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Voulgarelis S, Fathi F, Yu B, Palkovic B, Chatzizacharias NA, Allen KP, Stucke AG. Hepatic artery flow, inspired oxygen, and hemoglobin determine liver tissue saturation measured with visible diffuse reflectance spectroscopy (vis-DRS) in an in vivo swine model. Pediatr Transplant 2022; 26:e14230. [PMID: 35064720 DOI: 10.1111/petr.14230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prompt diagnosis of vascular compromise following pediatric liver transplantation and restoration of oxygen delivery to the liver improves organ survival. vis-DRS allows for real-time measurement of liver tissue saturation. METHODS The current study used vis-DRS to determine changes in liver saturation during clinically relevant conditions of reduced oxygen delivery. In an in vivo swine model (n = 15), we determined liver tissue saturation (St O2 ) during stepwise reduction in hepatic artery flow, different inspiratory oxygen fraction (FiO2 ), and increasing hemodilution. A custom vis-DRS probe was placed directly on the organ. RESULTS Liver tissue saturation decreased significantly with a decrease in hepatic artery flow. A reduction in hepatic artery flow to 25% of baseline reduced the St O2 by 15.3 ± 1.4% at FiO2 0.3 (mean ± SE, p < .0013), and by 8.3 ± 1.9% at FiO2 1.0 (p = .0013). After hemodilution to 7-8 g/dl, St O2 was reduced by 31.8% ± 2.7%, p < .001 (FiO2 0.3) and 26.6 ± 2.7%, p < .001 (FiO2 : 1.0) respectively. Portal venous saturation during low hepatic artery flow was consistently higher at FiO2 1.0. The gradient between portal venous saturation and liver tissue saturation was consistently greater at lower hemoglobin levels (7.0 ± 1.6% per g/dl hemoglobin, p < .001). CONCLUSIONS Vis-DRS showed prompt changes in liver tissue saturation with decreases in hepatic artery blood flow. At hepatic artery flows below 50% of baseline, liver saturation depended on FiO2 and hemoglobin concentration suggesting that during hepatic artery occlusion, packed red blood cell transfusion and increased FiO2 may be useful measures to reduce hypoxic damage until surgical revascularization.
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Affiliation(s)
- Stylianos Voulgarelis
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of Pediatric Anesthesia, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Faraneh Fathi
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bing Yu
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Barbara Palkovic
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Faculty of Medicine, University of Osijek, Osijek, Croatia
| | | | - Kenneth P Allen
- Department of Microbiology and Immunology, Biomedical Resource Center (BRC), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Astrid G Stucke
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of Pediatric Anesthesia, Children's Wisconsin, Milwaukee, Wisconsin, USA
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Voulgarelis S, Fathi F, Stucke AG, Daley KD, Kim J, Zimmerman MA, Hong JC, Starkey N, Allen KP, Yu B. Evaluation of visible diffuse reflectance spectroscopy in liver tissue: validation of tissue saturations using extracorporeal circulation. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210019R. [PMID: 34021537 PMCID: PMC8145982 DOI: 10.1117/1.jbo.26.5.055002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/03/2021] [Indexed: 05/13/2023]
Abstract
SIGNIFICANCE Real-time information about oxygen delivery to the hepatic graft is important to direct care and diagnose vascular compromise in the immediate post-transplant period. AIM The current study was designed to determine the utility of visible diffuse reflectance spectroscopy (vis-DRS) for measuring liver tissue saturation in vivo. APPROACH A custom-built vis-DRS probe was calibrated using phantoms with hemoglobin (Hb) and polystyrene microspheres. Ex vivo (extracorporeal circulation) and in vivo protocols were used in a swine model (n = 15) with validation via blood gas analysis. RESULTS In vivo absorption and scattering measured by vis-DRS with and without biliverdin correction correlated closely between analyses. Lin's concordance correlation coefficients are 0.991 for μa and 0.959 for μs ' . Hb measured by blood test and vis-DRS with (R2 = 0.81) and without (R2 = 0.85) biliverdin correction were compared. Vis-DRS data obtained from the ex vivo protocol plotted against the PO2 derived from blood gas analysis showed a good fit for a Hill coefficient of 1.67 and P50 = 34 mmHg (R2 = 0.81). A conversion formula was developed to account for the systematic deviation, which resulted in a goodness-of-fit R2 = 0.76 with the expected oxygen dissociation curve. CONCLUSIONS We show that vis-DRS allows for real-time measurement of liver tissue saturation, an indicator for liver perfusion and oxygen delivery.
