Know Your Numbers: Clinical Use of ScvO2, Lactate and Dynamic Measures of Preload Responsiveness

Early, aggressive, goal-directed resuscitation improves outcomes. Resuscitation endpoints should rapidly normalize following restoration of tissue perfusion, identify global tissue hypoxia, and allow for dynamic measurement of preload responsiveness to avoid overzealous fluid administration. Many goal-directed resuscitation strategies are using lactate, ScvO2, and dynamic measures of preload as therapeutic endpoints to reflect improving tissue perfusion. ScvO2 and lactate levels allows for identification of underlying global tissue hypoxia. ScvO2, a bedside measure of tissue oxygenation provides early warning and surveillance related to oxygen balance as well as immediate feedback about implemented interventions. Lactate, a cellular marker of perfusion, allows for evaluation of the effectiveness of resuscitation. Dynamic measures of preload predict fluid responsiveness prior to volume administration. This allows for preload optimization without the detrimental effects that occur with excessive fluid administration. This session challenges experienced critical care practitioners to explore the use of these additional therapeutic endpoints during resuscitation. Use of lactate and ScvO2 monitoring as strategies to identify underlying global tissue hypoxia will be discussed during this session. Dynamic measures of preload responsiveness will also be examined, including PPV, SVV and PLR. Critical thinking using case studies will be encouraged throughout this presentation.