R Svedjeholm1, E Håkanson, Z Szabó. 1. Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Sweden. rolf.svedjeholm@lio.se
Abstract
OBJECTIVE: It has been argued that the poor correlation between cardiac output and mixed venous oxygen saturation (SvO2) reduces the value of SvO2. Routine use of Swan Ganz catheters is also controversial in cardiac surgery. Here our clinical experience with a simplified method for routine hemodynamic monitoring and the short-term prognostic value of SvO2 after CABG surgery is presented. METHOD: Peroperatively an epidural catheter is routinely introduced through the outflow tract of the right ventricle into the pulmonary artery for monitoring of pressure and blood sampling. Clinical data were retrospectively retrieved from the records and related to SvO2 routinely obtained on admission to the ICU after 488 CABG procedures. RESULTS: Average SvO2 on arrival to ICU was 67+/-7%. The SvO2 value of 55% represented a cut off point below which a high incidence of complications were found. Outcome after 456 procedures with SvO2 > or = 55% compared with 32 procedures with SvO2 < 55%: mortality 0 vs. 9.4% (P = 0.0003), perioperative myocardial infarction 6.2 vs. 29% (P < 0.0001), ventilator treatment 8.9+/-10.1 vs. 25.7+/-54.9 h (P = 0.0074), ICU stay 1.4+/-1.2 vs. 2.1+/-1.7 days (P = 0.0010). CONCLUSIONS: SvO2 was of prognostic value and due to its specificity it seems particularly useful for telling which patients are unlikely to develop cardiorespiratory problems. Thus, this simple method for hemodynamic monitoring could contribute to cost containment as it seems that we can safely reserve Swan Ganz catheters for high-risk patients.
OBJECTIVE: It has been argued that the poor correlation between cardiac output and mixed venous oxygen saturation (SvO2) reduces the value of SvO2. Routine use of Swan Ganz catheters is also controversial in cardiac surgery. Here our clinical experience with a simplified method for routine hemodynamic monitoring and the short-term prognostic value of SvO2 after CABG surgery is presented. METHOD: Peroperatively an epidural catheter is routinely introduced through the outflow tract of the right ventricle into the pulmonary artery for monitoring of pressure and blood sampling. Clinical data were retrospectively retrieved from the records and related to SvO2 routinely obtained on admission to the ICU after 488 CABG procedures. RESULTS: Average SvO2 on arrival to ICU was 67+/-7%. The SvO2 value of 55% represented a cut off point below which a high incidence of complications were found. Outcome after 456 procedures with SvO2 > or = 55% compared with 32 procedures with SvO2 < 55%: mortality 0 vs. 9.4% (P = 0.0003), perioperative myocardial infarction 6.2 vs. 29% (P < 0.0001), ventilator treatment 8.9+/-10.1 vs. 25.7+/-54.9 h (P = 0.0074), ICU stay 1.4+/-1.2 vs. 2.1+/-1.7 days (P = 0.0010). CONCLUSIONS: SvO2 was of prognostic value and due to its specificity it seems particularly useful for telling which patients are unlikely to develop cardiorespiratory problems. Thus, this simple method for hemodynamic monitoring could contribute to cost containment as it seems that we can safely reserve Swan Ganz catheters for high-risk patients.