High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients

Dimitrios Velissaris, Charalampos Pierrakos, Sabino Scolletta, Daniel De Backer, Jean Louis Vincent, Dimitrios Velissaris, Charalampos Pierrakos, Sabino Scolletta, Daniel De Backer, Jean Louis Vincent

Abstract

Introduction: The aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. We also sought to define whether fluid responsiveness would be less likely in the presence of a high SvO2 (>70%).

Methods: This observational study was conducted in a 32-bed university hospital medicosurgical ICU. The hemodynamic response to a fluid challenge was evaluated in 65 critically ill patients with severe sepsis. Patients were divided into two groups (responders and nonresponders) according to their cardiac index (CI) response to the challenge (>10% or <10%).

Results: Of the 65 patients, 34 (52%) were fluid responders. Baseline SvO2, CI, heart rate (HR) and mean arterial pressure (MAP) were not statistically different between groups. The responders had lower pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) at baseline than the nonresponders. After the fluid challenge, there were no differences between the two groups in MAP, CVP, PAOP or HR. There was no correlation between changes in CI or stroke volume index and baseline SvO2. Receiver operating characteristic analysis showed that SvO2 was not a predictor of fluid responsiveness.

Conclusions: The response of septic patients to a fluid challenge is independent of baseline SvO2. The presence of a high SvO2 does not necessarily exclude the need for further fluid administration.

Figures

Figure 1
Figure 1
Scatterplots of baseline CI (top) and SvO2 (bottom) values in responders (RS) and nonresponders (NON-RS). CI: confidence interval; SvO2: mixed venous oxygen saturation. Thin lines represent mean values, and thick lines the standard errors.
Figure 2
Figure 2
Relationship between baseline SvO2 levels and changes in cardiac index (%DCI) and stroke volume (%DSVI) in all patients (responders [RS] and nonresponders [NON-RS]). SvO2: mixed venous oxygen saturation.
Figure 3
Figure 3
ROC curves for baseline values of SvO2 (green line), CVP (blue line) and PAOP (red line). Diagonal segments are produced by ties. AUC were 0.51, 0.68 and 0.71 for SvO2, CVP and PAOP, respectively. CVP at a cutoff of 11 mmHg had a sensitivity of 67% and a specificity of 54% for predicting fluid responsiveness. PAOP at a cutoff of 13 mmHg had a sensitivity of 59% and a specificity of 65%. AUC: area under the curve; CVP: central venous pressure; PAOP: pulmonary artery occlusion pressure; ROC: receiver operating characteristic; SvO2: mixed venous oxygen saturation.

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