Shuai HU, Zhi-yan HAN, Xiao-jian WANG, Jing-jun HAN, De-qiang WU, Lei ZHANG, Yan-gui LIN, Jian-wen LIANG, Wen-bin WEI, Wen-lin ZHANG, Cun-fu MU, Yi WANG, Dian-yuan LI. Monitoring Value of Central Venous Oxygen Saturation, the Substitute for Mixed Venous Oxygen Saturation, in Postoperative Care of Congenital Heart Disease with Pulmonary Arterial Hypertension:a Multicenter Prospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 228-233. doi: 10.3969/j.issn.1674-9081.2018.03.008
Citation: Shuai HU, Zhi-yan HAN, Xiao-jian WANG, Jing-jun HAN, De-qiang WU, Lei ZHANG, Yan-gui LIN, Jian-wen LIANG, Wen-bin WEI, Wen-lin ZHANG, Cun-fu MU, Yi WANG, Dian-yuan LI. Monitoring Value of Central Venous Oxygen Saturation, the Substitute for Mixed Venous Oxygen Saturation, in Postoperative Care of Congenital Heart Disease with Pulmonary Arterial Hypertension:a Multicenter Prospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 228-233. doi: 10.3969/j.issn.1674-9081.2018.03.008

Monitoring Value of Central Venous Oxygen Saturation, the Substitute for Mixed Venous Oxygen Saturation, in Postoperative Care of Congenital Heart Disease with Pulmonary Arterial Hypertension:a Multicenter Prospective Study

doi: 10.3969/j.issn.1674-9081.2018.03.008
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  • Corresponding author: LI Dian-yuan Tel: 755-83982222, E-mail: drdianyuanli@163.Com
  • Received Date: 2018-03-11
  • Publish Date: 2018-05-30
  •   Objective   This study aimed to investigate the agreement of central venous oxygen saturation (ScvO2) with mixed venous oxygen saturation (SvO2) in postoperative care of congenital heart disease (CHD)with pulmonary arterial hypertension (PAH).   Methods   Forty-three patients undergoing CHD-PAH repairing surgery were prospectively selected from Henan Provincial People's Hospital, Fuwai Hospital, the Eighth Affiliated Hospital of Sun Yat-sen University, and the First People's Hospital of Guanyuang from March 2016 to March 2017. Data of ScvO2 and SvO2 were synchronously collected after cardiopulmonary bypass (CPB), and 6, 12, 24, and 48 hours after admission to the intensive care unit. In addition, hemodynamic parameters, hemoglobin, and arterial lactate were recorded. Data were analyzed by Bland-Altman test and linear regression analysis.   Results   The overall R2 of ScvO2 to SvO2 for the pooled measurements was 0.369. R2 of post-CPB, 6, 12, 24, 48 hours after admission to the intensive care unit were 0.515, 0.375, 0.605, 0.712, and 0.252, respectively. Bland-Altman test for ScvO2 and SvO2 showed that the mean bias was -1.3% and limits of agreement (LOA) were -17.0% to 14.4%. In general, the influences of oxygen extraction rate (O2ER) (R2=0.030, P < 0.05), pulmonary artery systolic pressure (SPAP) (R2=0.030, P < 0.05), and heart rate (HR) (R2=0.032, P < 0.05) on △ScvO2-SvO2 were relatively small; when ScvO2 was < 70%, the influences of O2ER (R2=0.203, P < 0.01), SPAP (R2=0.110, P < 0.01), and HR (R2=0.150, P < 0.01) were much greater, and ScvO2 would underestimate SvO2; ScvO2 might overestimate SvO2 when ≥ 70%. Bland-Altman test indicated during mechanical ventilation the mean bias of ScvO2 and SvO2 (△ScvO2-SvO2) was -1.3% and LOA were -16.1% to 13.5%, the only factor influencing △ScvO2-SvO2 was O2ER (R2=0.122, P < 0.01); without mechanical ventilation, the mean bias was -1.3% and LOA were -19.5% to 16.8%, and the influence on △ScvO2-SvO2 were O2ER (R2=0.320, P < 0.01) and arterial oxygen saturation (R2=0.320, P < 0.01).   Conclusions   ScvO2 cannot replace SvO2 in postoperative care for patients with CHD-PAH. ScvO2 and SvO2 should be monitored respectively to exclude the hypo-perfusion state when ScvO2 ≥ 70%.
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