with patients with ScvO 2 ≥70%, those with low ScvO 2 had worse systemic oxygenation and hemodynamic parameters and were more likely to receive red blood cell transfusions (31.7% vs. 18.1%, P = 0.001), epinephrine (27.3% vs. 16.6%, P = 0.007), and inodilators. Outcomes such as median intensive care unit length of stay (7.5 vs. 8.3 days, P = 0.337) and hospital mortality (39.8% vs. 35.7%, P = 0.389) were not different between groups. When stratified by the central venous-to-arterial CO 2 difference (∆PCO 2 ), patients with a low ScvO 2 and normal ∆PCO 2 had lower median PaO 2 and hemoglobin levels and received more red blood cell transfusions, whereas those with an increased ∆PCO 2 had a lower pulse pressure and cardiac index and were more likely to receive epinephrine and milrinone. Conclusion: Low ScvO 2 is frequently observed in mechanically ventilated patients with severe hypoxemia, and these patients receive different interventions. Clinicians often use therapies targeting systemic oxygen delivery to correct low ScvO 2 . Prospective research is needed to identify patients with severe hypoxemia that might benefit from interventions targeting systemic oxygen delivery.</description><subject>Adult</subject><subject>Epinephrine</subject><subject>Humans</subject><subject>Hypoxia - therapy</subject><subject>Oxygen - therapeutic use</subject><subject>Oxygen Saturation</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial</subject><issn>1073-2322</issn><issn>1540-0514</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUV1PgzAUbYzGzek_MKaPvjBbSik8NtgBEcrCx7I9EcZKMrO5CduDv8K_bHHTGJvc9PbmnNPccwC4x2iMkcuesuBljP4c08TuBRhiaiEDUWxd6h4xYpjENAfgputeNcYiLrsGA8Jsl9rEGoJPMZ9GSRpKH-aBgGkSCZhMoCdknvIIzoRMigwm84UvJMx4XqQ8DxMJQ_mNFzMeFacJl88w5pL7ItbkXiQTM5EKGCymyVzEIe9JsfACLkOPR9GiV8_DiOfiGU61iH5lt-CqqTadujvfI1BMRO4FRpT4PcuoCWIHo2lWVG-DlzWlFXIqWjWYUKvBzCE1tZHNFFEWqhFjRGFMiHK0D4xQB62QpVcfgceT7r7dvR9Vdyi3665Wm031pnbHrjQduzdJl4ZaJ2jd7rquVU25b9fbqv0oMSr7KEodRfk_Ck17OP9wXG7V6pf04z35AvyMdwY</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Kanj, Amjad N</creator><creator>Rovati, Lucrezia</creator><creator>Zambrano, Claudia Castillo</creator><creator>Marquez, Alberto</creator><creator>Robbins, Kellie</creator><creator>Puentes, Gustavo Cortes</creator><creator>De Moraes, Alice Gallo</creator><creator>Gajic, Ognjen</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20231101</creationdate><title>EXPLORING THE ROLE OF CENTRAL VENOUS OXYGEN SATURATION IN THE EVALUATION AND MANAGEMENT OF SEVERE HYPOXEMIA IN MECHANICALLY VENTILATED PATIENTS</title><author>Kanj, Amjad N ; Rovati, Lucrezia ; Zambrano, Claudia Castillo ; Marquez, Alberto ; Robbins, Kellie ; Puentes, Gustavo Cortes ; De Moraes, Alice Gallo ; Gajic, Ognjen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-ffd50241bc55a08a5af1354f1783c56067e3e40c0773e1133e823273580d04563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Epinephrine</topic><topic>Humans</topic><topic>Hypoxia - therapy</topic><topic>Oxygen - therapeutic use</topic><topic>Oxygen Saturation</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kanj, Amjad N</creatorcontrib><creatorcontrib>Rovati, Lucrezia</creatorcontrib><creatorcontrib>Zambrano, Claudia Castillo</creatorcontrib><creatorcontrib>Marquez, Alberto</creatorcontrib><creatorcontrib>Robbins, Kellie</creatorcontrib><creatorcontrib>Puentes, Gustavo Cortes</creatorcontrib><creatorcontrib>De Moraes, Alice Gallo</creatorcontrib><creatorcontrib>Gajic, Ognjen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Shock (Augusta, Ga.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kanj, Amjad N</au><au>Rovati, Lucrezia</au><au>Zambrano, Claudia Castillo</au><au>Marquez, Alberto</au><au>Robbins, Kellie</au><au>Puentes, Gustavo Cortes</au><au>De Moraes, Alice Gallo</au><au>Gajic, Ognjen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>EXPLORING THE ROLE OF CENTRAL VENOUS OXYGEN SATURATION IN THE EVALUATION AND MANAGEMENT OF SEVERE HYPOXEMIA IN MECHANICALLY VENTILATED PATIENTS</atitle><jtitle>Shock (Augusta, Ga.)</jtitle><addtitle>Shock</addtitle><date>2023-11-01</date><risdate>2023</risdate><volume>60</volume><issue>5</issue><spage>646</spage><epage>651</epage><pages>646-651</pages><issn>1073-2322</issn><eissn>1540-0514</eissn><abstract>Background: Although central venous oxygen saturation (ScvO 2 ) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low ScvO 2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. Methods: Retrospective review of data from adult intensive care unit patients with hypoxemia who required invasive mechanical ventilation for over 24 h and had at least one ScvO 2 measured within 6 h of a PaO 2 /FiO 2 ratio <200. Results: Of 442 mechanically ventilated patients with severe hypoxemia, 249 (56%) had an ScvO 2 <70%. When compared with patients with ScvO 2 ≥70%, those with low ScvO 2 had worse systemic oxygenation and hemodynamic parameters and were more likely to receive red blood cell transfusions (31.7% vs. 18.1%, P = 0.001), epinephrine (27.3% vs. 16.6%, P = 0.007), and inodilators. Outcomes such as median intensive care unit length of stay (7.5 vs. 8.3 days, P = 0.337) and hospital mortality (39.8% vs. 35.7%, P = 0.389) were not different between groups. When stratified by the central venous-to-arterial CO 2 difference (∆PCO 2 ), patients with a low ScvO 2 and normal ∆PCO 2 had lower median PaO 2 and hemoglobin levels and received more red blood cell transfusions, whereas those with an increased ∆PCO 2 had a lower pulse pressure and cardiac index and were more likely to receive epinephrine and milrinone. Conclusion: Low ScvO 2 is frequently observed in mechanically ventilated patients with severe hypoxemia, and these patients receive different interventions. Clinicians often use therapies targeting systemic oxygen delivery to correct low ScvO 2 . Prospective research is needed to identify patients with severe hypoxemia that might benefit from interventions targeting systemic oxygen delivery.</abstract><cop>United States</cop><pmid>37695634</pmid><doi>10.1097/SHK.0000000000002219</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Epinephrine Humans Hypoxia - therapy Oxygen - therapeutic use Oxygen Saturation Prospective Studies Respiration, Artificial |
| title | EXPLORING THE ROLE OF CENTRAL VENOUS OXYGEN SATURATION IN THE EVALUATION AND MANAGEMENT OF SEVERE HYPOXEMIA IN MECHANICALLY VENTILATED PATIENTS |
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