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Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock
Author(s) -
NÉMETH M.,
TÁNCZOS K.,
DEMETER G.,
ÉRCES D.,
KASZAKI J.,
MIKOR A.,
MOLNÁR Z.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12312
Subject(s) - medicine , resuscitation , hypovolemia , anesthesia , hemorrhagic shock , carbon dioxide , shock (circulatory) , venous blood , oxygen , ecology , biology , chemistry , organic chemistry
Background Fluid resuscitation is still a major challenge. We aimed to describe changes in central venous oxygen saturation ( ScvO 2 ) and venous‐to‐arterial carbon dioxide gap ( dCO 2 ) during an experimental stroke volume ( SV ) index ( SVI )‐guided hemorrhage and fluid resuscitation model in pigs. Methods Twelve anesthetized, mechanically ventilated pigs were bled till baseline SVI ( T bsl ) dropped by 50% ( T 0 ), thereafter fluid resuscitation was performed with balanced crystalloid in four steps until initial SVI was reached ( T 4 ). Statistical analysis was performed with S tatistical P rogram for S ocial S ciences version 18.0; data are expressed as mean ± standard deviation. Results After bleeding, ScvO 2 dropped ( T bsl = 78 ± 7 vs. T 0 = 61 ± 5% P < 0.05) and oxygen extraction ratio increased ( T bsl = 0.20 ± 0.07 vs. T 0 = 0.36 ± 0.05, P < 0.05). By T 4 the ScvO 2 normalized, but on average it remained 5% lower than at T bsl ( T 4 = 73 ± 9% P < 0.05) and oxygen extraction also remained higher as compared with T bsl ( T 4 = 0.24 ± 0.09 P = 0.001). ScvO 2 showed significant correlation with SVI ( r = 0.564, P < 0.001). dCO 2 increased during hypovolemia ( T bsl :5.3 ± 2.0 vs. T 0 :9.6 ± 2.3 mmHg , P = 0.001), then returned to normal by T 4 = 5.1 ± 2.6 mmHg , and it also showed significant correlation with SVI ( R = −0.591, P < 0.001) and oxygen extraction ( R = 0.735, P < 0.001). Conclusions In this SV ‐guided bleeding and fluid resuscitation model, both ScvO 2 and dCO 2 correlated well with changes in SV , but only the dCO 2 returned to its baseline, normal value, while ScvO 2 remained significantly lower than at baseline. These results suggest that dCO 2 may be a good hemodynamic endpoint of resuscitation, while ScvO 2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.