La saturación venosa central de oxígeno es un factor predictor de mortalidad en el paciente con choque séptico

Authors

  • Fernando E. Jara Hospital Carlos Andrade Marín, Quito, Ecuador; Universidad Central del Ecuador
  • Liliana E. Torres Torres Hospital Carlos Andrade Marín, Quito, Ecuador; Universidad Central del Ecuador

DOI:

https://doi.org/10.29166/ciencias_medicas.v42i1.1518

Keywords:

Central venous oxygen saturation, Septic shock, Mortality, mechanical ventilation, Tissue oxygenation

Abstract

Objective: to determine the central venous saturation of abnormal initial oxygen (SvCO2) (high or low) as a predictor of mortality in patients with septic shock admitted to the emergency area of Carlos Andrade Marín Hospital.
Design and location: this is an analytical, observational, prospective study on a cohort of patients admitted to the critical area of emergency of this health unit. Subjects: 107 patients admitted in the months of June to September 2015, with a mortality follow-up of 28-day.Measurements and results: initial SvcO2 was measured by central venous catheter at the time of shock diagnosis. Mortality at 28 days was 46.2%. Only APACHE II values (OR 1.11, CI 1.04-1.19 p = <0.01) and
mechanical ventilation (OR 0.19, CI 0.05-0.62, p = 0.01) had significant statistical value in the logistic regression. APACHE II was the most important single factor, in the CART model arterial pH and procalcitonin were useful.
Conclusion: Central venous saturation of abnormal or high initial O2 (SvcO2) was not found to be useful in predicting mortality at 28 days of follow-up. Measurement of SvcO2 is a simple method that indirectly reflects tissue oxygenation. The APACHE II is an independent predictor of mortality at 28 days and the use of mechanical ventilation had an inverse relationship with mortality.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Fernando E. Jara, Hospital Carlos Andrade Marín, Quito, Ecuador; Universidad Central del Ecuador

Unidad de Cuidados Críticos del Hospital Carlos Andrade Marín, Quito, Ecuador

Facultad de Ciencias Médicas, Universidad Central del Ecuador

Liliana E. Torres Torres, Hospital Carlos Andrade Marín, Quito, Ecuador; Universidad Central del Ecuador

Unidad de Cuidados Críticos del Hospital Carlos Andrade Marín, Quito, Ecuador

Facultad de Ciencias Médicas, Universidad Central del Ecuador

References

Castro J, Bruhn A, Romero C. Sepsis y falla multiorgánica. 3ed. Santiago de Chile: Mediterráneo; 2011.

Carrillo-Esper R, Carrillo-Córdova JR, Carrillo-Córdova LD. Estudio epidemiológico de la sepsis en unidades de terapia intensiva mexicanas [Internet]. Cirugía y Cirujanos 2009; [citado el 1 de mayo de 2015].Recuperado a partir de: http://www.redalyc.org/resumen.oa?id=66211210008

Silva E, Pedro M, Sogayar A, Mohovic T, Silva CL, Janiszewski M, et al. Brazilian sepsis epidemiological study (BASES study). Crit Care Lond Engl 2004; 8(4):251–60.

Instituto Nacional de Estadísticas y Censo. Indicadores básicos de salud Ecuador 2010 [Internet].Organización Panamericana de la Salud; 2010. Recuperado a partir de: http://www.paho.org/ecu/index.php?option=com_docman&task=doc_downloa d&gid=325&Itemid=

Mesquida J, Borrat X, Lorente JA, Masip J, Baigorri F. Objetivos de la reanimación hemodinámica. Med Intensiva 2011; 35(8):499–508.

Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M. Lack of equivalence between central and mixed venous oxygen saturation. Chest 2004; 126(6):1891–6.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39(2):165–228.

Carrillo Esper R, Núñez Bacarreza JJ, Carrillo Córdova JR. Saturación venosa central. Conceptos actuales. Rev Mex Anestesiol; 30(3):165–71.

Richard C. Tissue hypoxia. How to detect, how to correct, how to prevent? Intensive Care Med 1996;22(11):1250–7.10. Pope JV, Jones AE, Gaieski DF, Arnold RC, Trzeciak S, Shapiro NI, et al. Multicenter study of central venous oxygen saturation (ScvO2) as a predictor of mortality in patients with sepsis. Ann Emerg Med 2010;55(1):40–6.

Exline MC, Crouser ED. Mitochondrial mechanisms of sepsis-induced organ failure. Front Biosci J Virtual Libr 2008; 13:5030–41.

Pinsky MR, Mancebo J, Hendenstierna G. Fisiología aplicada en medicina de cuidado intensivo. 2ed. Bogotá: Distribuna Ltda; 2012.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345(19):1368–77.

Beest PA van, Hofstra JJ, Schultz MJ, Boerma EC, Spronk PE, Kuiper MA. The incidence of low venous oxygen saturation on admission to the intensive care unit: a multi-center observational study in The Netherlands. Crit Care 2008; 12(2):33.

Bracht H, Hänggi M, Jeker B, Wegmüller N, Porta F, Tüller D, et al. Incidence of low central venous oxygen saturation during unplanned admissions in a multidisciplinary intensive care unit: an observational study. Crit Care Lond Engl 2007; 11(1):2.

Boulain T, Garot D, Vignon P, Lascarrou J-B, Desachy A, Botoc V, et al. Prevalence of low central venous oxygen saturation in the first hours of intensive care unit admission and associated mortality in septic shock patients: a prospective multicentre study. Crit Care 2014; 18(6):1–12.

ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014; 370(18):1683–93.

ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014; 371(16):1496–506.

Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015; 372(14):1301–11.

Textoris J, Fouché L, Wiramus S, Antonini F, Tho S, Martin C, et al. High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality. Crit Care 2011; 15(4):176.

Ruiz C, Bruhn A, Ince C. Rol de la microcirculación y la mitocondria en la falla orgánica múltiple en Sepsis y falla multiorgánica. 3ed. Santiago de Chile: Mediterráneo; 2011. pp 61–74.

Hernandez G, Peña H, Cornejo R, Rovegno M, Retamal J, Navarro JL, et al. Impact of emergency intubation on central venous oxygen saturation in critically ill patients: a multicenter observational study. Crit Care Lond Engl 2009; 13(3):63.

Hiltebrand LB, Krejci V, Hoevel ME, Banic A, Sigurdsson GH. Redistribution of microcirculatory blood flow within the intestinal wall during sepsis and general anesthesia. J Am Soc Anesthesiol 2003; 98(3):658–69.

Kopterides P, Bonovas S, Mavrou I, Kostadima E, Zakynthinos E, Armaganidis A. Venous oxygen saturation and lactate gradient from superior vena cava to pulmonary artery in patients with septic shock. Shock Augusta Ga 2009; 31(6):561–7.

Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol JVIR 2003;14(5):527–34.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13(10):818–29.

Universidad de Los Andes - articulo3.pdf [Internet]. [citado el 12 de noviembre de 2015]. Recuperado a partir de: http://www.saber.ula.ve/bitstream/123456789/37431/3/articulo3.pdf

Luce JM. Pathogenesis and management of septic shock. Chest 1987; 91(6):883–8.

Published

2017-06-01

How to Cite

1.
Jara FE, Torres LET. La saturación venosa central de oxígeno es un factor predictor de mortalidad en el paciente con choque séptico. Rev Fac Cien Med (Quito) [Internet]. 2017 Jun. 1 [cited 2024 Dec. 19];42(1):46-55. Available from: https://revistadigital.uce.edu.ec/index.php/CIENCIAS_MEDICAS/article/view/1518