• Guillermo Gutierrez, Pablo Comignani, Luis Huespe, F Javier Hurtado, Arnaldo Dubin, Vinayak Jha, Yanina Arzani, Silvio Lazzeri, Lombardo Sosa, Juan Riva, Wolf Kohn, Daniela Suarez, Gonzalo Lacuesta, Daniela Olmos, Carlos Mizdraji, and Alejandra Ojeda.
• Pulmonary and Critical Care Medicine Division, The George Washington University Medical Center, 2150 Pennsylvania Ave., N.W, Washington, DC, 20037, USA. ggutierrez@mfa.gwu.edu
• Intensive Care Med. 2008 Sep 1;34(9):1662-8.

ObjectiveBlood O(2) saturation and lactate concentration gradients from superior vena cava (SVC) to pulmonary artery (PA) occur in critically ill patients. These gradients (DeltaSO(2) and Delta[Lac]) may be positive or negative. We tested the hypothesis that positive DeltaSO(2) and Delta[Lac] are associated with improved survival in critically ill patients.Design And SettingMultinational, prospective observational study conducted in six medical and surgical ICUs.PatientsConsecutive sample of 106 adults requiring insertion of a pulmonary artery catheter (PAC). Average age was 59.5 +/- 15.5 years, APACHE II score was 15.5 +/- 6.7 (mean +/- SD). Main outcome measure was 28-day mortality.InterventionsNone.Measurements And ResultsWe drew blood samples from the proximal and distal ports of PACs every 6 h from the time of PAC insertion (Initial measurement) until its removal (Final measurement). Samples were analyzed for SO(2), [Lac], glucose concentration and blood gases. Hemodynamic measurements were obtained after blood samples. We monitored patients for 30.9 +/- 11.0 h. Overall mortality rate was 25.5%. More survivors had mean and final DeltaSO(2) > or = 0 and Delta[Lac] > or = 0 than decedents (p < 0.01; p < 0.05 respectively). On the average, DeltaSO(2) and Delta[Lac] were positive in survivors and negative in decedents. Survival odds ratios for final measurements of DeltaSO(2) > or = 0 and Delta[Lac] > or = 0 were 19.22 and 7.70, respectively (p < 0.05).ConclusionsA strong association exists between positive DeltaSO(2) and Delta[Lac] and survival in critically ill patients. Whether therapy aimed at increasing DeltaSO(2) and Delta[Lac] results in improved ICU survival remains to be determined.

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