Association of low mixed venous oxygen saturations during early ICU stay with increased 30-day and 1-year mortality after cardiac surgery : a single-center retrospective study
Kaakinen, Timo I; Ikäläinen, Tomi; Erkinaro, Tiina M; Karhu, Jaana M; Liisanantti, Janne H; Ohtonen, Pasi P; Ala-Kokko, Tero I (2022-10-19)
Kaakinen, T.I., Ikäläinen, T., Erkinaro, T.M. et al. Association of low mixed venous oxygen saturations during early ICU stay with increased 30-day and 1-year mortality after cardiac surgery: a single-center retrospective study. BMC Anesthesiol 22, 322 (2022). https://doi.org/10.1186/s12871-022-01862-8
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https://urn.fi/URN:NBN:fi-fe2023060652653
Tiivistelmä
Abstract
Background: Low postoperative mixed venous oxygen saturation (SvO₂) values have been linked to poor outcomes after cardiac surgery. The present study was designed to assess whether SvO₂ values of < 60% at intensive care unit (ICU) admission and 4 h after admission are associated with increased mortality after cardiac surgery.
Methods: During the years 2007–2020, 7046 patients (74.4% male; median age, 68 years [interquartile range, 60–74]) underwent cardiac surgery at an academic medical center in Finland. All patients were monitored with a pulmonary artery catheter. SvO₂ values were obtained at ICU admission and 4 h later. Patients were divided into four groups for analyses: SvO₂ ≥ 60% at ICU admission and 4 h later; SvO₂ ≥ 60% at admission but < 60% at 4 h; SvO₂ < 60% at admission but ≥ 60% at 4 h; and SvO₂ < 60% at both ICU admission and 4 h later. Kaplan–Meier survival curves, Cox regression models, and receiver operating characteristic curve analysis were used to assess differences among groups in 30-day and 1-year mortality.
Results: In the overall cohort, 52.9% underwent coronary artery bypass grafting (CABG), 29.1% valvular surgery, 12.1% combined CABG and valvular procedures, 3.5% surgery of the ascending aorta or aortic dissection, and 2.4% other cardiac surgery. The 1-year crude mortality was 4.3%. The best outcomes were associated with SvO₂ ≥ 60% at both ICU admission and 4 h later. Hazard ratios for 1-year mortality were highest among patients with SvO₂ <60% at both ICU admission and 4 h later, regardless of surgical subgroup.
Conclusions: SvO₂ values < 60% at ICU admission and 4 h after admission are associated with increased 30-day and 1-year mortality after cardiac surgery. Goal-directed therapy protocols targeting SvO₂ ≥ 60% may be beneficial. Prospective studies are needed to confirm these observational findings.
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