Peripheral measurements of venous oxygen saturation and lactate as a less invasive alternative for hemodynamic monitoring

Abstract

BACKGROUND: Peripheral measurement of venous oxygen saturation and lactate is a less invasive alternative to monitor tissue oxygenation as compared to measurements from a central venous catheter. However, there is a lack of evidence to support the use of peripheral measurements. In this study, we investigated the agreement between central and peripheral venous oxygen saturation and lactate. METHODS: We conducted a prospective observational study including 115 patients who underwent elective cardiac surgery between April and May 2015 at Rigshospitalet, Copenhagen, Denmark. Measurements were obtained simultaneously at induction of anaesthesia, upon arrival in the ICU and 3-4 h postoperatively. Bias and trending ability was identified using Bland-Altman analysis and a four-quadrant plot. RESULTS: Bias was 13.37% for venous oxygen saturation preoperatively (95% CI: 11.52-15.22, LoA: ±19.10, PE: 22.08%), 11.29% at arrival to the ICU (95% CI: 8.81-13.77, LoA: ±25.10, PE: 32.39%) and 16.49% at 3-4 h postoperatively (95% CI: 14.16-18.82, LoA: ±21.20, PE: 26.82%). A four-quadrant plot demonstrated an 89% concordance. Central and peripheral lactate showed a bias of 0.14 mmol/L preoperatively (95% CI: 0.11-0.17, LoA: ±0.30, PE: 32.08%), 0.16 mmol/L at arrival to ICU (95% CI: 0.09-0.23, LoA: ±0.70, PE: 38.88%) and 0.23 mmol/L at 3-4 h postoperatively (95% CI: 0.11-0.35, LoA: ±0.50, 25.18%). DISCUSSION: Measurements of peripheral oxygen saturation and lactate may be valuable in an emergency setting, avoiding unnecessary and time consuming application of a CVC. CONCLUSION: We found a high bias but an acceptable trending ability between central and peripheral venous oxygenation. Central and peripheral lactate had excellent agreement. Further studies are necessary to validate the use of peripheral venous samples to identify patients at risk of impaired tissue oxygenation.