Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients.
OBJECTIVE
Blood O(2) saturation and lactate concentration gradients from superior vena cava (SVC) to pulmonary artery (PA) occur in critically ill patients. These gradients (DeltaSO(2) and Delta[Lac]) may be positive or negative. We tested the hypothesis that positive DeltaSO(2) and Delta[Lac] are associated with improved survival in critically ill patients.


METHODS
Multinational, prospective observational study conducted in six medical and surgical ICUs.


METHODS
Consecutive sample of 106 adults requiring insertion of a pulmonary artery catheter (PAC). Average age was 59.5 +/- 15.5 years, APACHE II score was 15.5 +/- 6.7 (mean +/- SD). Main outcome measure was 28-day mortality.


METHODS
None.


RESULTS
We drew blood samples from the proximal and distal ports of PACs every 6 h from the time of PAC insertion (Initial measurement) until its removal (Final measurement). Samples were analyzed for SO(2), [Lac], glucose concentration and blood gases. Hemodynamic measurements were obtained after blood samples. We monitored patients for 30.9 +/- 11.0 h. Overall mortality rate was 25.5%. More survivors had mean and final DeltaSO(2) > or = 0 and Delta[Lac] > or = 0 than decedents (p < 0.01; p < 0.05 respectively). On the average, DeltaSO(2) and Delta[Lac] were positive in survivors and negative in decedents. Survival odds ratios for final measurements of DeltaSO(2) > or = 0 and Delta[Lac] > or = 0 were 19.22 and 7.70, respectively (p < 0.05).


CONCLUSIONS
A strong association exists between positive DeltaSO(2) and Delta[Lac] and survival in critically ill patients. Whether therapy aimed at increasing DeltaSO(2) and Delta[Lac] results in improved ICU survival remains to be determined.
Pulmonary and Critical Care Medicine Division, The George Washington University Medical Center, 2150 Pennsylvania Ave., N.W, Washington, DC, 20037, USA. ggutierrez@mfa.gwu.edu
Guillermo
G
Gutierrez
Pablo
P
Comignani
Luis
L
Huespe
F Javier
FJ
Hurtado
Arnaldo
A
Dubin
Vinayak
V
Jha
Yanina
Y
Arzani
Silvio
S
Lazzeri
Lombardo
L
Sosa
Juan
J
Riva
Wolf
W
Kohn
Daniela
D
Suarez
Gonzalo
G
Lacuesta
Daniela
D
Olmos
Carlos
C
Mizdraji
Alejandra
A
Ojeda
D018806:APACHE; D002405:Catheterization, Central Venous; D016638:Critical Illness / Q000145:classification / Q000401:mortality*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007773:Lactates / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D018805:Sepsis / Q000097:blood* / Q000401:mortality*; D016019:Survival Analysis
D007773:Lactates; D010100:Oxygen