scholarly journals Central Venous-to-ArterialCO2Gap Is a Useful Parameter in Monitoring Hypovolemia-Caused Altered Oxygen Balance: Animal Study

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Szilvia Kocsi ◽  
Gabor Demeter ◽  
Daniel Erces ◽  
Eniko Nagy ◽  
Jozsef Kaszaki ◽  
...  
Keyword(s):  
Central Venous Oxygen Saturation ◽  
Blood Gas Analysis ◽  
Significant Negative Correlation ◽  
Gas Analysis ◽  
Oxygen Extraction ◽  
Oxygen Balance ◽  
Capillary Perfusion ◽  
Central Venous ◽  
Significant Drop ◽  
Red Blood Cell Velocity

Monitoring hypovolemia is an everyday challenge in critical care, with no consensus on the best indicator or what is the clinically relevant level of hypovolemia. The aim of this experiment was to determine how central venous oxygen saturation (ScvO2) and central venous-to-arterial carbon dioxide difference (CO2gap) reflect hypovolemia-caused changes in the balance of oxygen delivery and consumption. Anesthetized, ventilated Vietnamese minipigs (n=10) were given a bolus followed by a continuous infusion of furosemide. At baseline and then in five stages hemodynamic, microcirculatory measurements and blood gas analysis were performed. Oxygen extraction increased significantly, which was accompanied by a significant drop in ScvO2and a significant increase in CO2gap. There was a significant negative correlation between oxygen extraction and ScvO2and significant positive correlation between oxygen extraction and CO2gap. TakingScvO2<73% and CO2gap >6 mmHg values together to predict an oxygen extraction >30%, the positive predictive value is 100%; negative predicted value is 72%. Microcirculatory parameters, capillary perfusion rate and red blood cell velocity, decreased significantly over time. Similar changes were not observed in the sham group. Our data suggest thatScvO2<73% and CO2gap >6 mmHg can be complementary tools in detecting hypovolemia-caused imbalance of oxygen extraction.

scholarly journals Monitoring Microcirculatory Blood Flow with a New Sublingual Tonometer in a Porcine Model of Hemorrhagic Shock

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Péter Palágyi ◽  
József Kaszaki ◽  
Andrea Rostás ◽  
Dániel Érces ◽  
Márton Németh ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Central Venous Oxygen Saturation ◽  
Carbon Dioxide Partial Pressure ◽  
Orthogonal Polarization ◽  
Rubber Tube ◽  
Capillary Perfusion ◽  
Central Venous ◽  
Significant Drop ◽  
Orthogonal Polarization Spectral ◽  
Indirect Evaluation

Tissue capnometry may be suitable for the indirect evaluation of regional hypoperfusion. We tested the performance of a new sublingual capillary tonometer in experimental hemorrhage. Thirty-six anesthetized, ventilated mini pigs were divided into sham-operated (n=9) and shock groups (n=27). Hemorrhagic shock was induced by reducing mean arterial pressure (MAP) to 40 mmHg for 60 min, after which fluid resuscitation started aiming to increase MAP to 75% of the baseline value (60–180 min). Sublingual carbon-dioxide partial pressure was measured by tonometry, using a specially coiled silicone rubber tube. Mucosal red blood cell velocity (RBCV) and capillary perfusion rate (CPR) were assessed by orthogonal polarization spectral (OPS) imaging. In the 60 min shock phase a significant drop in cardiac index was accompanied by reduction in sublingual RBCV and CPR and significant increase in the sublingual mucosal-to-arterial PCO2gap (PSLCO2gap), which significantly improved during the 120 min resuscitation phase. There was significant correlation betweenPSLCO2gap and sublingual RBCV (r=-0.65,p<0.0001), CPR (r=-0.64,p<0.0001), central venous oxygen saturation (r=-0.50,p<0.0001), and central venous-to-arterial PCO2difference (r=0.62,p<0.0001). This new sublingual tonometer may be an appropriate tool for the indirect evaluation of circulatory changes in shock.

