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Stellenwert des perioperativen SzvO2-Monitorings

Importance of perioperative ScvO2 monitoring

  • Leitthema
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Die venöse Oximetrie findet im Rahmen einer sog. zielgerichteten Kreislaufstabilisierung Verwendung. Dabei gilt die gemischtvenöse Sauerstoffsättigung (SvO2) als der Goldstandard der venösen Oximetrie und wird als ein Maß für die Adäquatheit der Gewebeoxygenierung eingesetzt. Die über einen zentralen Venenkatheter gewonnene zentralvenöse Sauerstoffsättigung (SzvO2) ist jedoch wesentlich einfacher zu bestimmen. Die SzvO2 bildet die SvO2 zwar nicht korrekt ab, jedoch konnte die SzvO2 in Studien sinnvoll als Therapieziel eingesetzt werden. Dabei ging eine niedrige SzvO2 mit einem erhöhten Letalitätsrisiko bzw. mit einer erhöhten postoperativen Komplikationsrate einher. In der Therapie des septischen Schocks ist das Erreichen einer SzvO2 >70% bereits Bestandteil der Therapieempfehlungen. Auch während und unmittelbar nach großen chirurgischen Eingriffen hat eine Therapiesteuerung mittels SzvO2 einen günstigen Einfluss auf den postoperativen Verlauf. Für die weitere intensivmedizinische Versorgung über die initiale Stabilisierung hinaus ist die Verwendung der SzvO2 allerdings noch nicht validiert.

Abstract

Venous oximetry is used in the goal-directed therapy of patients with circulatory insufficiency. The mixed venous oxygen saturation (SvO2) is the gold standard of venous oximetry and is used as a measure of the adequacy of tissue oxygenation. However, central venous oxygen saturation (ScvO2) measured via a central venous catheter is much easier to obtain. Several studies applied the ScvO2 as a meaningful treatment goal, although ScvO2 does not exactly mirror SvO2. A low ScvO2 was associated with high mortality rates and high complication rates after surgery. Current guidelines recommend achieving a ScvO2 of >70% in the therapy of septic shock. Furthermore, current studies suggest that implementation of ScvO2 as a treatment goal in patients during and immediately after major surgery improves the clinical course of these patients. Any further application of ScvO2 beyond initial resuscitation has not yet been validated in studies.

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  1. Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland

    F. Bloos Ph.D.

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Bloos, F. Stellenwert des perioperativen SzvO2-Monitorings. Intensivmed 47, 338–344 (2010). https://doi.org/10.1007/s00390-009-0147-8

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