Dynamics of Central Venous Oxygen Saturation and Serum Lactate during Septic Shock Resuscitation
Chairat Permpikul MD*, Kittima Noppakaorattanamanee MD*, Surat Tongyoo MD*, Ranistha Ratanarat MD*, Aekarin Poompichet MD*
Affiliation : * Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Septic shock is a serious condition leading to high mortality and morbidity. Many varieties of attempts aiming
toward improving outcomes have been implemented. However, the appropriate therapeutic end point of shock resuscitation
is still under investigation. The authors report here the dynamics of commonly used parameters, namely central venous
oxygen saturation (ScvO2) and lactate concentration during resuscitation.
Material and Method: Adult patients admitted with severe sepsis and septic shock from October 1, 2009 to January 31, 2009
were enrolled. During hemodynamic resuscitation, the central venous blood was drawn for ScvO2 and lactate measurement
right after the CVC was placed (T1) and at the point where the blood pressure goal was achieved (T2). The third and the fourth
measurements were obtained at 1 and 2 hours thereafter (T3 and T4). These samples were ice chilled and were sent to central
laboratory for blood gas analysis and lactate determination.
Results : Twenty patients underwent the study. There was no significant change in ScvO2 from T1 to T4. All but five ScvO2at
T1 were above 70%. Lactate level gradually declined during the course of treatment and the clearance from T1 to T3 was
calculated as 15.4%. No correlation between ScvO2 and lactate level was noted at any sampling time. When partitioning
venous oxygen saturation in to 4 groups, that is ScvO2< 65, 65-< 75, 75-<85 and > 85, respectively, those with ScvO2 > 85%
had the highest lactate concentration.
Conclusion : Central venous oxygen saturation and its changes during treatment were heterogeneous which made this
parameter less reliable than others to monitor management. The lactate clearance, although slow, is uniform and may be used
alone or in combination with other parameters to monitor resuscitation.
Keywords : Sepsis, Septic shock, ScvO2, Lactate, Lactate clearance
