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CeVOX Technology

CeVOX Technology

Continuous monitoring of central venous oxygen saturation

The CeVOX Technology uses the method of spectrophotometry

Overview

ScvO2 offers quick reacting information on the patients haemodynamic status. ScvO2 is much more sensitive than blood pressure and heart frequency for detecting shock status of any origin.

General

ScvO2 monitoring faciliates early detection of:

  • Imbalance between oxygen supply and oxygen consumption
  • State of shock of any origin
  • Insufficient cardiac output (surrogate parameter)

Advantages

  • Immediate recognition of insufficient tissue oxygenation
  • Access via standard CVC
  • Reduction of blood gas analysis
  • Oxygenbalance in real-time
  • Easy handling no in-vitro calibration required

Useful application in

  • Emergency department
  • Septic shock
  • Early goal directed therapy
  • Cardiogenic shock
  • Burns
  • Polytrauma
  • Perioperative monitoring in cardiac surgery
  • Postoperative monitoring

Disposables

CeVOX Probe

  • Continuous fiberoptic oxymetry
  • Comfortable application
  • Access via existing standard CVC
  • Easy placement
  • ScvO2 immediately available


CeVOX probes can be inserted in the distal lumen of 15, 20 or 30 cm CVCs that allow guide wires ≥ 0.032”.

Methodology

Spectrophotometry is the quantitative measurement of the reflection or transmission properties of a material as a function of wavelengths of light. The CeVOX technology is using this method to measure the oxygen saturation of the blood continuously. For this purpose a CeVOX probe with inbuilt fibre optics is inserted into a blood vessel, usually a central vein.

An optical module emits infrared light of specific wave lengths and transmits them through a fibre optic into the vessel. The light is reflected off the red blood cells and transmitted back through a separate fibre optic back into the optical module and analyzed by a sensor.

References

Tanczos K & Molnar Z  
The oxygen supply-demand balance: A monitoring challenge  
Best Pract Res Clin Anaesthesiol 2013; 27(2): 201-7 

Ducrocq N, Kimmoun A, Levy B  
LACTATE or ScvO2 as an endpoint in resuscitation of shock states?  
Minerva Anestesiol 2013; 79(9): 1049-58 

Reid M  
Central venous oxygen saturation: analysis, clinical use and effects on mortality  
Nurs Crit Care 2013; 18(5): 245-50 

Walley KR.  
Use of Central Venous Oxygen Saturation to Guide Therapy  
Am J Respir Crit Care Med 2011;184:514-20 

Bauer P, Reinhart K, Bauer M.  
Early goal directed therapy and outcome in septic shock  
Int J Intensive Care 2007; Autumn:19-24 

Marx G, Reinhart K.  
Venous oximetry  
Curr Opin Crit Care 2006; 12:263-8 

Goodrich C.  
Continuous central venous oximetry monitoring  
Crit Care Nurs Clin North Am 2006; 18:203-9 

Rivers EP, Ander DS, Powell D.  
Central venous oxygen saturation monitoring in the critically ill patient  
Curr Opin Crit Care 2001; 7:204-11 

Review

Tanczos K & Molnar Z
The oxygen supply-demand balance: A monitoring challenge
Best Pract Res Clin Anaesthesiol 2013; 27(2): 201-7

CeVOX Validation

Molnar Z, Umgelter A, Toth I, Livingstone D, Weyland A, Sakka SG, Meier-Hellmann A.
Continuous monitoring of ScvO(2) by a new fibre-optic technology compared with blood gas oximetry in critically ill patients: a multicentre study
Intensive Care Med 2007; 33(10): 1767-70

Septic Shock

Maddirala S and Khan A
Optimizing hemodynamic support in septic shock using central and mixed venous oxygen saturation
Crit Care Clin 2010; 26(2): 323-33

Rivers ER, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M.
Early goal-directed therapy in the treatment of severe sepsis and septic shock
N Eng J Med 2001; 345:1368–77

 

ScvO2 vs. SvO2 

el-Masry A, Mukhtar MA, el-Sherbeny AM, Fathy M, el-Meteini M  
Comparison of central venous oxygen saturation and mixed venous oxygen saturation during liver transplantation  
Anaesthesia 2009; 64(4): 378-82 

