Continuous mixed venous (SvO2) monitoring. Too expensive or indispensible?

Based on theoretic principles and clear literature support, SvO2 (mixed venous oxyhemoglobin) monitoring offers an important advantage over traditional hemodynamic parameters. SvO2 allows more precise understanding of the adequacy of cardiac and pulmonary function than traditional parameters. SvO2 values do not replace the need to measure individual parameters of oxygen delivery or consumption but serves as the standard for assessing the impact of each parameter on tissue oxygenation. SvO2 has the ability to reflect a threat to tissue oxygenation that is unmatched by other parameters. Its ability to give a real time indication of tissue oxygenation makes it a preferred parameter for monitoring the adequacy of hemodynamics. Its use as an end point for determining the adequacy of hemodynamics (BP, CO/CI), measurement of Qs/Qt, and prediction of potential hemodynamic instability make this parameter invaluable for the knowledgeable clinician. SvO2 catheters cost more than traditional PA catheters, a factor that has limited their acceptance as the standard PA catheter. The added cost of the SvO2 catheter has not been adequately addressed in the research literature. However, research does support SvO2 allows more rapid termination of drug therapies, may improve movement out of the ICU, and reduces the incidence of mechanical ventilator manipulation. These features increase the cost-effectiveness of SvO2 catheters. The cost-effectiveness of the catheter, like any technology, is predicated on the clinician. Clinicians++ must be educated to use SvO2 as a primary end point for treatment decisions regarding hemodynamic therapy and patient stability. If used properly, every PAC should use fiberoptic SvO2 capabilities.