Continuous venous oximetry for hemodynamic and oxygen transport stability post cardiac surgery.
Under the diagnostic-related group (DRG) reimbursement system, hospitals are looking to decrease costs related to unnecessary laboratory measurements. To assess the efficacy of continuous SvO2 as the only means to monitor the balance of the oxygen transport of the stable postoperative cardiac patient in the ICU, we studied 26 adult patients undergoing cardiac surgery with an uneventful postoperative course. All subjects had an Opticath fiberoptic PA catheter inserted for 29.6. +/- 11.0 hours (range 16-66) and spent an average of 42.4 +/- 17.5 hours in the Intensive Care Unit (range 20-87). Cardiac output, and Hemoglobin/Hematocrit were determined serially every 2 hours during the first 6 postoperative hours and 4 hours respectively according to our ICU practice. Arterial blood gases were determined freely in relation to changes in the hemodynamic and respiratory status. No clinical decisions were undertaken on the basis of SvO2. Retrospectively it was determined whether basing decisions on the SvO2 would have reduced the number of unnecessary cardiac outputs, ABGs and Hgb/Hcts. Using the SvO2 as potential indicator of hemodynamic and oxygen transport stability it could significantly reduce the number of determinations per patient, ie, cardiac output (11.7 +/- 4.2 vs 2.1 +/- 0.3, p less than 0.05), ABGs (11.3 +/- 2.8 vs 2.8 +/- 0.4, p less than 0.05) and Hgb/Hcts (5.7 +/- 1.3 vs 2.0 +/- 0.0, p less than 0.05). The use of SvO2 would save the hospital $84.5 +/- 27.5 (range 31.5 +/- 140.9) per stable patient in the ICU and a total of 220.4 +/- 69.9 minutes (range 90-300) of ICU nursing time.(ABSTRACT TRUNCATED AT 250 WORDS)
Cernaianu
A C
AC
Department of Anesthesia, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden.
DelRossi
A J
AJ
Boatman
G A
GA
Moore
M W
MW
Posner
M A
MA
Cilley
J H
JH
Baldino
W A
WA
Santos
Z L
ZL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000191:economics; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics; D010092:Oximetry / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D010100:Oxygen / Q000097:blood; D011182:Postoperative Care / Q000191:economics / Q000379:methods*
D010100:Oxygen