Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Perioperative central venous oxygen saturation and its correlation with mortality during cardiac surgery: an observational prospective study

Correlação entre saturação venosa central de oxigênio perioperatória e mortalidade em cirurgia cardíaca: estudo prospectivo observacional

César de Araujo Miranda, José F.A. Meletti, Laı́s H.N. Lima, Evaldo Marchi

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Cardiac surgery can produce persistent deficit in the ratio of Oxygen Delivery (DO2) to Oxygen Consumption (VO2). Central venous oxygen Saturation (ScvO2) is an accessible and indirect measure of DO2/VO2 ratio.

To monitor perioperative ScvO2 and assess its correlation with mortality during cardiac surgery.

This prospective observational study evaluated 273 patients undergoing cardiac surgery. Blood gas samples were collected to measure ScvO2 at three time points: T0 (after anesthetic induction), T1 (end of surgery), and T2 (24 hours after surgery). The patients were divided into two groups (survivors and nonsurvivors). The following outcomes were analyzed: intrahospital mortality, length of Intensive Care Unit (ICU) and hospital stay (LOS), and variation in ScvO2.

Of the 273 patients, 251 (92%) survived and 22 (8%) did not. There was a significant perioperative reduction of ScvO2 in both survivors (T0 = 78% ± 8.1%, T1 = 75.4% ± 7.5%, and T2 = 68.5% ± 9%; p <  0.001) and nonsurvivors (T0 = 74.4% ± 8.7%, T1 = 75.4%±7.7%, and T2 = 66.7%±13.1%; p < 0.001). At T0, the percentage of patients with ScvO2< 70% was greater in the nonsurvivor group (31.8% vs. 13.1%; p =  0.046) and the multiple logistic regression showed that ScvO2 is an independent risk factor associated with death, OR = 2.94 (95% CI 1.10 − 7.89) (p =  0.032). The length of ICU and LOS were 3.6 ± 3.1 and 7.4 ± 6.0 days respectively and was not significantly associated with ScvO2.

Early intraoperative ScvO2 < 70% indicated a higher risk of death. A perioperative reduction of ScvO2 was observed in patients undergoing cardiac surgery, with high intraoperative and lower postoperative levels.


Cardiac surgery procedures, Mortality, Perioperative care, Blood gas analyses, Venous catheterization


A cirurgia cardíaca pode produzir déficit persistente na razão entre oferta de oxigênio (DO2) e consumo de oxigênio (VO2). A Saturação venosa central de Oxigênio (SvcO2) é uma medida acessível e indireta da razão DO2/VO2.

Monitorar a SvcO2 perioperatória e avaliar sua correlação com a mortalidade em cirurgia cardíaca.

Este estudo observacional prospectivo avaliou 273 pacientes submetidos a cirurgia cardíaca. Coletamos amostras de sangue para medir a SvcO2 em três momentos: T0 (após indução anestésica), T1 (final da cirurgia) e T2 (24 horas após a cirurgia). Os pacientes foram divididos em dois grupos (sobreviventes e não sobreviventes). Os seguintes desfechos foram analisados: mortalidade intra-hospitalar, tempo de permanência na Unidade de Terapia Intensiva (UTI) e de internação hospitalar, e variação na SvcO2.

Dos 273 pacientes, 251 (92%) sobreviveram e 22 (8%) não. Houve queda significante da SvcO2 perioperatória nos sobreviventes (T0 = 78%±8,1%, T1 = 75,4% ± 7,5% e T2 = 68,5% ± 9%; p <  0,001) e nos não sobreviventes (T0 = 74,4% ± 8,7%, T1 = 75,4% ± 7,7% e T2 = 66,7% ± 13,1%; p <  0,001). No T0, a porcentagem de pacientes com SvcO2 < 70% foi maior no grupo não sobrevivente (31,8% vs. 13,1%; p =  0,046) e a regressão logística múltipla mostrou que a SvcO2 é um fator de risco independente associado ao óbito, OR = 2,94 (95% IC 1,10 − 7,89) (p = 0,032). O tempo de permanência na UTI e de hospitalização foi de 3,6 ± 3,1 e 7,4 ± 6,0 dias, respectivamente, e não foi significantemente associado à SvcO2.

