Equipment review: the success of early goal-directed therapy for septic shock prompts evaluation of current approaches for monitoring the adequacy of resuscitation.
A recent trial utilizing central venous oxygen saturation (SCVO2) as a resuscitation marker in patients with sepsis has resulted in its inclusion in the Surviving Sepsis Campaign guidelines. We review the evidence behind SCVO2 and its relationship to previous trials of goal-directed therapy. We compare SCVO2 to other tools for assessing the adequacy of resuscitation including physical examination, biochemical markers, pulmonary artery catheterization, esophageal Doppler, pulse contour analysis, echocardiography, pulse pressure variation, and tissue capnometry. It is unlikely that any single technology can improve outcome if isolated from an organized pattern of early recognition, algorithmic resuscitation, and frequent reassessment. This article includes a response to the journal's Health Technology Assessment questionnaire by the manufacturer of the SCVO2 catheter.
Gunn
Scott R
SR
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Fink
Mitchell P
MP
Wallace
Benjamin
B
D015415:Biomarkers / Q000097:blood; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods; D002985:Clinical Protocols; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D012151:Resuscitation / Q000592:standards*; D012772:Shock, Septic / Q000097:blood* / Q000628:therapy*; D016896:Treatment Outcome
D015415:Biomarkers; D010100:Oxygen