ScVO2 Catheter Protocol

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Policy and Procedure:

Indications for Fibrotic Catheter Insertion and ScvO₂ Monitoring in ICU:

Patients who require pulmonary artery catheterization for optimization of hemodynamic or oxygen kinetic balance shall be considered for a fibrotic pulmonary artery catheter (ScvO₂). No fibrotic PA catheter (ScvO₂) will be placed unless the patient meets appropriate indications as defined by this policy. The physician staff may decide to treat any patient even if they do not meet the criteria defined by this policy. Continuous ScvO₂ monitoring may be indicated under the following conditions for patients treated by the Trauma, Burn Surgery Service.

1. On admission, any TBE patient who meets any of the following conditions:
   • Systemic acidosis (pH < 7.30, and/or persistent hypotension with SBP < 100, and/or UO < 30-50 mL/hr) not corrected by what appears to be appropriate fluid resuscitation (ATLS guidelines).
   • An associated head injury undergoing aggressive ICP therapy (mannitol, diuretics, phenobarbital)
   • Associated major trauma with a history of heart (i.e., ischemic, valvular) liver (i.e. cirrhosis), pulmonary disease (i.e., COPD), or chronic renal failure requiring renal replacement therapy.
   • Thermally injured patients who have a major inhalation injury documented by bronchoscopy regardless of the total surface area of the injury.
   • Pulmonary failure defined by any of the following conditions:
     • PaO₂ / FIO₂ ratio < 200.
     • SaO₂ < 0.90 with FIO₂ > 0.50 and PEEP > 10 cmH₂
     • Static compliance < 30 mL / cmH₂
     • Intrapulmonary shunt > 25%.
   • Massive fluid resuscitation ( > 10 Liters crystalloid or 10 units blood products) with any of the preceding conditions.
2. Following admission all ACS Service patients will be monitored daily for the development of conditions which would warrant pulmonary artery catheterization. The conditions which would indicate a possible need for invasive PA-ScvO₂ monitoring are:
   • Pulmonary failure as defined by any of the following:
     • PaO₂ / FIO₂ ratio < 250.
     • SaO₂ < 0.90 with FIO₂ > 0.50 and PEEP > 10 cmH₂
     • Static compliance < 30 ml / cmH₂
     • Intrapulmonary shunt > 25%
   • Cardiovascular failure as defined by:
     • Evidence of ischemic dysfunction.
     • Systemic acidosis (as previously defined).
   • Renal failure defined by:
     • UO < 30-50 cc/hr (for adults) following fluid challenge.
     • Creatinine > 2x baseline admission value.

ScvO₂ catheters will be changed for any of the following reasons:

1. If no evidence of infection.
2. Non-functional ScvO₂.

Goals of Monitoring:

1. Optimize cardiac and pulmonary function as evidenced by:
   • SaO₂ > 0.90.
   • Cardiac index > 2.5 L/min/M₂.
   • Urine output > 30-50 cc/hr for adults.
   • SvO₂ > 0.65.
   • VO₂ (I) < 170 ml/min/M₂.
   • PaO₂ / FIO₂ ratio > 250.
2. Decrease unwarranted ancillary hemodynamic testing (thermal dilution cardiac output).