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Affiliation(s)
- Stylianos Voulgarelis
- Medical College of Wisconsin, Children’s Wisconsin, Department of Anesthesiology, Milwaukee, Wisconsin, United States
- Address all correspondence to Stylianos Voulgarelis,
| | - Faraneh Fathi
- Marquette University and Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
| | - Astrid G. Stucke
- Medical College of Wisconsin, Children’s Wisconsin, Department of Anesthesiology, Milwaukee, Wisconsin, United States
| | - Kevin D. Daley
- Herma Heart Institute, Children’s Wisconsin, Department of Perfusion, Milwaukee, Wisconsin, United States
| | - Joohyun Kim
- Medical College of Wisconsin, Children’s Hospital of Wisconsin, Department of Surgery, Division of Transplant Surgery, Milwaukee, Wisconsin, United States
| | - Michael A. Zimmerman
- Medical College of Wisconsin, Children’s Hospital of Wisconsin, Department of Surgery, Division of Transplant Surgery, Milwaukee, Wisconsin, United States
| | - Johnny C. Hong
- Medical College of Wisconsin, Children’s Hospital of Wisconsin, Department of Surgery, Division of Transplant Surgery, Milwaukee, Wisconsin, United States
| | - Nicholas Starkey
- Herma Heart Institute, Children’s Wisconsin, Department of Perfusion, Milwaukee, Wisconsin, United States
| | - Kenneth P. Allen
- Biomedical Resource Center, Medical College of Wisconsin, Department of Immunology Microbiology, Milwaukee, Wisconsin, United States
| | - Bing Yu
- Marquette University and Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
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Pinto GC, Leal LB, Magalhães NC, Pereira MF, Vassallo PF, Pereira TM, Barauna VG, Byrne HJ, Carvalho LFCS. The potential of FT-IR spectroscopy for improving healthcare in sepsis - An animal model study. Photodiagnosis Photodyn Ther 2021; 34:102312. [PMID: 33930577 DOI: 10.1016/j.pdpdt.2021.102312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/07/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
Fourier Transform-Infrared (FT-IR) absorption spectroscopy has been used to investigate pathophysiological changes caused by sepsis. Sepsis has been defined as a potentially fatal organic dysfunction caused by a dysregulated host response to infection and can lead a patient to risk of death. This study used samples consisting of the blood plasma of mice which were induced to sepsis state, compared to a healthy group using FT-IR associated with attenuated total reflectance (ATR) spectroscopy. For statistical analysis, principal components analysis (PCA) and linear discriminant analysis (LDA) were applied, independently, to the second derivative spectra of both the fingerprint (900-1800 cm-1) and the high wavenumber (2800-3100 cm-1) regions. The technique efficiently differentiated the blood plasma of the two groups, sepsis and healthy mice, the analysis indicating that fatty acids and lipids in the blood samples could be an important biomarker of sepsis.
