Hepatic venous oxygen saturation monitoring in patients with assisted circulation for severe cardiac failure.
In order to assess the adequacy of hepatic perfusion, hepatic venous oxygen saturation (ShvO2) was monitored in five patients undergoing mechanical circulatory support. Two patients were with intra-aortic balloon pumping (IABP), one was with a left ventricular assist device (LVAD), and two were with biventricular assist devices (BVAD). The mean ShvO2 values during assistance in each patient ranged from 27 to 84%. One patient with IABP showed persistently low ShvO2 (less than 30%) in spite of higher mixed venous oxygen saturation (SvO2) and subsequently developed hepatic dysfunction and multiple organ failure. In another patient, ShvO2 was 22% on average during LVAD, but increased to greater than 50% after adding a right ventricular assist device (RVAD). Of 3 patients with persistently high ShvO2 (44-80%, on average), only one developed hepatic failure--probably from prior severe shock--and the other two did not develop hepatic failure. There was a significant negative correlation between ShvO2 and splanchnic excess lactate, the parameter of anaerobic metabolism in the splanchnic area. In contrast, there was no correlation between simultaneously measured ShvO2 and SvO2 values when analyzed in a range of SvO2 below 70%. ShvO2 monitoring may be useful for evaluation of hepatic perfusion status in the management of critical patients, requiring assisted circulation.
Takano
H
H
First Department of Surgery, Osaka University Medical School, Japan.
Matsuda
H
H
Kaneko
M
M
Sakai
K
K
Matsuwaka
R
R
Takami
H
H
Shintani
H
H
Masai
T
T
Nakano
S
S
Kawashima
Y
Y
D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007423:Intra-Aortic Balloon Pumping; D008102:Liver Circulation / Q000502:physiology*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010100:Oxygen / Q000097:blood*
D010100:Oxygen