Tissue perfusion monitoring in the ICU

2016 ◽  
Author(s):  
Eric Kipnis ◽  
Benoit Vallet
Keyword(s):  
Blood Flow ◽  
Tissue Oxygenation ◽  
Venous Pressure ◽  
Blood Gas Analysis ◽  
Tissue Perfusion ◽  
Gas Analysis ◽  
Cellular Respiration ◽  
Tissue Blood Flow ◽  
Central Venous ◽  
Metabolic Markers

Resuscitation endpoints have shifted away from restoring normal values of routinely assessed haemodynamic parameters (central venous pressure, mean arterial pressure, cardiac output) towards optimizing parameters that reflect adequate tissue perfusion. Tissue perfusion-based endpoints have changed outcomes, particularly in sepsis. Tissue perfusion can be explored by monitoring the end result of perfusion, namely tissue oxygenation, metabolic markers, and tissue blood flow. Tissue oxygenation can be directly monitored locally through invasive electrodes or non-invasively using light absorbance (pulse oximetry (SpO2) or tissue (StO2)). Global oxygenation may be monitored in blood, either intermittently through blood gas analysis, or continuously with specialized catheters. Central venous saturation (ScvO2) indirectly assesses tissue oxygenation as the net balance between global O2 delivery and uptake, decreasing when delivery does not meet demand. Lactate, a by-product of anaerobic glycolysis, increases when oxygenation is inadequate, and can be measured either globally in blood, or locally in tissues by microdialysis. Likewise, CO2 (a by-product of cellular respiration) and PCO2 can be measured globally in blood or locally in accessible mucosal tissues (sublingual, gastric) by capnography or tonometry. Increasing PCO2 gradients, either tissue-to-arterial or venous-to-arterial, are due to inadequate perfusion. Metabolically, the oxidoreductive status of mitochondria can be assessed locally through NADH fluorescence, which increases in situations of inadequate oxygenation/perfusion. Finally, local tissue blood flow may be measured by laser-Doppler or visualized through intravital microscopic imaging. These perfusion/oxygenation resuscitation endpoints are increasingly used and studied in critical care.

Costs of intermittent measurement of central venous oxygen saturations by blood gas analysis

2009 ◽  
Vol 35 (7) ◽  
pp. 1316-1317 ◽  
Author(s):  
Frank Bloos ◽  
Florian Rissner ◽  
Martin Specht ◽  
Konrad Reinhart ◽  
Gernot Marx
Keyword(s):  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Central Venous ◽  
Intermittent Measurement

scholarly journals Intraoperative hyperglycemic stress response and tissue perfusion in cardiac surgery

2021 ◽  
Author(s):  
Aslı Demir ◽  
EDA BALCI ◽  
Hülya Yiğit Özay ◽  
MELİKE BAHÇECİTAPAR
Keyword(s):  
Cardiac Surgery ◽  
Tissue Oxygenation ◽  
Central Venous Oxygen Saturation ◽  
Tissue Perfusion ◽  
Extraction Rate ◽  
Oxygen Extraction ◽  
Diabetic Patients ◽  
Central Venous ◽  
Stress Hyperglycemia ◽  
Venous Oxygen Saturation

Background and aim of the study Approximately 30% of patients undergoing cardiac surgery have a history of diabetes and 60-80% of patients without diabetes have stress hyperglycemia. We examined patients undergoing cardiac surgery to determine the presence of stress hyperglycemia and its relationship to tissue perfusion. Methods Hemodynamic parameters, central venous oxygen saturation, lactate,oxygen delivery and consumption, oxygen extraction rate were analyzed at four intraoperative time points. Results The stress-induced hyperglycemic response during cardiac surgery was more severe in patients without diabetes. When focusing on the oxygen extraction rate in terms of tissue oxygenation, diabetic patients had 1.22 times higher and significant oxygen extraction rate than non-diabetic patients. Conclusions Although lactate values were slightly higher and central venous oxygen saturation were slightly lower in the diabetic group, considering the fact that oxygen extraction rate reflects the total outcome of small changes in all these parameters, we can emphasize the conclusion that diabetic patients undergoing cardiac surgery have greater tissue oxygen demand/supply imbalance compared to non-diabetic patients. In our study, this tissue oxygenation defect in diabetic patients was not found to be directly correlated with blood glucose levels. Perhaps, even if the disease is under control, the negative effects of diabetes on all systems have accumulated and led to such a result.