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Affiliation(s)
- G C Pinto
- Post Graduation Program in Physiological Sciences, Federal University of Espírito Santo, Marechal Campos Ave, 1468, Maruípe, 29040-090, Vitória, Espírito Santo, Brazil
| | - L B Leal
- Post Graduation Program in Physiological Sciences, Federal University of Espírito Santo, Marechal Campos Ave, 1468, Maruípe, 29040-090, Vitória, Espírito Santo, Brazil.
| | - N C Magalhães
- Universidade de Taubaté. R. dos Operários, 09 - Centro, Taubaté, SP, 12020-340, Brazil
| | - M F Pereira
- Post Graduation Program in Physiological Sciences, Federal University of Espírito Santo, Marechal Campos Ave, 1468, Maruípe, 29040-090, Vitória, Espírito Santo, Brazil
| | - P F Vassallo
- Post Graduation Program in Physiological Sciences, Federal University of Espírito Santo, Marechal Campos Ave, 1468, Maruípe, 29040-090, Vitória, Espírito Santo, Brazil; Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - T M Pereira
- Universidade Federal do Estado de São Paulo. R. Talim, 330 - Vila Nair, São José dos Campos, SP, 12231-0, Brazil
| | - V G Barauna
- Department of Physiological Sciences, Federal University of Espírito Santo (UFES), Marechal Campos Ave, 1468, Maruípe, 29040-090, Vitória, Espírito Santo, Brazil
| | - H J Byrne
- FOCAS Research Institute, Technological University Dublin, Kevin Street, Dublin 8, Ireland
| | - L F C S Carvalho
- Universidade de Taubaté. R. dos Operários, 09 - Centro, Taubaté, SP, 12020-340, Brazil; Centro Universitário Braz Cubas. Av. Francisco Rodrigues Filho, 1233 - Vila Mogilar, Mogi das Cruzes, SP, 08773-380, Brazil
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Prognostic Value of Tissue Oxygen Monitoring and Regional Cerebral Oxygen Saturation Monitoring and Their Correlation in Neurological Patients with Sepsis: A Preliminary, Prospective, Observational Study. J Neurosurg Anesthesiol 2020; 32:77-81. [PMID: 30475291 DOI: 10.1097/ana.0000000000000563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is paucity of literature on the prognostic value of tissue oxygen saturation (StO2) and regional cerebral oxygen saturation (rSO2) in neurological patients with sepsis. In this preliminary study, we investigated the prognostic value of StO2 and rSO2 in a group of neurological patients and correlated StO2 and rSO2 with hemodynamic and metabolic parameters. MATERIALS AND METHODS This preliminary, prospective observational study was conducted in 45 adult neurological patients admitted to intensive care unit. Once a diagnosis of sepsis or septic shock was established, parameters of oxygenation (StO2, rSO2, central venous oxygen saturation [ScvO2]), serum lactate, illness severity scores (Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, Glasgow Coma Scale) were recorded at 0, 6, 12, 24, 36, and 48 hours, and once daily thereafter. Outcomes were in-hospital mortality attributable to sepsis and the Glasgow outcome score at hospital discharge. RESULTS There was a moderately positive correlation between StO2 and rSO2 at baseline (r=0.599; P=0.001). StO2, illness severity scores and serum lactate, but not rSO2, were significantly different between survivors (n=29) and nonsurvivors (n=16) at baseline and during the first 48 hours. An rSO2 of 62.5% had a sensitivity of 83% and specificity of 67% to differentiate survivors and nonsurvivors of septic shock at 48 hours. StO2 had a higher correlation with ScvO2 and serum lactate than rSO2. CONCLUSIONS StO2 prognosticates survival and favorable/unfavorable outcomes in neurological patients with sepsis. The role of rSO2 in predicting survival in milder form of sepsis is doubtful.
