Abnormal Central Venous Oxygen Saturation as a Predictor of Mortality in patients with Sepsis and Polytrauma in the Surgical Intensive Care Unit

Jyothi, vula (2012) Abnormal Central Venous Oxygen Saturation as a Predictor of Mortality in patients with Sepsis and Polytrauma in the Surgical Intensive Care Unit. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Sepsis and trauma are major causes of mortality and morbidity in ICU patients. The common feature in these two conditions is systemic inflammation and deranged oxygen delivery. Unfortunately, until recently, numerous therapies to treat sepsis failed to improve mortality. The three main resuscitation targets are preload (measured by central venous pressure), perfusion (mean arterial pressure), and tissue hypoxia (base excess and blood lactate). The Early Goal Directed therapy (EGDT) trial in septic patients whose haemodynamic parameters were optimized within the first 6 hours after hospital admission showed an improved outcome. The trial demonstrated that optimization oxygen delivery by optimizing central venous oxygen saturation and mean arterial blood pressure improved outcome. Central venous oxygen saturation is obtained by measuring the oxygen saturation in venous blood returning to the heart. In simple form, it represents the balance between oxygen delivery and oxygen consumption which is an indication of oxygen extraction. In sepsis and trauma, oxygenation of blood in the lungs, delivery of oxygenated blood to the tissues, and utilization of oxygen by various tissues are affected by various mechanisms. Early Identification and treatment of this imbalance in oxygen delivery and utilization will prevent organ failure and reduce morbidity and mortality in the ICU patients. OBJECTIVES: Abnormal (low and supranormal) central venous oxygen saturation (ScvO2) with associated hyperlactatemia has been shown to be associated with increased mortality in post-operative cardiac surgery patients and in patients with sepsis. We want to assess the effect of these and incidence of morbidity and mortality in the population who are admitted with a diagnosis of sepsis and poly trauma to our surgical ICU. METHODS: A prospective observational study was done in all patients who met the inclusion criteria and had a diagnosis of sepsis and polytrauma. They were assessed during initial 6 hours and their SCV02 was measured at admission and 6 hours later and its association to mortality and other variables like lactates and base excess and duration of ICU stay and inotropic support were assessed and analysed using a multivariate model analysis. RESULTS: When compared to the normal group, the hyperoxia group had a risk ratio of 2.422 times more likelihood of mortality and the hypoxia group had 1.0256 times more likelihood of mortality. When the hypoxia group was compared with the hyperoxia group the risk ratio for mortality was 2.36 times more in the hyperoxia group though the p value was not significant. There was no statistically significant difference between the 3 groups of Scv02 when compared to duration of icu stay, duration of inotropic support and coagulopathy and need for dialysis and apache11 score and base excess and lactates. CONCLUSIONS: When lactates, base excess and Scv02 were compared to mortality though not significant; gave a j shaped curve suggesting that mortality is higher both in the hypoxia and the hyperoxia group compared to the normoxia group. The small sample size though was adequate to predict a trend, was insufficient to address secondary objectives.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Abnormal Central Venous Oxygen Saturation ; Predictor of Mortality ; patients ; Sepsis ; Polytrauma ; Surgical Intensive Care Unit.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 30 Apr 2018 02:54
Last Modified: 30 Apr 2018 02:54
URI: http://repository-tnmgrmu.ac.in/id/eprint/7329

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