title: Low and "supranormal" central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study.
abstract: OBJECTIVE
  To characterize incidence of low, normal and "supranormal" central venous oxygen saturation (ScvO(2)) and the relation to markers of tissue hypoxia, course and outcome in cardiac surgery patients.
  
  
  METHODS
  Prospective, observational study in a university multidisciplinary 50-bed intensive care unit including 205 consecutive patients undergoing elective cardiac surgery. Data were split into training and test data sets and subjected to 50 replications of fivefold cross-validation to estimate lower and upper bounds of ScvO(2) indicative of impaired tissue oxygenation.
  
  
  RESULTS
  Both low (≤ 60.8%) and supranormal (≥ 77.4%) ScvO(2) were associated with an unfavorable course, while the logistic EuroSCORE for risk adjustment was comparable between groups. Incidences of abnormal ScvO(2) were 13.2% low and 30.7% supranormal. Patients with low ScvO(2) and an uneventful course initially presented with normal lactate levels, whereas patients with supranormal ScvO(2) displayed consistently higher serum lactate levels. High ScvO(2) values were associated with the use of β-mimetics and signs of systemic inflammation. Mortality rates were comparable for patient populations presenting either low (14.8%) or supranormal ScvO(2) (7.9%) and higher than normals (0%, p < 0.001). Lactate was comparably increased in patients that ultimately died, irrespective whether they had low or supranormal ScvO(2) values. In contrast, neither low nor supranormal ScvO(2) was associated with altered gastric pCO(2.)
  
  
  CONCLUSIONS
  High ScvO(2) is an under-recognized warning sign for impaired tissue oxygenation in the peri-operative period. Including values ≥ 77.4% as 'normal' impaired performance of ScvO(2) monitoring to predict a complicated perioperative course.
authors.affiliation: Department of Anesthesiology and Critical Care Therapy, Jena University Hospital, 07740 Jena, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Perz
authors.forename: Thomas
authors.initials: T
authors.lastname: Uhlig
authors.forename: Matthias
authors.initials: M
authors.lastname: Kohl
authors.forename: Donald L
authors.initials: DL
authors.lastname: Bredle
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.forename: Andreas
authors.initials: A
authors.lastname: Kortgen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D015687:Cell Hypoxia; D005260:Female; D006801:Humans; D018496:Hyperoxia / Q000097:blood; D000860:Hypoxia / Q000097:blood; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood; D011446:Prospective Studies; D012016:Reference Values
chemical_list: D015415:Biomarkers; D010100:Oxygen