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Abstract
BACKGROUND Noninvasive evaluation of muscle perfusion using near-infrared spectroscopy (NIRS) coupled with a vascular occlusion test (VOT) may provide an early and simple marker of altered perfusion and microcirculatory function in sepsis. OBJECTIVE The aim of the study was to compare the time-course of NIRS-derived variables with systemic measures of perfusion in an experimental model of peritonitis. METHODS Peritonitis was induced in eight anesthetized, mechanically ventilated, adult sheep (24-34 kg), by injecting autologous feces into the peritoneal cavity. Animals were followed until death or for a maximum of 30 h. Muscle tissue oxygen saturation (StO2) was determined using NIRS on the right posterior leg and arterial VOTs were performed by intermittent intra-aortic balloon inflation. Microdialysis was used to measure muscle lactate and pyruvate levels. RESULTS Muscle StO2 was significantly lower than baseline values from 8 h after sepsis induction, but with considerable intersubject variability. The NIRS VOT ascending (Asc) slope decreased to values <120%/min in most animals from 12 h after sepsis induction. Muscle lactate/pyruvate ratios were higher than baseline from 16 h after sepsis induction. Mixed venous oxygen saturation (SvO2) decreased to <70% and blood lactate levels increased to >2 mmol/L in most of the animals only 24 and 28 h after sepsis induction, respectively. Muscle NIRS StO2 correlated strongly with femoral venous oxygen saturation (r = 0.820) and moderately with SvO2 (r = 0.436). CONCLUSIONS The muscle NIRS Asc slope after a VOT is altered earlier than global markers of tissue hypoperfusion during sepsis. This simple noninvasive test can detect early changes in peripheral perfusion in sepsis.
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Samraj RS, Kerrigan M, Mejia M, Wilson L, Fudge JC, Vyas HV, Gupta D. Thenar Muscle Oxygen Saturation Levels: A Surrogate for Central Venous Oxygen Saturation? Clin Pediatr (Phila) 2019; 58:528-533. [PMID: 30841742 DOI: 10.1177/0009922819832094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Shock is associated with increased tissue oxygen extraction. Near-infrared spectroscopy-derived thenar muscle tissue oxygenation (StO2) levels can provide an estimate of the oxygen supply-demand balance at the tissue level. We hypothesized that thenar StO2 levels would correlate with central venous oxygen saturation (ScvO2) levels, the gold standard for global tissue oxygen extraction in the body. METHODS We prospectively enrolled 60 pediatric subjects admitted to pediatric intensive care unit or who underwent cardiac catheterization from September 2015 to March 2018. Thenar StO2 levels were measured using the InSpectra StO2 probe. Concurrent measurements of ScvO2 and peripheral tissue oxygenation (StO2) were achieved through simultaneous testing. For ScvO2, a central line placed in the superior vena cava was utilized for serum specimen collection, while the InSpectra probe recorded StO2 measurements from the thenar eminence of the patient's right hand. RESULTS Sixty observations of thenar StO2 and ScvO2 levels were derived from 60 subjects. Mean thenar StO2 levels were 74.72 ± 11.18% and displayed significant correlation with paired ScvO2 measurements ( m = 72.17 ± 9.77%; ρ = 0.317, P = .018). Correlation was much more significant in subjects who were not on mechanical ventilatory support as opposed to those who were on it ( ρSORA = 0.496, PSORA = .003, vs ρVENT = 0.161, PVENT = .433). A thenar StO2 of 73% had a sensitivity of 80% and a specificity of 77.8% in predicting an ScvO2 of less than 65%. CONCLUSION This is the first study to report correlation of thenar StO2 and ScvO2 levels in children. Our study results show a significant correlation between these levels. Thenar StO2 measurements may have a role in the bedside management of critically ill children in whom ScvO2 monitoring is not available.
