Capnodynamic assessment of mixed venous oxygen saturation in a porcine experimental endotoxemic model.

Autor: Svedmyr A; Department of Physiology and Pharmacology, (FYFA), Karolinska Institute, C3, PA Lönnqvist Group- Section of Anesthesiology and Intensive Care, Anestesi-och Intensivvårdsavdelningen,, 171 76, Stockholm, Sweden. anders.svedmyr@ki.se.; Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden. anders.svedmyr@ki.se., Hedov J; Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden., Lipcsey M; Department of Surgical Sciences, Section of Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Wallin M; Department of Physiology and Pharmacology, (FYFA), Karolinska Institute, C3, PA Lönnqvist Group- Section of Anesthesiology and Intensive Care, Anestesi-och Intensivvårdsavdelningen,, 171 76, Stockholm, Sweden., Hallbäck M; Maquet Critical Care AB, Röntgenvägen 2, 171 06, Solna, Sweden., Lönnqvist PA; Department of Physiology and Pharmacology, (FYFA), Karolinska Institute, C3, PA Lönnqvist Group- Section of Anesthesiology and Intensive Care, Anestesi-och Intensivvårdsavdelningen,, 171 76, Stockholm, Sweden.; Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden., Karlsson J; Department of Physiology and Pharmacology, (FYFA), Karolinska Institute, C3, PA Lönnqvist Group- Section of Anesthesiology and Intensive Care, Anestesi-och Intensivvårdsavdelningen,, 171 76, Stockholm, Sweden.; Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2024 Nov 05; Vol. 14 (1), pp. 26807. Date of Electronic Publication: 2024 Nov 05.
DOI: 10.1038/s41598-024-77483-7
Abstrakt: Sepsis continues to be a major cause of death and illness globally, posing significant challenges for healthcare professionals. In the pursuit of more accurate and timely monitoring tools, the concept of capnodynamically derived mixed venous oxygen saturation (Capno-SvO 2 ) has emerged as a promising method. Capno-SvO 2 provides a non-invasive way to assess and track SvO 2 and could serve as an additional tool alongside more invasive methods like the pulmonary artery catheter. This could potentially be of great value in the care of critically ill patients with sepsis, where alternative minimal invasive monitoring methods may vary in reliability. The aim of the current study was to compare capno-SvO 2 against values obtained through pulmonary artery blood sample CO-oximetry and continuous fiberoptic SvO 2 monitoring, using a well-established porcine experimental sepsis model. Anesthetized pigs were exposed to a standardized endotoxin infusion sepsis protocol, followed by a series of maneuvers typically applied in sepsis care. Simultaneous recordings were done throughout the experiment for all three monitoring methods. Bland-Altman analysis corrected for repeated measurements was used to assess the agreement of absolute values between the paired recording of CO-oximetry and Capno-SvO 2 as well as between CO-oximetry and fiberoptic SvO 2 . The ability of Capno-SvO 2 and fiberoptic SvO2 to track changes was assessed by concordance rate. A total of 10 animals and 275 paired datapoints were included in the study. The majority of the animals displayed pronounced hemodynamical instability in response to endotoxin exposure and subsequent treatment interventions. Analysis of all paired data points showed a bias between Capno-SvO 2 and CO-oximetry SvO 2 of + 1% with 95% limits of agreement of -14% to + 17%. The corresponding numbers for fiberoptic SvO 2 and CO-oximetry SvO 2 were -4% and -15% to + 8%. The concordance rate as compared to CO-oximetry, were 97% and 93% for Capno-SvO 2 and fiberoptic SvO 2 , respectively. In this experimental sepsis model, continuous, non-invasive Capno-SvO 2 generates average absolute values comparable to the gold standard CO-oximetry albeit with relatively wide limits of agreement. Capno-SvO 2 displayed a concordance rate of 97% against CO-oximetry and exhibits better trending ability compared to invasive fiberoptic SvO 2 .
(© 2024. The Author(s).)
Databáze: MEDLINE
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