Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000600005
Brazilian Journal of Anesthesiology
Scientific Article

Influência da saturação venosa central de oxigênio na mortalidade hospitalar de pacientes cirúrgicos

Influence of central venous oxygen saturation on in-hospital mortality of surgical patients

João Manoel Silva Junior; Amanda Maria Ribas Rosa Oliveira; Sandra Zucchi de Morais; Luciana Sales de Araújo; Luiz Gustavo F Victoria; Lauro Yoiti Marubayashi

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Resumo

RESUMO JUSTIFICATIVA E OBJETIVOS: Saturação venosa central de oxigênio (SvcO2) baixa indica desequilíbrio entre oferta e consumo de oxigênio celular e, consequentemente, pior prognóstico em pacientes graves. No entanto, ainda não está claro qual o valor desse marcador em pacientes cirúrgicos. O objetivo deste estudo foi avaliar se SvcO2 baixa no perioperatório determina pior prognóstico. MÉTODO: Estudo observacional, durante 6 meses, em um hospital terciário. Foram incluídos pacientes que necessitassem de pós-operatório em terapia intensiva (UTI) com idade > 18 anos, submetidos a cirurgias de grande porte. Pacientes com cirurgias paliativas e pacientes com insuficiên cia cardíaca grave foram excluídos. Valores de SvcO2 foram mensurados antes da cirurgia, durante o procedimento e após a cirurgia na UTI. RESULTADOS: Foram incluídos 66 pacientes e não sobreviveram 25,8%. Os valores médios de SvcO2 dos pacientes foram maiores no intraoperatório, 84,7 ± 8,3%, do que no pré-operatório e UTI, respectivamente 74,1 ± 7,6% e 76,0 ± 10,5% (p = 0,0001). Porém, somente os valores de SvcO2 no pré-operatório dos pacientes não sobreviventes foram significativamente mais baixos que os sobreviventes. Pela regressão logística SvcO2 pré-operatória, OR = 0,85 (IC 95% 0,74-0,98) p = 0,02 foi fator independente de mortalidade hospitalar. Pacientes com SvcO2 < 70% no pré-operatório apresentaram maior necessidade de transfusão sanguínea (80,0% versus 37,0% p = 0,001) e reposição volêmica no intraoperatório 8.000,0 (6.500,0 - 9.225,0) mL versus 6.000,0 (4.500,0 - 8.500,0) mL p = 0,04), com maiores chances de complicações pós-operatórias (75% versus 45,7% p = 0,02) e maior tempo de internação na UTI 4,0 (2,0-5,0) dias versus 3,0 (1,7 - 4,0) dias p = 0,02. CONCLUSÕES: Os valores de SvcO2 no intraoperatório são maiores que os do pré- e pós-operatório. Contudo, a SvcO2 baixa no pré-operatório determina pior prognóstico.

Palavras-chave

COMPLICAÇÕES, OXIGÊNIO, níveis sanguíneos, RISCO

Abstract

BACKGROUND AND OBJECTIVES: Low central venous oxygen saturation (ScvO2) indicates an imbalance between cellular oxygen supply and consumption and, consequently, worse prognosis for critical patients. However, it is not clear what the value of this marker in surgical patients. The objective of the present study was to evaluate whether low perioperative ScvO2 determines a worse prognosis. METHODS: This is a 6-month observational study carried on in a tertiary hospital. Patients who needed to be in the intensive care unit (ICU) postoperatively, with age > 18 years, who underwent large surgeries, were included. Patients who underwent palliative surgeries and those with severe heart failure were excluded. Levels of ScvO2 were measured before the surgery, during the procedure, and after the surgery in the ICU. RESULTS: Sixty-six patients were included in this study, but 25.8% of them did not survive. Mean ScvO2 levels were higher intraoperatively, 84.7 ± 8.3%, than preoperatively and in the ICU, 74.1 ± 7.6% and 76.0 ± 10.5% (p = 0.0001), respectively. However, only preoperative SvcO2 levels of non-surviving patients were significantly lower than those who survived. By logistic regression, preoperative ScvO2, OR = 0.85 (95% CI 0.74-0.98) (p = 0.02), was an independent factor of in-hospital mortality. Patients with preoperative ScvO2 < 70% had greater need of intraoperative blood transfusion (80.0% versus 37.0%, p = 0.001) and volume replacement, 8,000.0 (6,500.0-9,225.0) mL versus 6,000.0 (4,500.0-8,500.0) mL (p = 0.04), with greater chances of postoperative complications (75% versus 45.7%, p = 0.02) and longer time in the ICU, 4.0 (20.0-5.0) days versus 3.0 (1.7-4.0) days (p = 0.02). CONCLUSIONS: Intraoperative ScvO2 levels are higher than those both in the pre- and postoperative period. However, low preoperative ScvO2 determines worse prognosis.

Keywords

COMPLICATIONS, OXYGEN, blood levels, RISK

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