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Affiliation(s)
- Ravi S Samraj
- 1 Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Maria Kerrigan
- 2 UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Maria Mejia
- 2 UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Laura Wilson
- 2 UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - James C Fudge
- 2 UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Himesh V Vyas
- 2 UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Dipankar Gupta
- 2 UF Health Shands Children's Hospital, Gainesville, FL, USA
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Abstract
PURPOSE OF REVIEW This article reviews the recent literature pertaining to assessment of the adequacy of oxygen delivery in critically ill patients with circulatory shock. RECENT FINDINGS The assessment of the adequacy of oxygen delivery has traditionally involved measurement of lactate, central (or mixed) venous oxygen saturation (ScvO2), and global hemodynamic markers such as mean arterial pressure and cardiac index. The search for noninvasive, reliable, and sensitive methods to detect derangements in oxygen delivery and utilization continues. Recent studies focus on near-infrared spectroscopy (NIRS) to assess regional tissue oxygenation, as well as bedside ultrasound techniques to assess the macrovascular hemodynamic factors in oxygen delivery. SUMMARY In this article, we review physiologic principles of global oxygen delivery, and discuss the bedside approach to assessing the adequacy of oxygen delivery in critically ill patients. Although there have been technological advances in the assessment of oxygen delivery, we revisit and emphasize the importance of a 'tried and true' method - the physical examination. Also potentially important in the evaluation of oxygen delivery is the utilization of biomarkers (e.g., lactate, ScvO2, NIRS). In complementary fashion, bedside ultrasound for hemodynamic assessment may augment the physical examination and biomarkers, and represents a potentially important adjunct for assessing the adequacy of oxygen delivery.
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[Prognostic relevance of tissue oxygen saturation in patients in the early stage of multiple organ dysfunction syndrome]. Med Klin Intensivmed Notfmed 2018; 114:146-153. [PMID: 29671035 DOI: 10.1007/s00063-018-0438-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Patients in circulatory shock exhibit insufficient peripheral perfusion to ensure adequate oxygenation of vital organs such as the heart and brain. Early detection of reduced tissue oxygen saturation (StO2) could be used for rapid therapeutic intervention and thus improve the prognosis of patients in the early stage of multiple organ dysfunction syndrome (MODS). MATERIALS AND METHODS A total of 60 patients in the early stage of MODS (APACHE [Acute Physiology and Chronic Health Evaluation] II score ≥20) were investigated in a monocentric, prospective, randomized phase II study. StO2 was measured using the InSpectraTM StO2 system and compared with known indicators of hypoxia (peripheral oxygen saturation [SpO2], arterial oxygen saturation [SaO2], central venous oxygen saturation [ScvO2], pH, serum lactate). Clinical endpoints of the study were 28-day and 6‑month mortality as well as the need for invasive mechanical ventilation and renal replacement therapy during the hospital stay, respectively. RESULTS An increased 28-day and 6‑month mortality is found for patients with StO2 <75% in contrast to patients with StO2 ≥75%. Correlations of StO2 with SpO2, ScvO2, and serum lactate are confirmed. Patients with reduced StO2 tend to show a higher disease severity as measured by APACHE II score. CONCLUSION StO2 shows prognostic relevance in patients at the early stage of MODS. Thus, the rapid and noninvasive assessment of StO2 could be useful in risk stratification of these patients.
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Iyengar A, Gaillardetz A, Tighiouart H, Castillo B, Romfh P, Davis JM. Direct Measurement of Tissue Oxygenation in Neonates via Resonance Raman Spectroscopy: A Pilot Study. Neonatology 2017; 112:137-142. [PMID: 28514777 DOI: 10.1159/000458514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The ability to monitor tissue oxygenation in neonates remains a challenge due to limited blood supply and the reliance on invasive procedures. Resonance Raman spectroscopy noninvasively measures tissue oxygenation (RRS-StO2). Peripheral tissue oxygenation using this novel technology has not been described in neonates. OBJECTIVES To examine the relationship between short-term RRS-StO2 measurements and central venous saturation (ScvO2) and pulse oximetry (SpO2) in preterm and term neonates. METHODS Ninety-seven term neonates had buccal and plantar RRS-StO2 measurements performed. In 15 preterm neonates, similar measurements were obtained in conjunction with ScvO2 in the first week of life. Simultaneous SpO2 and heart rate were also recorded. RESULTS In healthy neonates, buccal RRS-StO2 values negatively correlated with the day of life. No correlation existed between buccal and plantar RRS-StO2 values and ScvO2 or SpO2. Greater intra-patient plantar RRS-StO2 variability was seen in preterm neonates with increasing respiratory support. CONCLUSIONS Neonatal RRS-StO2 measurements are feasible short term but do not correlate with ScvO2 and SpO2. Healthy neonates had greater differences and variability in RRS-StO2 values, illustrating an evolving microcirculation not detected with pulse oximetry. Greater RRS-StO2 variability in sick neonates requiring respiratory support may indicate microcirculatory instability despite being within target SpO2 ranges. Further study is needed to establish if RRS-StO2 monitoring is an accurate representation of tissue oxygenation.
