Influence of Central Venous Oxygen Saturation on In-hospital Mortality of Surgical Patients
Revista Brasileira de Anestesiologia
Silva Junior JM, Oliveira AMRR, Morais SZ, Araújo LS, Victoria LGF, Marubayashi LY -Influence of Central Venous Oxygen Saturation on In-hospital Mortality of Surgical Patients. Background and objectives: Low central venous oxygen saturation (ScvO 2 ) indicates an imbalance between cellular oxygen supply and consumption and, consequently, worse prognosis for critical patients. However, it is not clear what the value of this marker in surgical patients. The objective of the present study was to
... sent study was to evaluate whether low perioperative ScvO 2 determines a worse prognosis. Methods: This is a 6-month observational study carried on in a tertiary hospital. Patients who needed to be in the intensive care unit (ICU) postoperatively, with age ≥ 18 years, who underwent large surgeries, were included. Patients who underwent palliative surgeries and those with severe heart failure were excluded. Levels of ScvO 2 were measured before the surgery, during the procedure, and after the surgery in the ICU. Results: Sixty-six patients were included in this study, but 25.8% of them did not survive. Mean ScvO 2 levels were higher intraoperatively, 84.7 ± 8.3%, than preoperatively and in the ICU, 74.1 ± 7.6% and 76.0 ± 10.5% (p = 0.0001), respectively. However, only preoperative SvcO 2 levels of non-surviving patients were significantly lower than those who survived. By logistic regression, preoperative ScvO 2 , OR = 0.85 (95% CI 0.74-0.98) (p = 0.02), was an independent factor of in-hospital mortality. Patients with preoperative ScvO 2 < 70% had greater need of intraoperative blood transfusion (80.0% versus 37.0%, p = 0.001) and volume replacement, 8,000.0 (6,500.0-9,225.0) mL versus 6,000.0 (4,500.0-8,500.0) mL (p = 0.04), with greater chances of postoperative complications (75% versus 45.7%, p = 0.02) and longer time in the ICU, 4.0 (20.0-5.0) days versus 3.0 (1.7-4.0) days (p = 0.02). Conclusions: Intraoperative ScvO 2 levels are higher than those both in the pre-and postoperative period. However, low preoperative ScvO 2 determines worse prognosis. Justificativa e objetivos: Saturação venosa central de oxigênio (SvcO 2 ) baixa indica desequilíbrio entre oferta e consumo de oxigênio celular e, consequentemente, pior prognóstico em pacientes graves. No entanto, ainda não está claro qual o valor desse marcador em pacientes cirúrgicos. O objetivo deste estudo foi avaliar se SvcO 2 baixa no perioperatório determina pior prognóstico. Método: Estudo observacional, durante 6 meses, em um hospital terciário. Foram incluídos pacientes que necessitassem de pós-operatório em terapia intensiva (UTI) com idade ≥ 18 anos, submetidos a cirurgias de grande porte. Pacientes com cirurgias paliativas e pacientes com insuficiên cia cardíaca grave foram excluídos. Valores de SvcO 2 foram mensurados antes da cirurgia, durante o procedimento e após a cirurgia na UTI.