Optimizing oxygen delivery in the critically ill: the utility of lactate and central venous oxygen saturation (ScvO2) as a roadmap of resuscitation in shock.

TitleOptimizing oxygen delivery in the critically ill: the utility of lactate and central venous oxygen saturation (ScvO2) as a roadmap of resuscitation in shock.
Publication TypeJournal Article
Year of Publication2014
AuthorsJoshi R, de Witt B, Mosier JM
JournalJ Emerg Med
Volume47
Issue4
Pagination493-500
Date Published2014 Oct
ISSN Number0736-4679
Abstract

<p><b>BACKGROUND: </b>Resuscitation of any critically ill patient is aimed at restoration of oxygen delivery to maintain aerobic metabolism. Thus, &quot;endpoints&quot; of resuscitation have been sought after as a measure of evaluating the adequacy of resuscitation. This review article describes the most commonly used endpoints, central venous oxygen saturation (ScvO2) and lactate, and provides a clinically useful paradigm for utilizing these endpoints during resuscitation of critically ill patients in the emergency department (ED).</p><p><b>OBJECTIVE: </b>This review article will summarize the pathophysiology of cellular shock, describe the available research regarding lactate and ScvO2, and provide an approach to utilizing these endpoints during resuscitation in the ED.</p><p><b>DISCUSSION: </b>ScvO2 and lactate each have been shown to be useful for the assessment of shock, yet each has inherent limitations. When used together, ScvO2 and lactate provide the emergency physician with a glimpse of the underlying pathophysiologic state, allowing targeted therapy to restore oxygen delivery.</p><p><b>CONCLUSION: </b>ScvO2 and lactate are useful endpoints of resuscitation, and when used together, provide a metabolic framework for guiding targeted therapy for critically ill patients in the ED with shock.</p>

DOI10.1016/j.jemermed.2014.06.016
Alternate JournalJ Emerg Med
PubMed ID25124137
Faculty Reference: 
Jarrod Mosier, MD
Weight: 
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