Accuracy of Peripheral and Central Venous Blood Gas Analysis in Evaluating Patients with Respiratory Failure

2017 ◽  
Vol 6 (07) ◽  
Author(s):  
Marwa Salah Ghanem ◽  
Heba Wagih Abdelwahab ◽  
Nesrine Saad Farrag ◽  
Ahmed M. Hamad
Keyword(s):  
Respiratory Failure ◽  
Venous Blood ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Central Venous ◽  
Arterial Blood ◽  
Venous Blood Gas ◽  
Venous Blood Gas Analysis

Objectives: Arterial blood samples are the gold standard test but these are more difficult to get than venous samples. In this study we assessed the possibility of utilization of venous (peripheral and central) blood gas samples in evaluation of subjects with respiratory failure instead of arterial samples. Methods: critically ill subjects with respiratory failure had paired venous (peripheral and central) and arterial samples taken. Assessment of agreement between blood gas samples (arterial and venous) as regard PH, Pco2 and HCO3 was done using Bland–Altman analyses. The spearmen correlation and linear regression tests were also performed to assess the degree of association between arterial and venous samples. Results: 100subjects were included. A good agreement was found between venous (peripheral and central) and arterial values of pHand HCO3.The agreements between peripheral venous and arterial PH and HCO3 values is higher than agreements between arterial and central venous measures. Conclusions: venous blood gas analysis (mainly peripheral samples) could replace arterial blood gas analysis in the evaluation of acid base balance in subjects with respiratory failure

scholarly journals Mismatch of arterial and central venous blood gas analysis during haemorrhage

2010 ◽  
Vol 27 (10) ◽  
pp. 890-896 ◽  
Author(s):  
Oliver M Theusinger ◽  
Caroline Thyes ◽  
Philippe Frascarolo ◽  
Sebastian Schramm ◽  
Burkhardt Seifert ◽  
...  
Keyword(s):  
Venous Blood ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Central Venous ◽  
Central Venous Blood ◽  
Venous Blood Gas ◽  
Venous Blood Gas Analysis

Thenar Muscle Oxygen Saturation Levels: A Surrogate for Central Venous Oxygen Saturation?

2019 ◽  
Vol 58 (5) ◽  
pp. 528-533 ◽  
Author(s):  
Ravi S. Samraj ◽  
Maria Kerrigan ◽  
Maria Mejia ◽  
Laura Wilson ◽  
James C. Fudge ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Tissue Oxygenation ◽  
Central Venous Oxygen Saturation ◽  
Oxygen Extraction ◽  
Critically Ill Children ◽  
Tissue Oxygen ◽  
Central Venous ◽  
Thenar Muscle ◽  
Study Results ◽  
Venous Oxygen Saturation

Purpose. Shock is associated with increased tissue oxygen extraction. Near-infrared spectroscopy–derived thenar muscle tissue oxygenation (StO2) levels can provide an estimate of the oxygen supply-demand balance at the tissue level. We hypothesized that thenar StO2 levels would correlate with central venous oxygen saturation (ScvO2) levels, the gold standard for global tissue oxygen extraction in the body. Methods. We prospectively enrolled 60 pediatric subjects admitted to pediatric intensive care unit or who underwent cardiac catheterization from September 2015 to March 2018. Thenar StO2 levels were measured using the InSpectra StO2 probe. Concurrent measurements of ScvO2 and peripheral tissue oxygenation (StO2) were achieved through simultaneous testing. For ScvO2, a central line placed in the superior vena cava was utilized for serum specimen collection, while the InSpectra probe recorded StO2 measurements from the thenar eminence of the patient’s right hand. Results. Sixty observations of thenar StO2 and ScvO2 levels were derived from 60 subjects. Mean thenar StO2 levels were 74.72 ± 11.18% and displayed significant correlation with paired ScvO2 measurements ( m = 72.17 ± 9.77%; ρ = 0.317, P = .018). Correlation was much more significant in subjects who were not on mechanical ventilatory support as opposed to those who were on it ( ρSORA = 0.496, PSORA = .003, vs ρVENT = 0.161, PVENT = .433). A thenar StO2 of 73% had a sensitivity of 80% and a specificity of 77.8% in predicting an ScvO2 of less than 65%. Conclusion. This is the first study to report correlation of thenar StO2 and ScvO2 levels in children. Our study results show a significant correlation between these levels. Thenar StO2 measurements may have a role in the bedside management of critically ill children in whom ScvO2 monitoring is not available.

scholarly journals Correlation of central venous pressure with venous blood gas analysis parameters; a diagnostic study

2017 ◽  
Vol 17 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Sima Rahim-Taleghani ◽  
Alireza Fatemi ◽  
Mostafa Alavi Moghaddam ◽  
Majid Shojaee ◽  
Abdelrahman Ibrahim Abushouk ◽  
...  
Keyword(s):  
Central Venous Pressure ◽  
Venous Pressure ◽  
Venous Blood ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Diagnostic Study ◽  
Blood Gas ◽  
Central Venous ◽  
Venous Blood Gas ◽  
Venous Blood Gas Analysis
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