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Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation*

van Beest, Paul A. MD; van der Schors, Alice MD; Liefers, Henriëtte MSc; Coenen, Ludo G. J. MD; Braam, Richard L. MD, PhD; Habib, Najib MD; Braber, Annemarije MD; Scheeren, Thomas W. L. MD, PhD; Kuiper, Michaël A. MD, PhD, FCCM; Spronk, Peter E. MD, PhD

doi: 10.1097/CCM.0b013e3182657591
Clinical Investigations

Objective: The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients.

Design: Prospective observational controlled study.

Setting: Nonacademic university-affiliated teaching hospital in The Netherlands.

Patients: One hundred cardiac outpatients, 30 high-risk surgical patients, and 30 critically ill patients.

Interventions: None.

Methods and Main Results: We concurrently determined femoral venous oxygen saturation and central venous oxygen saturation in a group of 100 stable cardiac patients, which served as control group. Furthermore, we determined simultaneously femoral venous oxygen saturation and central venous oxygen saturation in 30 surgical patients and in 30 critically ill patients and evaluated changes over time. Correlation and agreement of femoral venous oxygen saturation and central venous oxygen saturation were assessed, including the difference between femoral venous oxygen saturation and central venous oxygen saturation.

Despite significant correlation between obtained values of femoral venous oxygen saturation and central venous oxygen saturation (rs = 0.55; p < .001), the limits of agreement were wide in the control group (mean bias 2.7% ± 7.9%; 95% limits of agreement −12.9% to 18.2%). In both the surgical and critically ill patients, limits of agreement (mean bias of −1.9% ± 9.3%; 95% limits of agreement −20.0% to 16.3%, and mean bias of 4.6% ± 14.3%; 95% limits of agreement −23.5% to 32.6%, respectively) were wide. Results for changes of femoral venous oxygen saturation and central venous oxygen saturation were similar. During initial treatment of critically ill patients, the difference between femoral venous oxygen saturation and central venous oxygen saturation including its range of variation diminished.

Conclusion: There is lack of agreement between femoral venous oxygen saturation and central venous oxygen saturation in both stable and unstable medical conditions. Thus, femoral venous oxygen saturation should not be used as surrogate for central venous oxygen saturation.

From the Department of Anesthesiology (PAvB, TWLS), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Departments of Anesthesiology (AvdS, LGJC), Cardiology (HL, RLB), and Intensive Care Medicine (NH, AB, PES), Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands; Department of Intensive Care Medicine (MAK), Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Intensive Care Medicine (MAK, PES), Academic Medical Center, Amsterdam, The Netherlands; and HERMES Critical Care Group (MAK, PES), Apeldoorn, The Netherlands.

*See also p. 3318.

Dr. van Beest drafted the manuscript, participated in its design and coordination, and performed statistical analysis. Dr. van der Schors was responsible for acquisition of patient data (surgical patients) and helped to draft the manuscript. Mr. Liefers was responsible for acquisition of patient data (cardiac patients). Dr. Habib participated in entering patient data into the database (ICU patients). Dr. Braber was responsible for acquisition of patient data and entering data into the database (ICU patients). Dr. Coenen was responsible and provided support for acquisition of patient data (surgical patients) and helped to draft the manuscript. Dr. Braam was responsible for acquisition of patient data (cardiac patients). Dr. Scheeren provided general support and revised the manuscript for intellectual content. Dr. Kuiper participated in the design of the study, provided general support, and revised the manuscript for intellectual content. Dr. Spronk conceived of the study and participated in its design and coordination and helped to draft and finalize the manuscript.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: p.van.beest@umcg.nl

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins