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

Raj Joshi, Benjamin De Witt, Jarrod M. Mosier

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background Resuscitation of any critically ill patient is aimed at restoration of oxygen delivery to maintain aerobic metabolism. Thus, "endpoints" 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). Objective 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. Discussion ScvO2and lactate each have been shown to be useful for the assessment of shock, yet each has inherent limitations. When used together, ScvO2and lactate provide the emergency physician with a glimpse of the underlying pathophysiologic state, allowing targeted therapy to restore oxygen delivery. Conclusion ScvO2and 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.

Original languageEnglish (US)
Pages (from-to)493-500
Number of pages8
JournalJournal of Emergency Medicine
Volume47
Issue number4
DOIs
StatePublished - Oct 1 2014

Keywords

  • central venous oxygen saturation
  • lactate
  • microcirculation shock
  • oxygen delivery

ASJC Scopus subject areas

  • Emergency Medicine

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