I have a fairly complex guy in the SICU. He has hepatic failure from his EtOH career and Hep C. He was admitted for a hernia repair that revealed ~10 cm dead bowel. He had a normal 3 day post op course then crashed in a big way. Intubated, swanned, worked like sepsis etc. His initial picture was shock liver. He was treated and progressed well over the next five days. A long term HTN pt., as his insult resolved he became hypertensive. He actually was on nipride for 48 hours. Unable to extubate due to mentation. Encephalopathic vs. hypoxic injury vs. vascular accident vs. hypernatremia. He eventually got trached and is a TPN guy. I am new on the service and inherited him 3 days ago. In the last 48hours he spiked a temp, his UOP decreased, he got started on levophed for maps of 55. Today, blood cxs grew MRSA. I started Abs, steroids, have kept his pressure at goal with fluid and a whisper of norepi. He has had a climbing creatinine with a FENA that indicates pre-renal. The picture looked like classic sepsis, but this guy's evolution has me considering hepato-renal in the setting of infection. I'm an EM resident that felt foolish considering re-swanning this pt. after his other line got pulled just 5 days prior. I drew a scvo2 off his cvc and it came back 84%. His Hgb is 7.5 and he has a massive O2 requirement. Bucks the vent at any bilevel and barely tolerates APRV at 30mm with a FiO2 of 90%. (yep I said 90) I recognize this is a single data point in a big picture, but I believe I am misunderstanding the pathophys. of the scvo2 and could use some help. My questions are- Why am I seeing such a high percentage when this guy is looking sicker? How can I use Scvo2 in the long term maintenace of the septic pt? I am comfortable with EGDT and the use of the number on presentation and early mgt., but what about when all goals are met and I need something to guide therapy? Any suggestions for articles, or chapters are welcome. Thanks.