Key result
Baseline mixed venous oxygen saturation (SvO2) was not a predictor of fluid responsiveness in critically ill septic patients, and high SvO2 did not exclude the need for fluids.
Why the study?
Does baseline mixed venous oxygen saturation (SvO2) predict fluid responsiveness in critically ill septic patients?
Observational (n=65)
No
Does baseline mixed venous oxygen saturation (SvO2) predict fluid responsiveness in critically ill septic patients?
Baseline mixed venous oxygen saturation (SvO2) does not predict fluid responsiveness in severe sepsis, indicating that a high SvO2 should not preclude fluid administration if otherwise indicated.
Answers are grounded in this paper and cite their sources.
High SvO2 should not exclude fluids in septic shock; hypothesis-generating and requires prospective validation before practice change.
INTRODUCTION: The aim of the study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. We also sought to define whether fluid responsiveness would be less likely in the presence of a high SvO2 (>70%). METHODS: This observational study was conducted in a 32-bed, university hospital medico-surgical intensive care unit (ICU). The hemodynamic response to a fluid challenge was evaluated in 65 critically ill patients with severe sepsis. Patients were divided into two groups (responders and non-responders) according to their cardiac index (CI) response to the challenge (>or < 10%). RESULTS: Of the 65 patients, 34 (52%) were fluid responders. Baseline SvO2, CI, heart rate (HR), and mean arterial pressure (MAP) were not statistically different between groups. The responders had lower pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) at baseline than the non-responders. After the fluid challenge, there were no differences between the two groups in MAP, CVP, PAOP or HR. There was no correlation between changes in CI or stroke volume index (SVI) and baseline SvO2. ROC analysis showed that SvO2 was not a predictor of fluid responsiveness. CONCLUSIONS: The response of septic patients to a fluid challenge is independent of baseline SvO2. The presence of a high SvO2 does not necessarily exclude the need for further fluid administration.
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Velissaris et al. (2011) conducted an observational in Severe sepsis (n=65). Baseline mixed venous oxygen saturation (SvO2) vs. Low SvO2 (<70%) was evaluated on Prediction of fluid responsiveness (increase in cardiac index >10%) by baseline SvO2 (AUC 0.51, 95% CI 0.36-0.66, p=0.85). Baseline mixed venous oxygen saturation (SvO2) was not a predictor of fluid responsiveness in critically ill septic patients, and high SvO2 did not exclude the need for fluids.
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