Kopterides P, Bonovas S, Mavrou I, Kostadima E, Zakynthinos E, Armaganidis AS.  
Venous Oxygen Saturation and Lactate Gradient from Superior Vena Cava to Pulmonary Artery in Patients with Septic Shock  
Shock 2009; 31(6): 561-7 

Sander M, Spies CD, Foer A, Weymann L, Braun J, Volk T, Grubitzsch H, von Heymann C.
Agreement of central venous saturation and mixed venous saturation in cardiac surgery patients 
Intensive Care Med 2007; 33(10): 1719-25 

Reinhart K, Kuhn HJ, Hartog C, Bredle DL.  
Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill  
Curr Opin Crit Care 2004; 30:1572-8 

Ladakis C, Myrianthefs P, Karabinis A, Karatzas G, Dosios T, Fildissis G, Gogas J, Baltopoulos G.  
Central venous and mixed venous oxygen saturation in critically ill patients 
Respiration 2001; 68:279-85 

Continuous ScvO2 

Hofer CK, Ganter M, Fodor P, Tavakoli R, Genoni M, Zollinger A.  
Continuous central venous oxygenation measurement by CeVOX in patients undergoing off-pump coronary bypass grafting  
Crit Care 2006:P340 

Rivers ER, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M.  
Early goal-directed therapy in the treatment of severe sepsis and septic shock  
N Eng J Med 2001; 345:1368–7 

Rady MY, Rivers EP, Martin GB, Smithline H, Appelton T, Nowak RM.  
Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock  
Am J Emerg Med 1992; 10:538-41 

Molnar Z, Umgelter A, Toth I, Livingstone D, Weyland A, Sakka SG, Meier-Hellmann A. 
Continuous monitoring of ScvO(2) by a new fibre-optic technology compared with blood gas oximetry in critically ill patients: a multicentre study  
Intensive Care Med 2007; 33(10): 1767-70 

Muller M, Lohr T, Scholz S, Thul J, Akinturk H, Hempelmann G.  
Continuous SvO(2) measurement in infants undergoing congenital heart surgery - first clinical experiences with a new fiberoptic probe 
Paediatr Anaesth. 2007; 17(1):51-5. Feb 

Ducart A, Dejonckheere M, Koch M, Perrin L, Schmartz D.  
Continuous central venous and pulmonary artery oxygen saturation monitoring in cardiac surgery after cardiopulmonary bypass  
Eur J Anaesthesiol 2007; 4AP2-7 

Huber D, Osthaus W, Optenhöfel J, Breymann T, Marx G, Piepenbrock S, Sümpelmann R. 
Continuous monitoring of central venous oxygen saturation in neonates and small infants: in vitro evaluation of two different oximetry catheters  
Paediatr Anaesth 2006; 16(12):1257-61 

Hofer CK, Ganter M, Fodor P, Tavakoli R, Genoni M, Zollinger A.  
Continuous central venous oxygenation measurement by CeVOX in patients undergoing off-pump coronary bypass grafting  
Crit Care 2006:P340 

ScvO2 and Blood Gas Analysis Cost Comparison 

Bloos F, Rissner F, Specht M, Reinhart K, Marx G  
Costs of intermittent measurement of central venous oxygen saturations by blood gas analysis  
Intensive Care Med 2009; 35(7): 1316-7 

Publications

Outcome papers and guidelines

Guidelines and Standard Operating Procedures

Reinhart K, Brunkhorst FM et al. [Prevention, diagnosis, treatment, and follow-up care of sepsis. First revision of the 
S2k Guidelines of the German Sepsis Society (DSG) and the German Interdisciplinary Association for Intensive and Emergency Care Medicine (DIVI)]. 
Ger Med Sci 2010; Doc 14

Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL. 
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 
Intensive Care Med 2008; 34(1): 17-60

De Oliveira CF, de Oliveira DS, Gottschald AF, Moura JD, Costa GA, Ventura AC, Fernandes JC, Vaz FA, Carcillo JA, Rivers EP, Troster EJ. 
ACCM / PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation
ICM 2008; 34 (6): 1065-75

Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, Goepfert M, Gogarten W, Grosse J, Heller A, Heringlake M, Kastrup M, Kroener A, Loer S, Marggraf G, Markewitz A, Reuter M, Schmitt DV, Schirmer U, Wiesenack C, Zwissler B, Spies C. 
S3 Guidelines for Intensive Care in Cardiac Surgery Patients: Haemodynamic Monitoring and Circulatory system 
Ger Med Sci 2010; 8: Doc 12

Trzeciak S, Dellinger RP, Abate NL, Cowan RM, Stauss M, Kilgannon JH, Zanotti S, Parrillo JE. 
Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department 
Chest 2006; 129:225-32

Outcome Papers

Smetkin AA, Kirov M, Kuzkov VV, Lenkin AI, Eremeev AV, Slastilin VY, Borodin VV, Bjertnaes LJ. 
Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery. 
Acta Anaesthesiol Scand 2009; 53:505-14

Csontos C, Foldi V, Fischer T, Bogar L. 
Arterial thermodilution in burn patients suggests a more rapid fluid administration during early resuscitation. 
Acta Anaesthesiol Scand 2008; 52(6): 742-9

de Oliveira CF, de Oliveira DS, Gottschald AF, Moura JD, Costa GA, Ventura AC, Fernandes JC, Vaz FA, Carcillo JA, Rivers EP, Troster EJ. 
ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation.
Intensive Care Med 2008; 34(6): 1065-75.

Kortgen A, Niederprün P, Bauer M. 
Implementation of an evidence-based „standard operating procedure“ and outcome in septic shock 
Crit Care Med 2006; 34(4):943-9

Rivers ER, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. 
Early goal-directed therapy in the treatment of severe sepsis and septic shock 
N Eng J Med 2001; 345:1368–7

Clinical Use Septic Shock

Maddirala S and Khan A 
Optimizing hemodynamic support in septic shock using central and mixed venous oxygen saturation 
Crit Care Clin 2010; 26(2): 323-33

Pope JV, Jones AE, Gaieski DF, Arnold RC, Trzeciak S, Shapiro NI
Multicenter Study of Central Venous Oxygen Saturation (ScvO(2)) as a Predictor of Mortality in Patients With Sepsis 
Ann Emerg Med 2010; 55(1): 40-6

Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, Edwards J, Cho TW, Wittlake WA. 
Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality 
Crit Care Med 2007; 35 (4): 1105 - 12

Kortgen A, Niederprün P, Bauer M. 
Implementation of an evidence-based „standard operating procedure“ and outcome in septic shock 
Crit Care Med 2006; 34(4):939-9

Trzeciak S, Dellinger RP, Abate NL, Cowan RM, Stauss M, Kilgannon JH, Zanotti S, Parrillo JE. 
Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department 
Chest 2006;129: 225-32

Rivers ER, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. 
Early goal-directed therapy in the treatment of severe sepsis and septic shock 
N Eng J Med 2001; 345:1368–77

Cardiogenic Shock and Cardiopulmonary Resuscitation

Chin K, Channick RN, Kim NH, Rubin LJ. 
Central venous blood oxygen saturation monitoring in patients with chronic pulmonary arterial hypertension treated with continuous IV epoprostenol: correlation with measurements of hemodynamics and plasma brain natriuretic peptide levels.
Chest 2007; 132(3): 786-92.

Ander DS, Jaggi M, Rivers E, Rady MY, Levine TB, Levine AB, Masura J, Gryzbowski M.
Undetected cardiogenic shock in patients with congestive heart failure presenting to the emergency department 
Am J Cardiol 1998; 82:888-91

Rivers EP, Martin GB, Smithline H, Rady MY, Schultz CH, Goetting MG, Appleton TJ, Nowak RM. 
The clinical implications of continuous central venous oxygen saturation during human CPR 
Ann Emerg Med 1992; 21:1094-1101

Rivers EP, Rady MY, Martin GB, Fenn NM, Smithline HA, Alexander ME, Nowak RM.
Venous hyperoxia after cardiac arrest. Characterization of a defect in systemic oxygen utilization 
Chest. 1992; 102(6):1787-93

Cardiac Surgery

Hu BY, Laine GA, Wang S, Solis RT 
Combined central venous oxygen saturation and lactate as markers of occult hypoperfusion and outcome following cardiac surgery 
J Cardiothorac Vasc Anesth 2012; 26(1): 52-7.

