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Incidence of low central venous oxygen saturation after standard postoperative intensive care management

Introduction

Targeted early postoperative management of high-risk surgical patients has been reported to be associated with a lower rate of complications and shorter hospital length of stay (HLOS) compared with conventional management. A low postoperative central venous oxygen saturation (ScVO2) has also been shown to be associated with higher rates of complications and of HLOS for high-risk surgical patients. Benefit from early goal-directed therapy would be unlikely if 'standard' postoperative management resulted in a low incidence of patients with a low ScVO2 in the early postoperative period.

Methods

Arterial and central venous blood gas analysis was done on admission (T1) and after 8 hours (T2) of admission to the ICU. The HLOS and the incidence of complications were determined for patients with low (<70%) or normal (≥70%) ScVO2.

Results

Sixty-three postoperative patients were screened and 23 patients were analysed. Patients were excluded if they did not have a central line positioned in the superior vena cava or blood had not been sampled at both time points. Patients with pre-ICU HLOS > 5 days (n = 10), acute spinal cord injury (n = 3), or admitted for postoperative airway management (n = 4) were omitted. ScVO2 was low in 7/23 patients at T2 and six of these had lower gastrointestinal surgery. The HLOS (median (IQR)) was longer in those with low ScVO2 at T2 (17 (37.8) v 9.5 (5.0) days, P = 0.04). The incidence of complications was not different. There were no differences between the ScVO2 groups at T2 with respect to age, gender, standard base excess, lactate, haemoglobin, mean arterial pressure or central venous pressure. The volume of colloid the two groups received in the 8-hour observation period was not different although there was a trend for the low group to receive more crystalloid (P = 0.08).

Conclusion

A significant proportion of patients had a low ScVO2, which was associated with increased HLOS. The results provide a basis for the trial of postoperative early goal-directed therapy for high-risk surgical patients admitted to our ICU.

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Boyle, M., Steel, E., Murgo, M. et al. Incidence of low central venous oxygen saturation after standard postoperative intensive care management. Crit Care 11, P303 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5463

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Keywords

  • Acute Spinal Cord Injury
  • Central Venous Oxygen Saturation
  • Intensive Care Management
  • Postoperative Intensive Care
  • Central Venous Blood