[Continuous monitoring of mixed venous blood oxygen saturation].
Mixed venous oxygen saturation (SvO2), measured on pulmonary artery blood, is a convenient indicator of matching between O2 transport (TaO2) and O2 body consumption (VO2). The measurement technique is based on the haemoglobin reflection spectrophotometry principle using two or three wave lengths. The Fick principle points out that SvO2 depends on five parameters: SvO2 = SaO2 - (VO2/CI x Hb x PO) where SaO2, CI and PO respectively represent arterial O2 saturation, cardiac index and O2 affinity. SvO2 does not always reflect tissue O2 tension: when considering a given value of SvO2, PvO2 will depend upon the position of the oxyhaemoglobin dissociation curve. It is impossible to establish in the absolute a "normal" value of SvO2. However, in most clinical circumstances, an SvO2 ranging from 60 to 80% attests that O2 tissue delivery is appropriate. Under certain conditions a continuous monitoring of SvO2 allows to assess another index such as ventilation-perfusion index or the O2 tissue extraction index. Usually SvO2 variations are more informative than the absolute SvO2 value. However, their interpretation should be cautious. First and foremost, the ability of each of the four main SvO2 determinants to influence the SvO2 is unequal as the numerical ranges of variation of these determinants are very different. Moreover, the attribution of a variation of SvO2 to one of its determinants implies that each of them is independent from the others, a feature which is very rarely seen in clinical practice. Finally as the mathematical relationship between SvO2 and its determinants is linear (SaO2 and VO2), or hyperbolic (CI and Hb), the weight of SaO2 or VO2 is independent of their absolute value, whereas CI or Hb weights will depend on their value. The limits of SvO2 monitoring are linked first to the occurrence of an anaerobic metabolism state when TaO2 becomes too low; SvO2 then just provides informations on the aerobic part of the metabolism. Moreover, SvO2 is just a global indicator for tissue O2 oxygenation status which does not give any indication about regional flow distribution. Therefore, SvO2 enables systemic imbalance supervision only. Finally, the existence of a right-to-left shunt will modify the SvO2 values through various mechanisms. However the SvO2 measured, in the pulmonary artery, remains reliable, whereas the presence of a left-to-right shunt will highly alter SvO2 basal value, only its time course remaining significant. SvO2 monitoring, element of diagnosis and monitoring, as well as a warning signal, has a priori specific indications poorly assessed, so far. (ABSTRACT TRUNCATED AT 400 WORDS)
Journois
D
D
Département d'Anesthésie-Réanimation, Hôpital Laennec, Paris.
Safran
D
D
D006348:Cardiac Surgical Procedures; D002407:Catheterization, Swan-Ganz; D016638:Critical Illness; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D008991:Monitoring, Physiologic; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D014680:Veins
D010100:Oxygen
Monitorage continu de la saturation du sang veineux mêlé en oxygène.