Valores precoces de SvcO2 intraoperatória < 70% indicaram maior risco de óbito em pacientes submetidos à cirurgia cardíaca. Observamos redução perioperatória da SvcO2, com altos níveis no intraoperatório e mais baixos no pós-operatório.


Procedimentos de cirurgia cardíaca, Mortalidade, Cuidado perioperatório, Análise de gases no sangue, Cateterismo venoso


1. Van Beest P, Wietasch G, Scheeren T, et al. Clinical Review: use of venous oxygen saturation as a goal – a yet unfinished puzzle. Crit Care. 2011;15:232.

2. Jain A, Shroff SG, Janicki JS, et al. Relation between Mixed venous oxygen and cardiac index: Nonlinearity and normalization for oxygen uptake and hemoglobin. Chest. 1991;99:1403-9.

3. Lobo SM, de Oliveira NE. Clinical review: What are the best hemodynamic targets for noncardiac surgical patients. Crit Care. 2013;17:210.

4. Silva ED, Perrino AC, Teruya A, et al. Brazilian Consensus on perioperative hemodynamic therapy goal guided in patients undergoing noncardiac surgery: fluid management strategy – produced by the São Paulo State Society of Anesthesiology (Sociedade de Anestesiologia do Estado de São Paulo – SAESP). Rev Bras Anestesiol. 2016;66:557-71. -p

5. Reinhart K, Kuhn HJ, Hartog C, et al. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med. 2004;30:1572-8.

6. Reinhart K, Rudolph T, Bredle DL, et al. Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest. 1989;95:1216-21.

7. Marik PE. Obituary: pulmonary artery catheter 1970 to 2013. Ann Intensive Care. 2013;3:38.

8. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-77.

9. Pölönen P, Ruokonen E, Hippeläinen M, et al. A prospective, randomized study of goal-oriented therapy in cardiac surgery patients. Anesth Analg. 2000;90:1052-9.

10. Balzer F, Sander M, Simon M, et al. High central venous saturation is associated with increased organ failure and long-term mortality − an observational cross-sectional study. Crit Care. 2015;19:168.

11. Silva Junior JM, Oliveira AMRR, Morais SZ, et al. Influence of central venous oxygen saturation on in-hospital mortality of surgical patients. Rev Bras Anestesiol. 2010;60:6:593-602.

12. Pearse R, Rhodes A. Mixed and central venous oxygen saturation. In: Vincent JL, ed. Yearbook of Intensive Care and Emergency Medicine. ed. Berlin: Springer. 2005:592-602.

13. Squara P. Central venous oxygenation: When physiology explains apparent discrepancies. Crit Care. 2014;18:579.

14. Hayes MA, Timmins AC, Yau EH, et al. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med. 1994;330:1717-22

15. Pearse R, Dawson D, Fawcet J, et al. Changes in central venous saturation after major surgery, and association with outcome. Crit Care. 2005;9:R694-699.

16. Holm J, Hakanson E, Vanky F, et al. Mixed venous oxygen saturation predicts short-and long-term outcome after coronary artery bypass grafting surgery: a retrospective cohort analysis. Br J Anaesth. 2011;107:344-50.

17. Holm J, Hakanson RE, Vanky F, et al. Mixed venous oxygen saturation is a prognostic marker after surgery for aortic stenosis. Acta Anaesthesiol Scand 2010;54:589-95.

18. Lisboa LAF, Mejia OAV, Moreira LFP, et al. EuroSCORE II e a importância de um -p modelo local, InsCor e o futuro SP-SCORE. Rev Bras Cir Cardiovasc. 2014;19:1-8

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