Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2009-11-30

AUTHORS

Didier Payen, Cecilia Luengo, Laurent Heyer, Matthieu Resche-Rigon, Sébastien Kerever, Charles Damoisel, Marie Reine Losser

ABSTRACT

IntroductionThe study objectives were to evaluate septic shock-induced alterations in skeletal muscle hemoglobin oxygenation saturation (StO2) using near-infrared spectroscopy (NIRS) and forearm skin blood flow velocity using laser Doppler (LD) to determine the relationship of macroperfusion and microperfusion parameters, and to test the relationship of the worst NIRS parameters during the first 24 hours of shock with 28-day prognosis.MethodsA prospective, observational study was performed in a 21-bed university hospital surgical intensive care unit. Forty-three septic shock patients with at least another organ failure underwent a 3-minute, upper arm (brachial artery) vascular occlusion test (VOT). Microperfusion parameters (thenar eminence StO2 and forearm LD skin blood flow) were collected on days 1, 2 and 3, before (baseline StO2 and LD values) and during the 3-minute VOT with calculation of occlusion and reperfusion slopes for StO2 and LD. Daily Sequential Organ Failure Assessment (SOFA) score, macrohemodynamic parameters (systolic arterial blood pressure, cardiac output (pulmonary artery catheter or transesophageal Doppler), mixed venous oxygen saturation (pulmonary artery or superior vena cava catheter)) and metabolic parameters (pH, base excess, lactate) were determined.ResultsBaseline StO2 (82% (75 to 88) vs. 89% (85 to 92), P = 0.04) and reperfusion slope (2.79%/second (1.75 to 4.32) vs. 9.35%/second (8.32 to 11.57), P < 0.0001) were lower in septic shock patients than in healthy volunteers. StO2 reperfusion slope correlated with occlusion slope (P < 0.0001), cardiac output (P = 0.01) and LD reperfusion slope (P = 0.08), and negatively with lactate level (P = 0.04). The worst StO2 reperfusion slope during the first day of shock was lower in nonsurvivors than in survivors (P = 0.003) and improved significantly the predictive value of Simplified Acute Physiology Score II and SOFA scores.ConclusionsThe alteration of StO2 reperfusion slope in septic shock patients compared with healthy volunteers was related with macrohemodynamic, microhemodynamic and metabolic parameters. The addition of the worst value of the day 1 StO2 reperfusion slope improved the outcome prediction of Simplified Acute Physiology Score II and SOFA scores. More... »

PAGES

s6

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http://scigraph.springernature.com/pub.10.1186/cc8004

DOI

http://dx.doi.org/10.1186/cc8004

DIMENSIONS

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PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19951390


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32 schema:description IntroductionThe study objectives were to evaluate septic shock-induced alterations in skeletal muscle hemoglobin oxygenation saturation (StO2) using near-infrared spectroscopy (NIRS) and forearm skin blood flow velocity using laser Doppler (LD) to determine the relationship of macroperfusion and microperfusion parameters, and to test the relationship of the worst NIRS parameters during the first 24 hours of shock with 28-day prognosis.MethodsA prospective, observational study was performed in a 21-bed university hospital surgical intensive care unit. Forty-three septic shock patients with at least another organ failure underwent a 3-minute, upper arm (brachial artery) vascular occlusion test (VOT). Microperfusion parameters (thenar eminence StO2 and forearm LD skin blood flow) were collected on days 1, 2 and 3, before (baseline StO2 and LD values) and during the 3-minute VOT with calculation of occlusion and reperfusion slopes for StO2 and LD. Daily Sequential Organ Failure Assessment (SOFA) score, macrohemodynamic parameters (systolic arterial blood pressure, cardiac output (pulmonary artery catheter or transesophageal Doppler), mixed venous oxygen saturation (pulmonary artery or superior vena cava catheter)) and metabolic parameters (pH, base excess, lactate) were determined.ResultsBaseline StO2 (82% (75 to 88) vs. 89% (85 to 92), P = 0.04) and reperfusion slope (2.79%/second (1.75 to 4.32) vs. 9.35%/second (8.32 to 11.57), P < 0.0001) were lower in septic shock patients than in healthy volunteers. StO2 reperfusion slope correlated with occlusion slope (P < 0.0001), cardiac output (P = 0.01) and LD reperfusion slope (P = 0.08), and negatively with lactate level (P = 0.04). The worst StO2 reperfusion slope during the first day of shock was lower in nonsurvivors than in survivors (P = 0.003) and improved significantly the predictive value of Simplified Acute Physiology Score II and SOFA scores.ConclusionsThe alteration of StO2 reperfusion slope in septic shock patients compared with healthy volunteers was related with macrohemodynamic, microhemodynamic and metabolic parameters. The addition of the worst value of the day 1 StO2 reperfusion slope improved the outcome prediction of Simplified Acute Physiology Score II and SOFA scores.
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39 ConclusionsThe alteration
40 Doppler
41 IntroductionThe study objective
42 MethodsA
43 NIRS parameters
44 Organ Failure Assessment score
45 SOFA score
46 Score II
47 Sequential Organ Failure Assessment score
48 Simplified Acute Physiology Score II
49 StO2
50 addition
51 alterations
52 assessment scores
53 blood flow velocity
54 calculations
55 cardiac output
56 care unit
57 daily Sequential Organ Failure Assessment score
58 day 1
59 days
60 failure
61 first day
62 flow velocity
63 healthy volunteers
64 hemoglobin oxygen saturation
65 hours
66 hours of shock
67 intensive care unit
68 lactate levels
69 laser Doppler
70 levels
71 macrohemodynamic parameters
72 macrohemodynamic variables
73 macroperfusion
74 metabolic parameters
75 microperfusion parameters
76 nonsurvivors
77 objective
78 observational study
79 occlusion
80 occlusion slope
81 occlusion test
82 organ failure
83 outcome prediction
84 outcomes
85 output
86 oxygen saturation
87 oxygenation saturation
88 parameters
89 patients
90 prediction
91 predictive value
92 prognosis
93 relationship
94 reperfusion slope
95 saturation
96 scores
97 septic shock
98 septic shock patients
99 shock
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101 shock-induced alterations
102 skin blood flow velocity
103 slope
104 spectroscopy
105 study
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108 survivors
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110 tissue hemoglobin oxygen saturation
111 units
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