S35: a new parameter in blood gas analysis for monitoring the systemic oxygenation

In the estimation of oxygen transport the term oxygen availability is used as the product of cardiac output and the arterial oxygen content (CaO2). Attempts can be made to modify the concept of oxygen availability by subtracting from the CaO2 the venous content at a critical PO2 as measured in mixed venous blood (Pv-O2), where oxygen diffusion into tissue becomes compromised and oxygen uptake (VO2) may decrease. The real arterial available oxygen content (CavlO2) can be calculated by estimating the saturation at the critical Pv-O2. For our concept S35 was chosen as such a dynamic baseline. Similar modification of oxygen extraction ratio (ERav) defined as VO2 divided by the real oxygen availability (O2av) should give, more than the classic ER, a realistic indices of oxygen availability in relation to oxygen consumption. It can be hypothesized that VO2 starts to decline when ERav is around 1.0. During isovolemic hemodilution VO2 started to drop when ERav reached 1.08 +/- 0.09. The S35 changed from 55.0 +/- 2.1% to 41.5 +/- 4.1%, correlated with changes in Pv-O2. A direct correlation was also found between the increase of the classic ER and the change in S35. We conclude that the S35, the CavlO2 and the ERav can be of value in monitoring the systemic oxygenation and that the concept also includes the effect of changes in oxyhemoglobin characteristics on oxygen delivery.