PMID- 9212114
OWN - NLM
STAT- MEDLINE
DCOM- 19970723
LR  - 20190704
IS  - 0003-2999 (Print)
IS  - 0003-2999 (Linking)
VI  - 85
IP  - 1
DP  - 1997 Jul
TI  - Predictive factors for usefulness of fiberoptic pulmonary artery catheter for 
      continuous oxygen saturation in mixed venous blood monitoring in cardiac surgery.
PG  - 2-10
AB  - The main goal of this prospective study was to identify among cardiac surgery 
      patients, usually monitored through a standard pulmonary artery catheter (PAC), 
      those in whom a fiberoptic catheter oximeter to measure oxygen saturation in 
      mixed venous blood (SVO2 PAC) would be most useful. Data from 286 patients who 
      underwent coronary artery bypass graft (50%) or valvular surgery were recorded, 
      including ASA physical status, New York Heart Association (NYHA) classification, 
      and Parsonnet score (PS). Hemodynamic events and SVO2 changes were collected 
      intra- and postoperatively until weaning from mechanical ventilation. The 
      anesthesiologist in charge graded the usefulness of SVO2 PAC, and another 
      anesthesiologist carried out a blindly controlled overall evaluation. Usefulness 
      was defined as the presence of a change in therapeutic maneuver triggered solely 
      by continuous SVO2 data that would not have occurred based on other routine 
      parameters. SVO2 was also considered useful if earlier recognition of significant 
      adverse events occurred. SVO2 PAC was useful in 57% of the patients. Independent 
      predictive factors (multivariate analysis) for the perioperative usefulness of 
      SVO2 in the whole population consisted of ASA class > or = 4 (P < 10(-5); 
      relative risk [RR] 1.78, 1.51-2.07), mitral surgery (P < 10(-4); RR 1.72, 
      1.4-2.02), and NYHA score > or = 3 (P < 0.01; RR 1.66, 1.35-2.05). Independent 
      predictive factors for the perioperative usefulness of SVO2 in the coronary 
      artery bypass graft population were NYHA score > or = 3 (P < 10(-5); RR 1.90, 
      1.42-2.55) and ASA class > or = 4 (P < 0.01; RR 1.99, 1.51-2.63). The presence of 
      three stenosed coronary arteries showed borderline significance (P < 0.06). 
      Independent predictive factors for perioperative usefulness of SVO2 in the 
      valvular population were mitral pathology (P < 10(-5)) and ASA class > or = 4 (P 
      < 0.01). The receiver operator characteristic curve assessed the predictivity of 
      the PS. SVO2 PAC was more useful in the group of patients with the greatest 
      severity of illness (PS in useful group 17.0 +/- 10.3; in nonuseful group 8.7 +/- 
      6.6; P < 10(-4)). Intensive care unit duration and hospital stay in the useful 
      group was prolonged compared with the nonuseful group. Similarly, morbidity was 
      frequent in the useful group, although it was not always significantly different 
      from the nonuseful group according to the type of complications. Mortality was 
      comparable in the groups despite their different degree of illness and was 
      reduced when taking into account the predictive and observed mortality provided 
      by the PS. This study defined independent preoperative factors associated with 
      SVO2 PAC monitoring and proposed a cutoff point above which SVO2 may be useful.
FAU - Vedrinne, C
AU  - Vedrinne C
AD  - Department of Cardiothoracic Anesthesia and Intensive Care, Hopital 
      Cardiovasculaire & Pneumologique Louis Pradel, Lyon, France.
FAU - Bastien, O
AU  - Bastien O
FAU - De Varax, R
AU  - De Varax R
FAU - Blanc, P
AU  - Blanc P
FAU - Durand, P G
AU  - Durand PG
FAU - Du Gres, B
AU  - Du Gres B
FAU - Bouvier, H
AU  - Bouvier H
FAU - Saroul, C
AU  - Saroul C
FAU - Lehot, J J
AU  - Lehot JJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
SB  - IM
MH  - Aged
MH  - *Cardiac Surgical Procedures/adverse effects
MH  - Catheterization, Swan-Ganz/*instrumentation
MH  - Coronary Artery Bypass/adverse effects
MH  - Female
MH  - Fiber Optic Technology
MH  - Heart Valves/surgery
MH  - Hemodynamics
MH  - Humans
MH  - Intensive Care Units
MH  - Intraoperative Complications
MH  - Length of Stay
MH  - Male
MH  - *Monitoring, Intraoperative
MH  - Oximetry/*instrumentation/methods
MH  - Prospective Studies
MH  - ROC Curve
MH  - Risk Factors
MH  - Sensitivity and Specificity
EDAT- 1997/07/01 00:00
MHDA- 1997/07/01 00:01
CRDT- 1997/07/01 00:00
PHST- 1997/07/01 00:00 [pubmed]
PHST- 1997/07/01 00:01 [medline]
PHST- 1997/07/01 00:00 [entrez]
AID - 10.1097/00000539-199707000-00002 [doi]
PST - ppublish
SO  - Anesth Analg. 1997 Jul;85(1):2-10. doi: 10.1097/00000539-199707000-00002.