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Affiliation(s)
- Anjali Iyengar
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
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Endothélium et microcirculation au cours des états critiques. Actes du séminaire de recherche translationnelle de la Société de réanimation de langue française (1er décembre 2015). MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Salcedo MC, Tart K, Hall K. A systematic review of human and veterinary applications of noninvasive tissue oxygen monitoring. J Vet Emerg Crit Care (San Antonio) 2016; 26:323-32. [PMID: 27062438 DOI: 10.1111/vec.12465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/27/2014] [Accepted: 09/15/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe the methodology for and utilization of tissue oxygen monitoring by near infrared spectroscopy, and to review the current literature on the use of this monitoring modality in human and veterinary settings. DATA SOURCES Scientific reviews and original research found using the PubMed and CAB Abstract search engines with the following keywords: "tissue oxygen monitoring," "near-infrared tissue spectroscopy," and "tissue oxygen saturation (StO2 )." HUMAN DATA SYNTHESIS Tissue oxygen monitors have been evaluated in a wide variety of human clinical applications including trauma and triage, surgery, sepsis, and septic shock, and early goal-directed therapy. StO2 more rapidly identifies occult shock in human patients compared to traditional methods, which can lead to earlier intervention in these patients. VETERINARY DATA SYNTHESIS Veterinary studies involving tissue oxygen monitoring are limited, but the technology may have utility for identification of hemorrhagic shock earlier than changes in base excess, blood lactate concentration, or other traditional perfusion parameters. CONCLUSION Tissue oxygen monitoring is most commonly performed utilizing a noninvasive, portable monitor, which provides real-time, continuous, repeatable StO2 measurements. A decline in StO2 is an early indicator of shock in both human and veterinary patients. Low StO2 values in human patients are associated with increased morbidity, mortality, and length of hospitalization, as well as the development of multiple organ system dysfunction and surgical site infections.
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Affiliation(s)
- Mallory C Salcedo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
| | - Kelly Tart
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
| | - Kelly Hall
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
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Pavlisko ND, Killos M, Henao-Guerrero N, Riccó CH, Werre S. Evaluation of tissue hemoglobin saturation (StO 2 ) using near-infrared spectroscopy during hypoxemia and hyperoxemia in Beagle dogs. Vet Anaesth Analg 2016; 43:18-26. [DOI: 10.1111/vaa.12258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 10/22/2014] [Indexed: 11/27/2022]
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Davies DJ, Su Z, Clancy MT, Lucas SJE, Dehghani H, Logan A, Belli A. Near-Infrared Spectroscopy in the Monitoring of Adult Traumatic Brain Injury: A Review. J Neurotrauma 2015; 32:933-41. [PMID: 25603012 DOI: 10.1089/neu.2014.3748] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cerebral near-infrared spectroscopy (NIRS) has long represented an exciting prospect for the noninvasive monitoring of cerebral tissue oxygenation and perfusion in the context of traumatic brain injury (TBI), although uncertainty still exists regarding the reliability of this technology specifically within this field. We have undertaken a review of the existing literature relating to the application of NIRS within TBI. We discuss current "state-of-the-art" NIRS monitoring, provide a brief background of the technology, and discuss the evidence regarding the ability of NIRS to substitute for established invasive monitoring in TBI.