Perz S, Uhlig T, Kohl M, Bredle DL, Reinhart K, Bauer M, Kortgen A. 
Low and "supranormal" central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study. 
Intensive Care Med 2011; 1: 52-9

Nogueira PM, Mendonca-Filho MT, Campos LA, Gomes RV, Felipe AR, Fernandes MA, Villela-Nogueira CA, Rocco JR. 
Central Venous Saturation: A Prognostic Tool in Cardiac Surgery Patients 
J Intensive Care Med 2010; 25(2): 111-6

Smetkin AA, Kirov M, Kuzkov VV, Lenkin AI, Eremeev AV, Slastilin VY, Borodin VV, Bjertnaes LJ. 
Single transpulmonary thermodilution and ocntinuous monitoring of central venous oxygen saturation during off-pump coronary surgery. 
Acta Anaesthesiol Scand 2009; 53: 505-14

General Surgery

Meguro M, Mizuguchi T, Kawamoto M, Nakamura Y, Ota S, Kukita K, Ishii M, Tatsumi H, Hirata K 
Continuous monitoring of central venous oxygen saturation predicts postoperative liver dysfunction after liver resection 
Surgery 2013; 15482): 351-62

Jakob S. 
Multicentre study on peri-postoperative central venous oxygen saturation in high-risk surgical patients 
Critical Care 2006; 10:R158

Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED.
Changes in central venous saturation after major surgery, and association with outcome 
Crit Care 2005; 9:R694-9

Paediatrics

de Oliveira CF, de Oliveira DS, Gottschald AF, Moura JD, Costa GA, Ventura AC, Fernandes JC, Vaz FA, Carcillo JA, Rivers EP, Troster EJ. 
ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation.
Intensive Care Med 2008; 34(6): 1065-75.

Seear MD, Scarfe JC, Leblanc JG. 
Predicting major adverse events after cardiac surgery in children 
Pediatr Crit Care Med 2008; 9(6): 606-11

Muller M, Lohr T, Scholz S, Thul J, Akinturk H, Hempelmann G. 
Continuous SvO(2) measurement in infants undergoing congenital heart surgery - first clinical experiences with a new fiberoptic probe 
Paediatr Anaesth. 2007; 17(1):51-5.

Osthaus WA, Huber D, Beck C , Roehler A, Marx G, Hecker H, Sümpelmann R. 
Correlation of oxygen delivery with central venous oxygen saturation, mean arterial pressure and heart rate in piglets 
Paediatr Anaesth. 2006; 16(9):944-7.

Huber D, Osthaus W, Optenhöfel J, Breymann T, Marx G, Piepenbrock S, Sümpelmann R.
Continuous monitoring of central venous oxygen saturation in neonates and small infants: in vitro evaluation of two different oximetry catheters 
Paediatr Anesth. 2006; 16(12):1257-61

ScvO2 As Indicator For Blood Transfusion

Krantz T, Warberg J, Secher NH. 
Venous oxygen saturation during normovolaemic haemodilution in the pig 
Acta Anaesthesiol Scand 2005; 49:1149-56

Schou H, Perez de Sa V, Larsson A. 
Central and mixed venous blood oxygen correlate well during acute normovolemic hemodilution in anesthetized pigs 
Acta Anaesthesiol Scand 1998; 42:172-7

Burns

Csontos C, Foldi V, Fischer T, Bogar L. 
Arterial thermodilution in burn patients suggests a more rapid fluid administration during early resuscitation. 
Acta Anaesthesiol Scand 2008; 52(6): 742-9

Medical

Giraud R, Siegenthaler N, Gayet-Ageron A, Combescure C, Romand JA, Bendjelid K.
ScvO2 As a Marker to Define Fluid Responsiveness 
J Trauma 2011;70(4): 802-7

Jansen TC, van Bommel J, Schoonderbeek J, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, Willemsen SP, Bakker J 
Early Lactate-Guided Therapy in ICU Patients: A Multicenter, Open-Label, Randomized, Controlled Trial. 
Am J Respir Crit Care Med 2010; 182: 752-61