Unresponsive Low Mixed Venous Oxygen Saturation During Early Intensive Care Unit Stay is Associated With Increased Risk of Organ Dysfunction After Cardiac Surgery: A Single-Center Retrospective Study.

Autor:	Holm P; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland. Electronic address: petteri.holm@pohde.fi., Erkinaro TM; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland., Karhu JM; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland., Ohtonen PP; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Service Unit, Oulu University Hospital, Oulu, Finland., Liisanantti JH; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland., Taskinen P; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland., Ala-Kokko TI; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Critical Care Center and Research Group of Intensive Care Medicine, Oulu University Hospital, MRC Oulu and University of Oulu, Oulu, Finland., Kaakinen TI; Research Group of Surgery, Intensive Care Unit, Anaesthesiology and Intensive Care Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; OYS Heart, Oulu University Hospital, Research Group of Anaesthesiology, MRC Oulu and University of Oulu, Oulu, Finland.
Jazyk:	angličtina
Zdroj:	Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2024 Feb; Vol. 38 (2), pp. 423-429. Date of Electronic Publication: 2023 Nov 17.
DOI:	10.1053/j.jvca.2023.11.021
Abstrakt:	Objectives: The aim of the study was to determine if unresponsive mixed venous oxygen saturation (SvO 2 ) values during early postoperative hours are associated with postoperative organ dysfunction. Design: A single-center retrospective observational study. Setting: A university hospital. Participants: A total of 6,282 adult patients requiring cardiac surgery who underwent surgery in a University Hospital from 2007 to 2020. Interventions: A pulmonary artery catheter was used to gather SvO 2 samples after surgery at admission to the intensive care unit (ICU) and 4 hours later. For the analysis, patients were divided into 4 groups according to their SvO 2 values. The rate of organ dysfunctions categorized according to the SOFA score was then studied among these subgroups. Measurements and Main Results: The crude mortality rate for the cohort at 1 year was 4.3%. Multiple organ dysfunction syndrome (MODS) was present in 33.0% of patients in the early postoperative phase. During the 4-hour initial treatment period, 43% of the 931 patients with low SvO 2 on admission responded to goal-directed therapy to increase SvO 2 >60%; whereas, in 57% of the 931 patients, the low SvO 2 was sustained. According to the adjusted logistic regression analyses, the odds ratio for MODS (4.23 [95% CI 3.41-5.25]), renal- replacement therapy (4.97 [95% CI 3.28-7.52]), time on a ventilator (2.34 [95% CI 2.17-2.52]), and vasoactive-inotropic score >30 (3.62 [95% CI 2.96-4.43]) were the highest in the group with sustained low SvO 2 . Conclusions: Patients with SvO 2 <60% at ICU admission and 4 hours later had the greatest risk of postoperative MODS. Responsiveness to a goal-directed therapy protocol targeting maintaining or increasing SvO 2  ≥60% at and after ICU admission may be beneficial. Competing Interests: Declaration of Competing Interest None. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu Full Text from ScienceDirect