The optimal SVO2 and SCVO2

The optimal goals for SvO2 (mixed venous oxyegen saturation) and SCVO2 ( central venous oxygen saturation) during goal-directed haemodynamic optimisation are controversial.

Observational data have shown that postoperative SvO2 concentrations in the range 55%-64% are associated with increased postoperative mortality and/or morbidity in patients after cardiac surgery.

However, two randomized trials have clearly shown that even a small increase in SvO2 might lead to considerably less mortality .The guidelines for the management of acute heart failure in medical patients from the European Society of Cardiology suggest to target a SvO2 > 65%.

Prospective observational studies have shown a close correlation (r=0.88) between ScvO2 and ScO2 in critically ill patients. However, agreement seems to be better with levels above 70%

The current evidence and consensus-based guideline for monitoring and treatment of cardiac surgery patients during the postoperative period in ICU recommends an ScvO2 > 70% and an SvO2 > 65% as the optimal targets.

Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, et al. [Guidelines for intensive care in cardiac surgery patients:

haemodynamic monitoring and cardio-circulatory treatment guidelines of the German Society for Thoracic and Cardiovascular Surgery and the German Society of Anaesthesiology and Intensive Care Medicine]. Thorac Cardiovasc Surg 2007;

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock.

N Engl J Med 2001;

Sander M, Spies CD, Berger K, Grubitzsch H, Foer A, Kramer M, et al. Prediction of volume response under openchest conditions during coronary artery bypass surgery. Crit Care 2007; 11: R121

345: 1368-7755: 130-48.

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