First off, here are a couple decent webpages you might want to review:
Multi-Center Study of Central Venous Oxygen Saturation (ScvO2) as a Predictor of Mortality in Patients with Sepsis
Surviving Sepsis Campaign
In early sepsis, you'll frequently see a hyperdynamic phase. During this phase, heart rate & cardiac output are increased, in an attempt to maintain adequate perfusion/oxygen supply to tissues.
ScVO2 normally runs ~71-89% (first webpage listed above). If your pt's ScVO2 is low, there are several possible approaches to increasing oxygen delivered to the tissues:
- Ensure that your pt has an adequate circulating volume (as directed by CVP or a FloTrac SVV number) - give crystalloids or
colloids if needed
- Increase FiO2 (increase oxygen percentage inspired by the pt)
- Increase Hematocrit (transfuse more oxygen carrying red blood cells)
- If circulating volume, FiO2, and HCT are decent, then consider adding an inotrope such as dobutamine to increase cardiac output
In later sepsis, things are shutting down. Tissue & organs are dying, thus not using available oxygen circulated to them. This is a "bad thing", and may be more lethal than a low ScVO2 (again, see NIH paper).
Goes into some interesting theories as to WHY hyperoxia occurs in sepsis (impairment in microcirculatory blood flow vs mitochondrial dysfunction), the theory that excessive oxygen may be harmful in sepsis pts, and one approach to try and "kick start" dysfunctional mitochondria.