Venöse Sauerstoffsättigung

Kernaussagen

Die venöse Sauerstoffsättigung ist ein globaler Parameter zur Abschätzung der Balance zwischen Sauerstoffangebot und Sauerstoffbedarf. Aussagen zu regionalen Störungen der Sauerstoffbilanz sind mit der venösen Sauerstoffsättigung aber nicht zu treffen.

Zur Frage, ob die zentralvenöse Sättigung die gemischtvenöse ersetzen kann, gibt es unterschiedliche Auffassungen. Entscheidet man sich für die routinemäßige Verwendung der zentralvenösen Sättigung, so steht immer die Verlaufsbeobachtung, nie der Einzelwert im Vordergrund.

Eine erniedrigte gemischtvenöse (< 65 %) oder zentralvenöse Sättigung (< 70 %) kann ein Hinweis auf eine Gewebehypoxie sein und sollte zunächst auf Plausibilität überprüft werden. Dazu gehören Kontrolle der Katheterlage, Überprüfung des Trends und Interpretation im Kontext mit anderen Indikatoren einer Gewebehypoxie (Laktat, Organfunktion).

Bei Bestätigung oder weiterem Absinken der venösen Sättigung verbessert man Sauerstoffangebot und Sauerstoffverbrauch durch eine Optimierung aller Determinanten der venösen Sauerstoffsättigung.

Eine normale zentralvenöse oder gemischtvenöse Sättigung schließt eine Gewebehypoxie nicht aus.

