Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock

M. Németh, K. Tánczos, G. Demeter, D. Érces, J. Kaszaki, A. Mikor, Z. Molnár

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Abstract

Background Fluid resuscitation is still a major challenge. We aimed to describe changes in central venous oxygen saturation (ScvO2) and venous-to-arterial carbon dioxide gap (dCO2) 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 (Tbsl) dropped by 50% (T0), thereafter fluid resuscitation was performed with balanced crystalloid in four steps until initial SVI was reached (T4). Statistical analysis was performed with Statistical Program for Social Sciences version 18.0; data are expressed as mean ± standard deviation. Results After bleeding, ScvO2 dropped (Tbsl = 78 ± 7 vs. T0 = 61 ± 5% P <0.05) and oxygen extraction ratio increased (Tbsl = 0.20 ± 0.07 vs. T0 = 0.36 ± 0.05, P <0.05). By T 4 the ScvO2 normalized, but on average it remained 5% lower than at Tbsl (T4 = 73 ± 9% P <0.05) and oxygen extraction also remained higher as compared with Tbsl (T 4 = 0.24 ± 0.09 P = 0.001). ScvO2 showed significant correlation with SVI (r = 0.564, P <0.001). dCO2 increased during hypovolemia (Tbsl:5.3 ± 2.0 vs. T 0:9.6 ± 2.3 mmHg, P = 0.001), then returned to normal by T4 = 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 ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.

Original languageEnglish
Pages (from-to)611-619
Number of pages9
JournalActa Anaesthesiologica Scandinavica
Volume58
Issue number5
DOIs
Publication statusPublished - 2014

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Hemorrhagic Shock
Carbon Dioxide
Resuscitation
Oxygen
Stroke Volume
Hemorrhage
Swine
Hemodynamics
Hypovolemia
Social Sciences
Oxygen Consumption
Reference Values

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock. / Németh, M.; Tánczos, K.; Demeter, G.; Érces, D.; Kaszaki, J.; Mikor, A.; Molnár, Z.

In: Acta Anaesthesiologica Scandinavica, Vol. 58, No. 5, 2014, p. 611-619.

Research output: Contribution to journalArticle

Németh, M. ; Tánczos, K. ; Demeter, G. ; Érces, D. ; Kaszaki, J. ; Mikor, A. ; Molnár, Z. / Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock. In: Acta Anaesthesiologica Scandinavica. 2014 ; Vol. 58, No. 5. pp. 611-619.
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abstract = "Background Fluid resuscitation is still a major challenge. We aimed to describe changes in central venous oxygen saturation (ScvO2) and venous-to-arterial carbon dioxide gap (dCO2) 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 (Tbsl) dropped by 50{\%} (T0), thereafter fluid resuscitation was performed with balanced crystalloid in four steps until initial SVI was reached (T4). Statistical analysis was performed with Statistical Program for Social Sciences version 18.0; data are expressed as mean ± standard deviation. Results After bleeding, ScvO2 dropped (Tbsl = 78 ± 7 vs. T0 = 61 ± 5{\%} P <0.05) and oxygen extraction ratio increased (Tbsl = 0.20 ± 0.07 vs. T0 = 0.36 ± 0.05, P <0.05). By T 4 the ScvO2 normalized, but on average it remained 5{\%} lower than at Tbsl (T4 = 73 ± 9{\%} P <0.05) and oxygen extraction also remained higher as compared with Tbsl (T 4 = 0.24 ± 0.09 P = 0.001). ScvO2 showed significant correlation with SVI (r = 0.564, P <0.001). dCO2 increased during hypovolemia (Tbsl:5.3 ± 2.0 vs. T 0:9.6 ± 2.3 mmHg, P = 0.001), then returned to normal by T4 = 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 ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.",
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T1 - Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock

AU - Németh, M.

AU - Tánczos, K.

AU - Demeter, G.

AU - Érces, D.

AU - Kaszaki, J.

AU - Mikor, A.

AU - Molnár, Z.

PY - 2014

Y1 - 2014

N2 - Background Fluid resuscitation is still a major challenge. We aimed to describe changes in central venous oxygen saturation (ScvO2) and venous-to-arterial carbon dioxide gap (dCO2) 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 (Tbsl) dropped by 50% (T0), thereafter fluid resuscitation was performed with balanced crystalloid in four steps until initial SVI was reached (T4). Statistical analysis was performed with Statistical Program for Social Sciences version 18.0; data are expressed as mean ± standard deviation. Results After bleeding, ScvO2 dropped (Tbsl = 78 ± 7 vs. T0 = 61 ± 5% P <0.05) and oxygen extraction ratio increased (Tbsl = 0.20 ± 0.07 vs. T0 = 0.36 ± 0.05, P <0.05). By T 4 the ScvO2 normalized, but on average it remained 5% lower than at Tbsl (T4 = 73 ± 9% P <0.05) and oxygen extraction also remained higher as compared with Tbsl (T 4 = 0.24 ± 0.09 P = 0.001). ScvO2 showed significant correlation with SVI (r = 0.564, P <0.001). dCO2 increased during hypovolemia (Tbsl:5.3 ± 2.0 vs. T 0:9.6 ± 2.3 mmHg, P = 0.001), then returned to normal by T4 = 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 ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.

AB - Background Fluid resuscitation is still a major challenge. We aimed to describe changes in central venous oxygen saturation (ScvO2) and venous-to-arterial carbon dioxide gap (dCO2) 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 (Tbsl) dropped by 50% (T0), thereafter fluid resuscitation was performed with balanced crystalloid in four steps until initial SVI was reached (T4). Statistical analysis was performed with Statistical Program for Social Sciences version 18.0; data are expressed as mean ± standard deviation. Results After bleeding, ScvO2 dropped (Tbsl = 78 ± 7 vs. T0 = 61 ± 5% P <0.05) and oxygen extraction ratio increased (Tbsl = 0.20 ± 0.07 vs. T0 = 0.36 ± 0.05, P <0.05). By T 4 the ScvO2 normalized, but on average it remained 5% lower than at Tbsl (T4 = 73 ± 9% P <0.05) and oxygen extraction also remained higher as compared with Tbsl (T 4 = 0.24 ± 0.09 P = 0.001). ScvO2 showed significant correlation with SVI (r = 0.564, P <0.001). dCO2 increased during hypovolemia (Tbsl:5.3 ± 2.0 vs. T 0:9.6 ± 2.3 mmHg, P = 0.001), then returned to normal by T4 = 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 ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.

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