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<p>Septic shock is a life-threatening syndrome characterized by profound circulatory dysfunction and disordered cellular metabolism, necessitating precise physiologic monitoring to guide resuscitation. In this context, sepsis-induced hemodynamic derangements range from early vasoplegia and hyperdynamic circulation to later-stage myocardial depression and microcirculatory failure. These dynamic changes create a heterogeneous perfusion landscape that challenges traditional approaches to oxygen transport assessment. Central venous oxygen saturation (ScvO<sub>2</sub>) has long been used as a surrogate marker of cardiac output and global tissue oxygenation; however, in sepsis, impaired cellular oxygen utilization may result in paradoxically normal or elevated ScvO<sub>2</sub> despite ongoing tissue hypoxia. In contrast, the oxygen extraction ratio (O<sub>2</sub>ER) offers a more integrative assessment of oxygen transport by reflecting the balance between oxygen delivery and consumption. Unlike ScvO<sub>2</sub>, O<sub>2</sub>ER may remain informative in the presence of microcirculatory and mitochondrial dysfunction and may demonstrate greater sensitivity to changes in oxygen delivery, based on physiological reasoning and observational data. Accordingly, O<sub>2</sub>ER may provide complementary physiological insight in complex shock states, although this approach has not been validated in randomized interventional trials. This narrative review synthesizes foundational and contemporary evidence to propose a physiologically grounded framework for oxygen transport monitoring, delineating the strengths, limitations, and clinical utility of ScvO<sub>2</sub>, O<sub>2</sub>ER, and metabolic markers in guiding resuscitation strategies for patients with septic shock.&#xa0;</p>

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Central venous oxygen saturation vs. oxygen extraction ratio in septic shock resuscitation: Which metric is more informative?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月22日

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  • Athanasios Chalkias,
  • Konstantina Katsifa,
  • Stavroula Amanetopoulou,
  • Aikaterini Nodarou,
  • Petros Lampropoulos,
  • Ioannis Thiveos,
  • Konstantinos Sakellaridis,
  • Varvara Grammatikopoulou,
  • Athanasios Prekates,
  • Paraskevi Tselioti

摘要

Septic shock is a life-threatening syndrome characterized by profound circulatory dysfunction and disordered cellular metabolism, necessitating precise physiologic monitoring to guide resuscitation. In this context, sepsis-induced hemodynamic derangements range from early vasoplegia and hyperdynamic circulation to later-stage myocardial depression and microcirculatory failure. These dynamic changes create a heterogeneous perfusion landscape that challenges traditional approaches to oxygen transport assessment. Central venous oxygen saturation (ScvO2) has long been used as a surrogate marker of cardiac output and global tissue oxygenation; however, in sepsis, impaired cellular oxygen utilization may result in paradoxically normal or elevated ScvO2 despite ongoing tissue hypoxia. In contrast, the oxygen extraction ratio (O2ER) offers a more integrative assessment of oxygen transport by reflecting the balance between oxygen delivery and consumption. Unlike ScvO2, O2ER may remain informative in the presence of microcirculatory and mitochondrial dysfunction and may demonstrate greater sensitivity to changes in oxygen delivery, based on physiological reasoning and observational data. Accordingly, O2ER may provide complementary physiological insight in complex shock states, although this approach has not been validated in randomized interventional trials. This narrative review synthesizes foundational and contemporary evidence to propose a physiologically grounded framework for oxygen transport monitoring, delineating the strengths, limitations, and clinical utility of ScvO2, O2ER, and metabolic markers in guiding resuscitation strategies for patients with septic shock.