Mixed venous oxygen saturation (SvO2)

(Pressure based haemodynamic monitoring)

Prepared by
O C Monokwane (MBBS, Bmedsci, Yr1 PG
Anaes)
Outline
Objectives
Definitions
Indications
Contra indications
Interpretations
Summary
References
Objectives
Understand relevance of mixed venous blood oxygen
saturation as haemodynamic monitoring tool
Identify conditions where utilisation mixed venous
blood oxygen saturation will be most relevant
Define central venous blood oxygen saturation
(ScVO2) and mixed venous blood saturation (SVO2)
Definitions
Mixed venous oxygen saturation (SvO2) is blood
oxygen saturation measured in the pulmonary artery
Plethismography
Intermitent (VBG)
Central venous oxygen saturation (ScvO2) is a
measure of venous oxygen saturation in the superior
vena cava , ideally within right atrium (in exclusion of
coronary sinus venous return)
Indirect measure of tissue/ cellular level oxygen
demand, extraction and utilisation
Definitions
Varies with change in Cardiac output, Haemoglobin
(Hgb) availability , Arterial oxygen saturation and whole-
body oxygen consumption hence complex interpretation
Normal ranges
 SvO2 60%- 80 %
ScvO2 65%- 85% (2-5% lower than SvO2)
Flactuates average < 5%
Change is SvO2 > 5% persisting for longer than 5 mins
considered significant
Normal extraction oxygen 25-30% corresponds to Sv02
>65%
Indications
Monitoring Critical care patient in ICU to assess tissue
oxygenation
Management of cardiac arrest and or post resus
Trauma /haemorrhage
Occult cardiogenic shock – normal vital signs ScvO2
26.4 -36.8 %
Severe Sepsis and septic shock
Contraindications
Central line and pulmonary artery catheter (PAC)
contraindications
 Uncooperative patients
 Bleeding diasthesis uncorrected
 Skin infection over site
 Distortion of anatomic landmarks
 Pneumothorax or hemothorax
 Morbid obesity
Interpretations of mixed venous oxygen
saturation
Normal body match demand to intake such that mixed
venous saturation remains stable ≈ 75%
Decreasing Svo2 (<60%)
Supply not meeting demand
 Reduced cardiac output
 Low arterial oxygen content
 Increased oxygen consumption
 Fever
 Shivering
 Exercise
 Maligmant Hyperthermia
 Thyroid storm
Interpretations of mixed venous oxygen
saturation
Decreasing Svo2 (<60%)
 Reduced oxygen Delivery
 Hypoxia
 Decreased cardiac out put
 Decreased HB concentration
 Abnormal HB
 Interpretations of mixed venous oxygen
saturation
Increased SvO2
Left to right shunting
High cardiac out put
Impaired tissue uptake – cyanide poisoning
Decreased O2 consumption- Hypothermia
Sepsis (70%)
Sampling error –wedged pulmonary artery pressure
Interpretations of mixed venous oxygen
saturations
Interpretations of mixed venous oxygen
saturations
Interpretations of mixed venous oxygen
saturations
Summary of key points
Measurement of SvO2 gives realtime measure of
tissue perfusion adequacy and aids quick response to
abberrations
References
https://www.slideserve.com/hua
/haemodynamic-monitoring