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Affiliation(s)
- David J Davies
- 1 Department of Neurosurgery Clinical Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
| | - Zhangjie Su
- 1 Department of Neurosurgery Clinical Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
| | - Michael T Clancy
- 2 School of Computational Science Medical Imaging Group, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Samuel J E Lucas
- 3 Department of Exercise Physiology, School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Hamid Dehghani
- 4 Department of Medical Imaging, School of Computer Science, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Ann Logan
- 5 Department of Molecular Neuroscience, School of Clinical and Experimental Medicine, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Antonio Belli
- 6 Department of Surgical Neurology, National Institute for Health Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
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Prospective evaluation of regional oxygen saturation to estimate central venous saturation in sepsis. J Clin Monit Comput 2015; 29:443-53. [PMID: 25757404 DOI: 10.1007/s10877-015-9683-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/27/2015] [Indexed: 01/01/2023]
Abstract
Current treatment guidelines for sepsis claim an early goal-directed hemodynamic optimization including fluid resuscitation, use of vasopressors and inotropic agents. We investigated the correlation between the prominent treatment goal central venous saturation (ScvO2) and the frontal and the thenar regional oxygen saturation (rSO2) measured by near infrared spectroscopy. Secondary, we examined the value of ScvO2, lactate levels and rSO2 as surrogate markers of an impaired tissue oxygenation for outcome prediction in sepsis. This prospective, observational study was performed at the surgical intensive care unit of the University Hospital Giessen. A total of 50 patients with sepsis, severe sepsis or septic shock were included. ScvO2, rSO2 and lactate were measured at sepsis diagnosis (baseline), 24 and 48 h, thereafter. We investigated the predictive value of frontal and thenar rSO2 for a decreased SvcO2 under 70%. For survivor and non-survivors ScvO2, rSO2 and lactate were analysed. Patients with ScvO2 >70% showed a trend to higher levels of fontal rSO2 (62.81 ± 8.06 vs. 53.54 ± 15.48; p = 0.058). ROC-analysis revealed a minor prediction of a decreased ScvO2 by frontal rSO2 levels at baseline (AUC = 0.687; 95% CI 0.511-0.863; p = 0.047). Combined measurements of lactate and ScvO2 showed significantly elevated mortality for patients with ScvO2 ≥70% and lactate levels ≥2.5 mmol/l (log rank test p = 0.004). In the group with ScvO2 <70% and lactate levels <2.5 mmol/l no patients died during the observation period. Frontal rSO2 correlates with ScvO2 but both frontal and thenar rSO2 do not exactly discriminate between patients with high or low ScvO2 in sepsis. The combination of elevated lactate >2.5 mmol/l and ScvO2 >70 % is highly associated with poor outcome in ICU patients with sepsis, severe sepsis and septic shock.
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Barrett OSH, Macdonald SPJ, Playford DA. Near-infrared spectroscopy-based microcirculatory assessment in acute atrial fibrillation. Anaesth Intensive Care 2015; 43:105-10. [PMID: 25579297 DOI: 10.1177/0310057x1504300116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-infrared spectroscopy is a means of assessing microcirculatory function, but has not been studied in atrial fibrillation (AF). We evaluated the effect of acute AF on thenar eminence near-infrared spectroscopy-derived microcirculatory variables. Stable patients presenting to the emergency department with acute onset AF underwent dynamic near-infrared spectroscopy assessment with a three minute vascular occlusion test (VOT). This was repeated after cardioversion to sinus rhythm (SR). Each assessment included baseline tissue oxygen saturation (StO2), slope of StO2 decrease during VOT, slope of StO2 increase post VOT, minimum and maximum StO2, amplitude of StO2 response and post-ischaemic hyperperfusion. Pre and post cardioversion values were compared by Wilcoxon signed-rank test. Twelve participants (seven male, five female) with a median age of 63 years (interquartile range 52 to 70 years) were enrolled. Median baseline StO2 was 74% before and 77% after cardioversion (P=0.03). The median slope of StO2 decrease during VOT was -0.19%/second and -0.16%/second (P=0.018) and the median slope of StO2 increase post VOT was 3.03%/second and 2.56%/second (P=0.002), pre and post cardioversion, respectively. Minimum StO2 was lower (39% versus 52%, P=0.002) and the amplitude of StO2 response greater (49% versus 40%, P=0.005) in AF, but there was no significant difference in maximum StO2 or the degree of reperfusion hyperaemia. In summary, baseline and minimum StO2 were lower with a greater ischaemic decrease in StO2 during AF, reflecting reduced tissue perfusion, compared with sinus rhythm. Recovery after ischaemia was higher in AF, suggesting normalisation of capillary recruitment during ischaemia.
