Crit Care Med 2000; 28:1569–71, Dörges V, Wenzel V, Dix S, Kühl A, Schumann T, Hüppe M, Iven H, Gerlach K: The effect of midazolam on stress levels during simulated emergency medical service transport: A placebo-controlled, dose-response study. Clinical relevance of data from the pulmonary artery catheter. A critical stock taking]. Anesth Analg 2002; 95:417–22, Scheeren T, Schwarte L, Arndt J: Metabolic regulation of cardiac output during inhalation anaesthesia in dogs. An ScvO2 measurement is a surrogate for the SvO2. lactic acid) that is difficult for the body to eliminate quickly. PCWP CO SVR SVO2 Hypovolemic v v ^ v Cardiogenic ^ v ^ v Septic v or = ^ v ^ Prevalence • Occurs in 5-8% of STEMI and 2.5% of NonSTEMI • 40,000-50,000 cases annually in the US. Anesth Analg 2007; 104:689–702, Chawla L, Zia H, Gutierrez G, Katz N, Seneff M, Shah M: Lack of equivalence between central and mixed venous oxygen saturation. J Intens Care Soc 2009; 10:99–101, Reinhart K, Rudolph T, Breedle D, Hannemann L, Cain S: Comparison of central-venous to mixed-venous oxygen saturations during changes in oxygen supply/demand. In patients undergoing major abdominal as well as cardiac surgical procedures, intraoperative reductions in SvO2 and Scvo2 have been associated with postoperative complications. Ann Fr Anesth Reanim. In otherwords, a decreased SvO2 indicates that the cardiac output is not high enough to meet tissue oxygen needs. J Cardiothorac Vasc Anesth 2001; 15:574–9, Reinhart K, Kersting T, Föhring U, Schäfer M: Can central-venous replace mixed-venous oxygen saturation measurements during anesthesia? Anesthesiology 1972; 36:378–400, Bernard J, Bourreli B, Pinaud M: Effects of systemic morphine and epidural bupivacaine on postoperative oxygen consumption during rewarming. It is impossible to estimate the cardiac output merely by looking at the central venous oxygen saturation. This concept has a certain physiologic appeal and has been advocated by some authors (Gattinoni 2013). The oxygen extraction ratio is the ratio of the oxygen consumed by the body (VO2) to the oxygen delivered to the body (DO2). The bottom line is that the Fick equation amplifies the amount of random error involved in each of the values entered into it. It can be very useful if measured before and after changes are made to cardiac medications or mechanical ventilation, particularly in unstable patients. J Clin Anesth 1994; 6:95–8, Freebairn R, Derrick J, Gomersall C, Young R, Joynt G: Oxygen delivery, oxygen consumption, and gastric intramucosal pH are not improved by a computer-controlled, closed-loop, vecuronium infusion in severe sepsis and septic shock. Epub 2014 Apr 26. Intens Care Med 1988; 14:373–8, Harms M, Lieshout JV, Jenstrup M, Pott F, Secher N: Postural effects on cardiac output and mixed venous oxygen saturation in humans. Diagnostic accuracy of central venous saturation in estimating mixed venous saturation is proportional to cardiac performance among cardiac surgical patients. An increase in extraction is the bodies way to meet tissue oxygen needs when the amount of oxygen reaching the tissues is less than needed. Unfortunately, there are several limitations which prevent cvO2% from being an accurate measurement of oxygenation: This blog has taken a more theoretical approach, due to a lack of direct evidence. EXAMPLE:13:01 48 yo W M with chest pressure, VS BP-130/90, P-68 Br Med J 2006; 332:1482, Khuri S, Henderson W, DelPalma R, Mosca C, Healey N, Kumbhani D: Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. It is well established in the literature that septic shock may be accompanied by low, normal, or high cvO2% values. The PulmCrit blog doesn't actually advocate for using a Magic 8-ball for clinical care. If this is not sufficient to meet tissue energy needs, third compensation come in to play. Ann Surg 1966; 163:866–85, Kusano C, Baba M, Takao S, Sana S, Scimada M, Shirao K, Natsugoe S, Fukumoto T, Aiko T: Oxygen delivery as a factor in the development of fatal postoperative complications after oesophagectomy. A mixed venous blood gas is a sample aspirated from the most distal port of the PA catheter, offering a mixture of inferior vena cava blood, superior vena cava blood, and the coronary sinuses. Second Compensation: Tissue oxygen extraction increases. Br J Anaesth 1975; 47:686–94, DeLaunay L, Bonnet F, Duval P: Clonidine decreases post-operative oxygen consumption in patients recovering from general anaesthesia. Intens Care Med 2006; 32:1336–43, Turnaoglu S, Tugrul M, Camci E, Cakar N, Akinci Ō, Ergin P: Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. Ann Thorac Surg 1990; 49:497–9, Edwards J, Mayall R: Importance of the sampling site for measurement of mixed venous oxygen saturation in shock.

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