Dataset Information

Association of low mixed venous oxygen saturations during early ICU stay with increased 30-day and 1-year mortality after cardiac surgery: a single-center retrospective study.

ABSTRACT:

Background

Low postoperative mixed venous oxygen saturation (SvO₂) values have been linked to poor outcomes after cardiac surgery. The present study was designed to assess whether SvO₂ values of < 60% at intensive care unit (ICU) admission and 4 h after admission are associated with increased mortality after cardiac surgery.

Methods

During the years 2007-2020, 7046 patients (74.4% male; median age, 68 years [interquartile range, 60-74]) underwent cardiac surgery at an academic medical center in Finland. All patients were monitored with a pulmonary artery catheter. SvO₂ values were obtained at ICU admission and 4 h later. Patients were divided into four groups for analyses: SvO₂ ≥ 60% at ICU admission and 4 h later; SvO₂ ≥ 60% at admission but < 60% at 4 h; SvO₂ < 60% at admission but ≥ 60% at 4 h; and SvO₂ < 60% at both ICU admission and 4 h later. Kaplan-Meier survival curves, Cox regression models, and receiver operating characteristic curve analysis were used to assess differences among groups in 30-day and 1-year mortality.

Results

In the overall cohort, 52.9% underwent coronary artery bypass grafting (CABG), 29.1% valvular surgery, 12.1% combined CABG and valvular procedures, 3.5% surgery of the ascending aorta or aortic dissection, and 2.4% other cardiac surgery. The 1-year crude mortality was 4.3%. The best outcomes were associated with SvO₂ ≥ 60% at both ICU admission and 4 h later. Hazard ratios for 1-year mortality were highest among patients with SvO₂ < 60% at both ICU admission and 4 h later, regardless of surgical subgroup.

Conclusion

SvO₂ values < 60% at ICU admission and 4 h after admission are associated with increased 30-day and 1-year mortality after cardiac surgery. Goal-directed therapy protocols targeting SvO₂ ≥ 60% may be beneficial. Prospective studies are needed to confirm these observational findings.

SUBMITTER: Kaakinen TI

PROVIDER: S-EPMC9580133 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Association of low mixed venous oxygen saturations during early ICU stay with increased 30-day and 1-year mortality after cardiac surgery: a single-center retrospective study.

Kaakinen Timo I TI Ikäläinen Tomi T Erkinaro Tiina M TM Karhu Jaana M JM Liisanantti Janne H JH Ohtonen Pasi P PP Ala-Kokko Tero I TI

BMC anesthesiology 20221019 1

<h4>Background</h4>Low postoperative mixed venous oxygen saturation (SvO<sub>2</sub>) values have been linked to poor outcomes after cardiac surgery. The present study was designed to assess whether SvO<sub>2</sub> values of < 60% at intensive care unit (ICU) admission and 4 h after admission are associated with increased mortality after cardiac surgery.<h4>Methods</h4>During the years 2007-2020, 7046 patients (74.4% male; median age, 68 years [interquartile range, 60-74]) underwent cardiac surg ...[more]

PMID: 36261783

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Project description:BackgroundNear-infrared spectroscopy (NIRS) is a non-invasive approach that measures cerebral regional oxygen saturation (rScO2). In this study, we evaluated the evidence on the validity of NIRS and the interchangeability between NIRS and common invasive approaches by exploring the correlation and consistency and comparing the mean and standard deviation between the NIRS rScO2 and jugular bulb venous oxygen saturation (SjvO2) as well as central venous oxygen saturation (ScvO2) in the perioperative period of children with congenital heart disease (CHD).MethodsWe searched electronic bibliographic databases (PubMed, The Cochrane Library and Embase) and screened the studies that met the inclusion criteria. We included cross-sectional studies of CHD pediatric patients in the perioperative period receiving both tests for NIRS rScO2 and SjvO2 or NIRS rScO2 and ScvO2. Methodological quality assessment and heterogeneity analyses were performed. We qualitatively summarized the results of Bland-Altman's analysis. Meta-regression, subgroup analyses, and sensitivity analyses were carried out to explore the causes of heterogeneity.ResultsThere was no significant difference in Cohen's d between rScO2 and ScvO2 or between rScO2 and SjvO2 (Cohen's d =0.06, 95% CI: -0.16 to 0.28; Cohen's d =0.03, 95% CI: -0.25 to 0.31, respectively) and notable heterogeneity existed (I2=76.0%, P<0.001; I2=73.6%, P<0.001, respectively). A positive linear correlation was present between rScO2 and ScvO2 or between rScO2 and SjvO2 (r=0.58, 95% CI: 0.54 to 0.63; r=0.60, 95% CI: 0.54 to 0.66, respectively) and the heterogeneity was not significant (I2=36.7%, P=0.065; I2=12.7%, P=0.328, respectively). In most studies, the 95% limits of agreements of Bland-Altman's analysis were large. No evidence of publication bias was observed.ConclusionsThe rScO2 measured by NIRS reflected the SjvO2 and ScvO2 monitored by invasive measurements in the perioperative period of children with CHD to some extent. However, wide limits of agreements between rScO2 and SjvO2 as well as ScvO2 indicated that NIRS and SjvO2 as well as ScvO2 are not interchangeable. Whether NIRS plays a prominent role in monitoring cerebral oxygen saturation in children with CHD needs further research.

Dataset Information

Association of low mixed venous oxygen saturations during early ICU stay with increased 30-day and 1-year mortality after cardiac surgery: a single-center retrospective study.

Background

Methods

Results

Conclusion

Publications

Association of low mixed venous oxygen saturations during early ICU stay with increased 30-day and 1-year mortality after cardiac surgery: a single-center retrospective study.

Similar Datasets

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