Objective: To determine whether maintaining normal levels of mixed venous oxygen saturation (SvO2) in patients with multiple injuries is more relevant to survival than maintaining above-normal levels of oxygen transport.
Design: Non-randomised, retrospective control study over a 38-month period.
Setting: Multidisciplinary intensive care unit in a university hospital.
Patients: 40 patients with multiple injuries divided in to group A (23 patients) and group B (17 patients).
Interventions: In group A patients, we maintained normal SvO2 by manipulation of oxygen transport variables; oxygen delivery (DO2) was increased only if SvO2 decreased or the dobutamine test was positive. In group B patients, DO2 was routinely maintained at above-normal levels by aggressive use of fluids and dobutamine.
Measurements and results: In group A we measured SvO2 continuously and performed the dobutamine test. Oxygen transport-related variables were recorded every 12 h in the first 5 days after injury in both groups, as well as lactate concentrations. Survival was significantly greater in group A than in group B (p<0.01). Multiple organ failure was less frequent in group A than in group B (p<0.01). The average DO2 in group A was significantly lower than in group B from day 2 onwards (p<0.05–0.01). Average values of DO2 of 605–688 ml/min per m2 were required to maintain normal SvO2 and aerobic metabolism in group A; 10 patients required dobutamine 2.5–5 μg/kg per min. The average DO2 in group B was 622 ml/min per m2 on day 1 and then it increased to 835 ml/min per m2 on day 5 after trauma.
Conclusions: Our results indicate that for patients with multiple injuries maintaining normal SvO2 values and increasing DO2 only if required are more relevant for survival than routine maintenance of above-normal oxygen transport values.
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Received: 4 March 1996 Accepted: 28 September 1996
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Kremzˇar, B., Sˇpec-Marn, A., Kompan, L. et al. Normal values of SvO2 as therapeutic goal in patients with multiple injuries. Intensive Care Med 23, 65–70 (1997). https://doi.org/10.1007/s001340050292
- Key words Patients with multiple injuries
- Oxygen transport