• Alessandro Protti, Serge Masson, Roberto Latini, Roberto Fumagalli, Marilena Romero, Carla Pessina, Giovanni Pasetti, Gianni Tognoni, Antonio Pesenti, Luciano Gattinoni, and Pietro Caironi.
• Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
• Chest. 2018 Dec 1; 154 (6): 1291-1300.

BackgroundRelevance of low (< 70%) central venous oxygen saturation (Scvo2) during early sepsis has been recently questioned by three negative trials (Protocol-Based Care for Early Septic Shock, Australasian Resuscitation in Sepsis Evaluation, and Protocolized Management in Sepsis) on early goal-directed therapy; however, subjects included in those trials had Scvo2 at enrollment as high as 71 ± 13%, 73 ± 11%, and 70 ± 12%. Here we assess the association between Scvo2 < 70% at 6 h and 90-day mortality in subjects enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial, focusing on those with initial Scvo2 < 70%.MethodsRegardless of treatment assignment (to receive albumin or not), all subjects enrolled in the ALBIOS trial received early goal-directed therapy aiming for Scvo2 ≥ 70% at 6 h. Using multivariable logistic regression analyses, we tested the association between Scvo2 < 70% at 6 h and 90-day mortality in those with initial Scvo2 < 70% (n = 514) or ≥ 70% (n = 961).ResultsScvo2 < 70% at 6 h was independently associated with higher 90-day mortality in subjects with initial Scvo2 < 70% (OR, 1.84; 95% CI, 1.19-2.85; P = .007) but not in those with initial Scvo2 ≥ 70% (OR, 1.25; 95% CI, 0.79-1.95; P = .357). Scvo2 < 70% at enrollment and at 6 h was associated with history and/or signs of cardiac dysfunction but not with greater severity of disease or more aggressive resuscitation (required per protocol).ConclusionsIn the ALBIOS trial, persistence of low Scvo2 was associated with higher 90-day mortality, possibly because it reflected underlying cardiac dysfunction. Subjects with Scvo2 < 70% may benefit most from individually tailored interventions aimed at normalizing the balance between systemic oxygen delivery and consumption.Trial RegistryClinicalTrials.gov; No. NCT00707122; URL: www.clinicaltrials.gov.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

33 keywords...

hide…