Background. Low mixed venous saturation (SvO2) can reveal global tissue hypoxia and therefore can predict an increase of myocardial oxygen consumption (MvO2) and a poor prognosis in patients with cardiogenicshock after ST elevation myocardial infarction (STEMI). Early goal directed therapy, aiming to an SvO2 ≥70%, has been shown to be a valuable strategy in patients with a low output syndrome. Aim. The aim of this retrospective study was to determine the agreement between SvO2 and early hemodynamic status of patients with cardiogenic shock after STEMI. Methods. During the observation period (16-months), 79 patients were admitted in our ICU for cardiogenic shock after STEMI; patients who required an intra-aortic balloon pump (n=15) and/or mechanical ventilation (n=21) were excluded from the analysis. The hemodynamic management of studied patients was based on guideline treatment, and to maintain individual cardiac index and mixed venous oxygen saturation between 1.5 and 2.7 L/min/m2 and 55 and 65%, respectively, all patients were treated with an inotropic agent (dobutamine or levosimendan). Heart rate (HR), arterial blood pressure (ABP), central venous pressure (CVP), SvO2, pulmonary artery pressure (PAP), lactate plasma levels (LAC) and cardiac index (CI) were recorded for 24.2±2.9 hours. To optimize systemic afterload and coronary perfusion, mean arterial blood pressure (MAP) was individually maintained between 50 and 75 mmHg using sodium nitroprusside to decrease or norepinephrine to increase systemic vascular resistances, as clinically indicated. Results. In the Dobutamine group (n=24) the mean SvO2 value was 68.2±11.8% with mean CVP of 13.0±4.9 mmHg, LAC of 6.3±4.2 mmol/l and APACHE II score of 21.7±7.3; in-hospital mortality in this group was 32.0%. The Levosimendan group (n=19) showed a CVP of 13.7±4.6 mmHg, mean ScvO2 values of 78.6±10.2%, LAC of 3.3±2.3 mmol/l and APACHE II score of 22.2±5.4; in-hospital mortality in this group was 28.0%. Conclusions. SvO2 , in our study, was significantly (p<0.001) lower in dobutamine group (68.2±11.8%) compared to levosimendan group (78.6±10.2%); this difference correlated with an increase in oxygen consumption and extraction ratio, and it is associated with a negative metabolic effect.

Role of mixed venous oxygen saturation in patients developing cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with inotropic therapy / M., Poli; P., Trambaiolo; Basso, Valentina; M., Mustilli; V., Lukic; M., De Luca; M., Simonetti; F., Ferraiuolo; G., Ferraiuolo. - In: GIORNALE ITALIANO DI CARDIOLOGIA. - ISSN 1972-6481. - Vol 13 - Suppl 2 - N5 2012 - P407:(2012), pp. 157S-158S.

Role of mixed venous oxygen saturation in patients developing cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with inotropic therapy

BASSO, VALENTINA;
2012

Abstract

Background. Low mixed venous saturation (SvO2) can reveal global tissue hypoxia and therefore can predict an increase of myocardial oxygen consumption (MvO2) and a poor prognosis in patients with cardiogenicshock after ST elevation myocardial infarction (STEMI). Early goal directed therapy, aiming to an SvO2 ≥70%, has been shown to be a valuable strategy in patients with a low output syndrome. Aim. The aim of this retrospective study was to determine the agreement between SvO2 and early hemodynamic status of patients with cardiogenic shock after STEMI. Methods. During the observation period (16-months), 79 patients were admitted in our ICU for cardiogenic shock after STEMI; patients who required an intra-aortic balloon pump (n=15) and/or mechanical ventilation (n=21) were excluded from the analysis. The hemodynamic management of studied patients was based on guideline treatment, and to maintain individual cardiac index and mixed venous oxygen saturation between 1.5 and 2.7 L/min/m2 and 55 and 65%, respectively, all patients were treated with an inotropic agent (dobutamine or levosimendan). Heart rate (HR), arterial blood pressure (ABP), central venous pressure (CVP), SvO2, pulmonary artery pressure (PAP), lactate plasma levels (LAC) and cardiac index (CI) were recorded for 24.2±2.9 hours. To optimize systemic afterload and coronary perfusion, mean arterial blood pressure (MAP) was individually maintained between 50 and 75 mmHg using sodium nitroprusside to decrease or norepinephrine to increase systemic vascular resistances, as clinically indicated. Results. In the Dobutamine group (n=24) the mean SvO2 value was 68.2±11.8% with mean CVP of 13.0±4.9 mmHg, LAC of 6.3±4.2 mmol/l and APACHE II score of 21.7±7.3; in-hospital mortality in this group was 32.0%. The Levosimendan group (n=19) showed a CVP of 13.7±4.6 mmHg, mean ScvO2 values of 78.6±10.2%, LAC of 3.3±2.3 mmol/l and APACHE II score of 22.2±5.4; in-hospital mortality in this group was 28.0%. Conclusions. SvO2 , in our study, was significantly (p<0.001) lower in dobutamine group (68.2±11.8%) compared to levosimendan group (78.6±10.2%); this difference correlated with an increase in oxygen consumption and extraction ratio, and it is associated with a negative metabolic effect.
2012
mixed venous oxygen saturatio; cardiogenic shock; STEMI
04 Pubblicazione in atti di convegno::04c Atto di convegno in rivista
Role of mixed venous oxygen saturation in patients developing cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with inotropic therapy / M., Poli; P., Trambaiolo; Basso, Valentina; M., Mustilli; V., Lukic; M., De Luca; M., Simonetti; F., Ferraiuolo; G., Ferraiuolo. - In: GIORNALE ITALIANO DI CARDIOLOGIA. - ISSN 1972-6481. - Vol 13 - Suppl 2 - N5 2012 - P407:(2012), pp. 157S-158S.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/512551
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