Resuscitation using SvO2 and ScvO2
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- Опубліковано 28 лип 2024
- You've heard all these fancy terms, mixed venous blood gas, ScvO2, SvO2, thrown around the ICU all the time. Regardless of whether you're a nurse, respiratory therapist, medical student, resident, or even a fellow, these terms may sometimes be quite confusing as everyone talks about them like, "duh, you're supposed to know this".
You're here because you don't know this. Or perhaps you don't know that you don't know this. Or perhaps you need a refresher course. I am not going to get into the deep dive complexities of venous oxygen levels as that could be a complete chapter in a textbook but feel free to ask questions below and either I or our community will try to answer the questions.
SvO2:
- venous oxygen saturation
- taken from a Swan Ganz catheter. without a PA catheter, you can't measure this
- also called a mixed venous oxygen saturation.
- this is a combination of venous oxygen from both the SVC and IVC
ScvO2
- stands for central venous oxygen saturation
- taken from a central line that terminates in the SVC or right atrium. Could be an internal jugular, subclavian, or axillary line.
- it's easy to confuse the two because the PA is more "central" but think about it as getting this value from the "central line"
Correlation
ScvO2 is generally 5-6% higher (sometimes more) as this blood comes from the brain and upper extremities which generally consume less O2 than the organs and lower extremities. This is more pronounced in shock states.
I'll dig deeper into this in the near future. The article where these images were taken from is FREE! A hat tip to the authors.
-EJ
Rivers EP, McIntyre L, Morro DC, Rivers KK. Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity. CMAJ. 2005;173(9):1054‐1065. doi:10.1503/cmaj.050632
Link to Articles and my Blog Post: eddyjoemd.com/scvo2svo2/
My website: www.eddyjoemd.com
Instagram: eddyjoemd
Twitter: eddyjoemd
Books I recommend for ICU Beginners.
Marino's The ICU Book: amzn.to/2M2oFVm
The Washington Manual of Critical Care: amzn.to/2MfmDR4
The Ventilator Book: Second Edition: amzn.to/3cdBYvf
The Advanced Ventilator Book: amzn.to/2nhvyTY
Essentials of Mechanical Ventilation: amzn.to/2vqQAnF
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Phenomenal video Doc! Exactly what I was looking for. Thank you!
Phenomenal video. You break this concept down perfectly, so easy to follow. You are great; have seen many of your lectures. They are applicable to so many different viewers -- resident, attending, respiratory, nurses, med student, etc. Please continue to make more!
Amazing class . Great video. Thanks .
Very useful! Thanks a million and stay safe!
my pleasure! you too!
good way to explain in you made it simpler than the average, that's what medicine needs people that know how to explain stuff to learn this material faster.
My pleasure!
Great new format, Eddy Joe! Keep it up!
Trying new things! Your channel is doing great!
I would do one thing… talk about what the values or reading will look like in relation to consumption and delivery…
I like how you explained it. thanks
Greattttt my broth! You are a top teacher ! Thanks for sharing
So simple and easy, nice work
Glad you enjoyed it!
Wow~~~ Thank you so much!!
Thank You Eddy great video!
My pleasure!
Was a bit confused re difference in Scvo2 vs SVO2.
Doesn't normal brain metabolism result in higher O2 extraction than lower extremities? Hence SVC o2 content is lower than IVC, and not the other way around like you suggested; AKA Scvo2 is generally lower than SVO2 physiologically.
During shock however Scvo2 is higher than SVO2 due to combination of splanchnic vasoconstriction, decreased cerebral o2 extraction etc ??
Great explanation!
💪🏼💪🏼💪🏼
Thank you Doc , just subscribed will be looking forward to new content . Kenny RRT, Respiratory Therapist
09:30 there is strong correlation between acidotic state and low C.O/SVO2 - might be a good idea to give bicarb if base deficit is > 4 on ABG
Thanks!
My pleasure!
Thank you
My pleasure!
Soo good! Thank you!
Glad you enjoyed it!
@@eddyjoemd can you do a video on fluid status of pts? I dnt fully understand when Drs say things like "oh this is pt is 7L ahead etc" . Sincerely appreciate all your work!
Actually, I’m working on that lecture right now.
Thank you ! This was great, will use on rounds tomorrow lol.
You'll be a rockstar!
THANKS A LOT ❤❤
💪🏼💪🏼💪🏼
Hey Eddy, thanks for the material! What is the software that you use for the lectures and your other videos? Looks extremely helpful
My pleasure. I use very simple stuff. My iPad where I record the screen. The notes app and my Apple Pencil. I upload it onto final cut (although iMovie would do the same) and upload. 20 minutes total. Does that help?
@@eddyjoemd Helps a lot! Keep the grind and thank you very much.
💪🏼💪🏼💪🏼
Is a simple fingertip pulse oximeter measuring both arterial and venous blood?
If so, could a high reading be bad if oxygen is not being utilized and just recirculating?
Also,
What about using thiamine and Methylene Blue to increase oxygen consumption by the mitochondria?
What would you say is happening when after breathing 90% oxygen for a few minutes and a pulse oximeter reads 100‰ , this 100% can be hit for many minutes afterwards, when normally it would be much lower?
Any ideas?
Question: so where about do you insert the pulmonary catheter to get the Svo2? I'm trying to see images on Google, and I'm seeing you can insert at the subclavian or brachial artery? Maybe I'm not getting the right results. Can you please clarify? Also for the Scvo2 that goes in the jugular vein or the subclavian, correct?
Great 👍👍👍👍👍👍
Thanks 👍
In sepsis, the ScvO2 would be above 70%?
That's what the Rivers paper shoots for but you can't look at use one number to make clinical decisions.
what range do you want ScvO2 to be in sepsis? and what interventions do you implement ?