Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-22T10:01:18.935Z Has data issue: false hasContentIssue false
  • English
  • Français

The monitoring of venous saturations of oxygen in children with congenitally malformed hearts

Published online by Cambridge University Press:  20 January 2009

Jeff Martin  and
Lara S. Shekerdemian
Jeff Martin*
Affiliation:
Department of Paediatric Intensive Care, Birmingham Children’s Hospital NHS Trust, Steelhouse Lane, Birmingham, United Kingdom
Lara S. Shekerdemian
Affiliation:
Department of Paediatric Intensive Care, Royal Children’s Hospital, Melbourne, Australia
*
Correspondence to: Jeff Martin, Paediatric Intensive Care Unit, Birmingham Children’s Hospital NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom. Tel: 00 44 121 333 9652; Fax: 00 44 121 333 9651; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Mixed venous saturation of oxygen has for some time been used as a tool to assess the adequacy of systemic delivery of oxygen in intensive care. In the post-operative child with cardiac disease, it is increasingly being used to assess adequacy of cardiac output. In many of these patients, true sampling of mixed venous saturation of oxygen is not possible due to the infrequent use of pulmonary arterial catheters, or the presence of intra-cardiac left to right shunting leading to mixing of systemic and pulmonary venous blood. The use of saturation of oxygen in the central venous blood as a surrogate for mixed venous saturation of oxygen has been widely investigated in adults, but its use remains controversial. In this review, we discuss the theory behind the use of mixed venous saturation of oxygen in evaluating cardiac output, the problems pertinent to those patients with congenitally malformed hearts, and explore the evidence for central venous saturation of oxygen as a surrogate for mixed venous saturation of oxygen, and its use as a therapeutic target to improve outcomes in this population of patients.

Keywords

Venous oxyhaemoglobin saturationoxygen consumptionheart defectscongenitalhypoplastic left heart syndromeanaerobic threshold
Type
Review Article
Information
Cardiology in the Young , Volume 19 , Issue 1 , February 2009 , pp. 34 - 39
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: a comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 2226–2235.CrossRefGoogle ScholarPubMed
2. Tibby, SM, Hatherill, M, Marsh, MJ, Murdoch, IA. Clinician’s ability to estimate cardiac index in ventilated children and infants. Arch Dis Child 1997; 77: 516–518.CrossRefGoogle ScholarPubMed
3. Jai, L, Bush, A, Schulze-Neick, I, Penny, DJ, Redington, AN, Shekerdemian, LS. Measured versus estimated oxygen consumption in ventilated patients with congenital heart disease: The validity of predictive equations. Crit Care Med 2003; 31: 1235–1240.Google Scholar
4. Li, J, Zhang, G, Holtby, HM, et al. Inclusion of oxygen consumption improves the accuracy of arterial and venous saturation of oxygen interpretation after the Norwood procedure. J Thorac Cardiovasc Surg 2006; 131: 1099–1107.CrossRefGoogle ScholarPubMed
5. Li, J, Schulze-Neick, I, Lincoln, C, et al. Oxygen consumption after cardiopulmonary bypass surgery in children: determinants and implications. J Thorac Cardiovasc Surg 2000; 119: 525–533.CrossRefGoogle ScholarPubMed
6. Tibby, SM, Murdoch, IA. Monitoring cardiac function in intensive care. Arch Dis Child 2003; 88: 46–52.CrossRefGoogle ScholarPubMed
7. Nelson, LD. Continuous venous oximetry in surgical patients. Ann Surg 1986; 203: 329–333.CrossRefGoogle ScholarPubMed
8. Marx, G, Reinhart, K. Venous oximetry. Curr Opin Crit Care 2006; 12: 263–268.CrossRefGoogle ScholarPubMed
9. Pirwitz, MJ, Willard, JE, Landau, C, Hillis, LD, Lange, RA. A critical reappraisal of the oximetric assessment of intracardiac left-to-right shunting in adults. Am Heart J 1997; 133: 413–417.CrossRefGoogle ScholarPubMed
10. Rivers, EP, Ander, DS, Powell, D. Central venous saturation monitoring in the critically ill patient. Curr Opin Crit Care 2001; 7: 204–211.CrossRefGoogle ScholarPubMed
11. Reinhart, K, Kuhn, HJ, Hartog, C, Bredle, DL. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Inten Care Med 2004; 30: 1572–1578.CrossRefGoogle ScholarPubMed
12. Bloos, F, Reinhart, K. Venous oximetry. Inten Care Med 2005; 31: 911–913.CrossRefGoogle ScholarPubMed
13. Dueck, MH, Klimek, M, Appenrodt, S, Weingand, C, Boerner, U. Trends but not individual values of central venous saturation of oxygen agree with mixed venous saturation of oxygen during varying hemodynamic conditions. Anesth 2005; 103: 249–257.CrossRefGoogle Scholar
14. Reinhart, K, Bloos, F. The value of venous oximetry. Curr Opin Crit Care 2005; 11: 259–263.CrossRefGoogle ScholarPubMed
15. Rivers, E, Nguyen, B, Havstad, S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368–1377.CrossRefGoogle ScholarPubMed
16. Reinhart, K, Rudolph, T, Bredle, DL, Hannemann, L, Cain, SM. Comparison of central venous to mixed venous saturation of oxygen during changes on oxygen supply/demand. Chest 1989; 95: 1216–1221.CrossRefGoogle ScholarPubMed
17. Buheitel, G, Scharf, J, Hofbeck, M, Singer, H. Estimation of cardiac index by means of the arterial and the mixed venous oxygen content and pulmonary oxygen uptake determination in the early post-operative period following surgery of congenital heart disease. Int Care Med 1994; 20: 500–503.CrossRefGoogle ScholarPubMed
18. Hoffman, GM, Ghanayem, NS, Kampine, JM, et al. Venous saturation and the anaerobic threshold in neonates after the Norwood procedure for hypoplastic left heart syndrome. Ann Thorac Surg 2000; 70: 1515–1521.CrossRefGoogle ScholarPubMed
19. Tweddell, JS, Ghanayem, NS, Mussatto, KA, et al. Mixed venous saturation of oxygen monitoring after stage I palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2007; 84: 1301–1311.CrossRefGoogle Scholar
20. Hoffman, GM, Mussatto, KA, Brosig, CL, et al. Systemic venous saturation of oxygen after the Norwood procedure and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg 2005; 130: 1094–1100.CrossRefGoogle ScholarPubMed
21. Rossi, AF, Sommer, RJ, Lotvin, A, et al. Usefulness of intermittent monitoring of mixed venous saturation of oxygen after stage I palliation for hypoplastic left heart syndrome. Am J Cardiol 1994; 73: 1118–1123.CrossRefGoogle Scholar
22. Duke, T, Butt, W, South, M, Karl, TR. Early markers of major adverse events in children after cardiac operations. J Thorac Cardiovasc Surg 1997; 114: 1042–1052.CrossRefGoogle ScholarPubMed