Literatur

• 1 Rivers E, Nguyen B, Havstad S. et al . Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001;  345 1368-1377
• 2 Reinhart K. Monitoring O2 transport and tissue oxygenation in critically ill patients. In: Reinhart KE, ed Clinical aspects of O2 transport and tissue oxygenation. Berlin; Springer 1989: 195-211
• 3 Rady M Y, Rivers E P, Nowak R M. Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate.  Am J Emerg Med. 1996;  14 218-225
• 4 Marx G, Reinhart K. Venous oximetry.  Curr Opin Crit Care. 2006;  12 263-268
• 5 Reinhart K, Bloos F. The value of venous oximetry.  Curr Opin Crit Care. 2005;  11 259-263
• 6 Harvey S, Harrison D A, Singer M. et al . Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial.  Lancet. 2005;  366 472-477
• 7 Sakr Y, Vincent J L, Reinhart K. et al . Use of the pulmonary artery catheter is not associated with worse outcome in the ICU.  Chest. 2005;  128 2722-2731
• 8 Vincent J L, De Backer D. Oxygen transport – the oxygen delivery controversy.  Intensive Care Med. 2004;  30 1990-1996
• 9 Fick A. Über die Messung des Butquantums in den Herzventrikeln.  Sitzungsber Phys Med Ges Würzburg. 1870;  Bd II XVI
• 10 Barrat-Boyes B G, Wood E H. The oxygen saturation of blood in the venae cavae, right-heart chambers, and pulmonary vessels of healthy subjects.  J Lab Clin Med. 1957;  50 93-106
• 11 Hall J B. Mixed venous oxygen saturation (SvO2). In: Pinsky MR, ed Functional hemodynamic monitoring. Berlin; Springer 2004: 233-240
• 12 Kasnitz P, Druger G L, Yorra F, Simmons D H. Mixed venous oxygen tension and hyperlactatemia. Survival in severe cardiopulmonary disease.  Jama. 1976;  236 570-574
• 13 Kandel G, Aberman A. Mixed venous oxygen saturation. Its role in the assessment of the critically ill patient.  Arch Intern Med. 1983;  143 1400-1402
• 14 Schlichtig R, Cowden W L, Chaitman B R. Tolerance of unusually low mixed venous oxygen saturation. Adaptations in the chronic low cardiac output syndrome.  Am J Med. 1986;  80 813-818
• 15 Hoffman G M, Ghanayem N S, Kampine J M. et al . Venous saturation and the anaerobic threshold in neonates after the Norwood procedure for hypoplastic left heart syndrome. (Discussion 1521).  Ann Thorac Surg. 2000;  70 1515-1520
• 16 Spronk P E. Microcirculatory and Mitochondrial Distress Syndrome (MMDS). In: Pinsky MR, ed Functional hemodynamic monitoring. Berlin; Springer 2004: 47-67
• 17 Rivers E P, Ander D S, Powell D. Central venous oxygen saturation monitoring in the critically ill patient.  Curr Opin Crit Care. 2001;  7 204-211
• 18 Vincent J L. Does central venous oxygen saturation accurately reflect mixed venous oxygen saturation? Nothing is simple, unfortunately.  Intensive Care Med. 1992;  18 386-387
• 19 Baskin K M, Jimenez R M, Cahill A M, Jawad A F, Towbin R B. Cavoatrial junction and central venous anatomy: implications for central venous access tip position.  J Vasc Interv Radiol. 2008;  19 359-365
• 20 Vesely T M. Central venous catheter tip position: a continuing controversy.  J Vasc Interv Radiol. 2003;  14 527-534
• 21 Peres P W. Positioning central venous catheters – a prospective survey.  Anaesth Intensive Care. 1990;  18 536-539
• 22 Dueck M H, Klimek M, Appenrodt S, Weigand C, Boerner U. Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions.  Anesthesiology. 2005;  103 249-257
• 23 Chawla L S, Zia H, Gutierrez G, Katz N M, Seneff M G, Shah M. Lack of equivalence between central and mixed venous oxygen saturation.  Chest. 2004;  126 1891-1896
• 24 Berridge J C. Influence of cardiac output on the correlation between mixed venous and central venous oxygen saturation.  Br J Anaesth. 1992;  69 409-410
• 25 Edwards J D, Mayall R M. Importance of the sampling site for measurement of mixed venous oxygen saturation in shock.  Crit Care Med. 1998;  26 1356-1360
• 26 Herrera A, Pajuelo A, Morano M J. et al . Comparison of oxygen saturations in mixed venous and central blood during thoracic anesthesia with selective single-lung ventilation.  Rev Esp Anestesiol Reanim. 1993;  40 349-353
• 27 Ladakis C, Myrianthefs P, Karabinis A. et al . Central venous and mixed venous oxygen saturation in critically ill patients.  Respiration. 2001;  68 279-285
• 28 Martin C, Auffray J P, Badetti C, Perrin G, Papazian L, Gouin F. Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients.  Intensive Care Med. 1992;  18 101-104
• 29 Lee J, Wright F, Barber R, Stanley L. Central venous oxygen saturation in shock: a study in man.  Anesthesiology. 1972;  36 472-478
• 30 Reinhart K, Kuhn H J, Hartog C, Bredle D L. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill.  Intensive Care Med. 2004;  30 1572-1578
• 31 Tahvanainen J, Meretoja O, Nikki P. Can central venous blood replace mixed venous blood samples?.  Crit Care Med. 1982;  10 758-761
• 32 Scheinman M M, Brown M A, Rapaport E. Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients.  Circulation. 1969;  40 165-172
• 33 Pieri M, Brandi L S, Bertolini R, Calafa M, Giunta F. Comparison of bench central and mixed pulmonary venous oxygen saturation in critically ill postsurgical patients.  Minerva Anestesiol. 1995;  61 285-291
• 34 Wendt M, Hachenberg T, Albert A, Janzen R. Mixed venous versus central venous oxygen saturation in intensive medicine.  Anasth Intensivther Notfallmed. 1990;  25 102-106
• 35 Varpula M, Karlsson S, Ruokonen E, Pettila V. Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock.  Intensive Care Med. 2006;  32 1336-1343
• 36 Sander M, Spies C D, Foer A. et al . Agreement of central venous saturation and mixed venous saturation in cardiac surgery patients.  Intensive Care Med. 2007;  33 1719-1725
• 37 Gutierrez G, Comignani P, Huespe L. et al . Central venous to mixed venous blood oxygen and lactate gradients are associated with outcome in critically ill patients.  Intensive Care Med. 2008;  34 1662-1668
• 38 Turnaoglu S, Tugrul M, Camci E, Cakar N, Akinci O, Ergin P. Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation.  J Cardiothorac Vasc Anesth. 2001;  15 574-579
• 39 Bland J M, Altman D G. Statistical methods for assessing agreement between two methods of clinical measurement.  Lancet. 1986;  1 307-310
• 40 Dellinger R P, Carlet J M, Masur H. et al . Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.  Intensive Care Med. 2004;  30 536-555
• 41 Reinhart K, Brunkhorst F, Bone H. et al . Diagnosis and therapy of sepsis: guidelines of the German Sepsis Society Inc. and the German Interdisciplinary Society for Intensive and Emergency Medicine.  Anaesthesist. 2006;  55 [Suppl 1] 43-56
• 42 Hayes M A, Timmins A C, Yau E H, Palazzo M, Hinds C J, Watson D. Elevation of systemic oxygen delivery in the treatment of critically ill patients.  N Engl J Med. 1994;  330 1717-1722
• 43 Gattinoni L, Brazzi L, Pelosi P. et al . A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group.  N Engl J Med. 1995;  333 1025-1032
• 44 Dellinger R P, Levy M M, Carlet J M. et al . Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.  Crit Care Med. 2008;  36 296-327
• 45 Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J. A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients.  Anesth Analg. 2000;  90 1052-1059
• 46 Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds R M, Bennett E D. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445].  Crit Care. 2005;  9 R687-R693
• 47 Rady M Y, Rivers E P, Martin G B, Smithline H, Appelton T, Nowak R M. Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock.  Am J Emerg Med. 1992;  10 538-541
• 48 Scalea T M, Hartnett R W, Duncan A O. et al . Central venous oxygen saturation: a useful clinical tool in trauma patients.  J Trauma. 1990;  30 1539-1543
• 49 Gore J M, Sloan K. Use of continuous monitoring of mixed venous saturation in the coronary care unit.  Chest. 1984;  86 757-761
• 50 Goldman R H, Klughaupt M, Metcalf T, Spivack A P, Harrison D C. Measurement of central venous oxygen saturation in patients with myocardial infarction.  Circulation. 1968;  38 941-946
• 51 Nakazawa K, Hikawa Y, Saitoh Y, Tanaka N, Yasuda K, Amaha K. Usefulness of central venous oxygen saturation monitoring during cardiopulmonary resuscitation.  Intensive Care Med. 1994;  20 450-451
• 52 Heinze H, Hanke T, Misfeld M. A mysterious difference between central and mixed venous oxygen saturation after cardiac surgery.  Appl Cardiopulm Pathophysiol. 2008;  12 20-22
• 53 Vincent J L, Pinsky M R, Sprung C L. et al . The pulmonary artery catheter: in medio virtus.  Crit Care Med. 2008;  36 3093-3096