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Affiliation(s)
- O S H Barrett
- Emergency Department, Armadale Health Service, Armadale, Western Australia
| | - S P J Macdonald
- Emergency Department, Armadale Health Service, Armadale, Western Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research and Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia
| | - D A Playford
- Faculty of Medicine, University of Notre Dame, Fremantle, Western Australia
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Early identification and management of patients with severe sepsis and septic shock in the emergency department. Emerg Med Clin North Am 2014; 32:759-76. [PMID: 25441033 DOI: 10.1016/j.emc.2014.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Severe sepsis and septic shock have great relevance to Emergency Medicine physicians because of their high prevalence, morbidity, and mortality. Treatment is time-sensitive, depends on early identification risk stratification, and has the potential to significantly improve patient outcomes. In this article, we review the pathophysiology of, and evidence basis for, the emergency department management of severe sepsis and septic shock.
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Al-Subu AM, Rehder KJ, Cheifetz IM, Turner DA. Non invasive monitoring in mechanically ventilated pediatric patients. Expert Rev Respir Med 2014; 8:693-702. [PMID: 25119483 DOI: 10.1586/17476348.2014.948856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy.
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Affiliation(s)
- Awni M Al-Subu
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Duke Children's Hospital, Durham, DUMC Box 3046, Durham, NC 27710, NC, USA
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Epstein CD, Haghenbeck KT. Bedside assessment of tissue oxygen saturation monitoring in critically ill adults: an integrative review of the literature. Crit Care Res Pract 2014; 2014:709683. [PMID: 24900919 PMCID: PMC4034454 DOI: 10.1155/2014/709683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/23/2014] [Accepted: 04/03/2014] [Indexed: 12/22/2022] Open
Abstract
Objective. Tissue oxygen saturation (StO2) monitoring is a noninvasive technology with the purpose of alerting the clinician of peripheral hypoperfusion and the onset of tissue hypoxia. This integrative review examines the rigor and quality of studies focusing on StO2 monitoring in adult critically ill patients. Background. Clinicians must rapidly assess adverse changes in tissue perfusion while minimizing potential complications associated with invasive monitoring. The noninvasive measurement of tissue oxygen saturation is based on near-infrared spectroscopy (NIRS), an optical method of illuminating chemical compounds which absorb, reflect, and scatter light directed at that compound. Methods. An integrative review was conducted to develop a context of greater understanding about complex topics. An Integrative review draws on multiple experimental and nonexperimental research methodologies. Results. Fourteen studies were graded at the C category. None reported the use of probability sampling or demonstrated a cause-and-effect relationship between StO2 values and patient outcomes. Conclusions. Future research should be based on rigorous methods of sampling and design in order to enhance the internal and external validity of the findings.
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Affiliation(s)
- Carol Diane Epstein
- College of Health Professions, Lienhard School of Nursing, Pace University, Office 319, 861 Bedford Road, Pleasantville, NY 10570, USA
| | - Karen Toby Haghenbeck
- College of Health Professions, Lienhard School of Nursing, Pace University, Office L308, 861 Bedford Road, Pleasantville, NY 10570, USA
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Low StO2 measurements in surgical intensive care unit patients is associated with poor outcomes. J Trauma Acute Care Surg 2014; 76:809-16. [PMID: 24553553 DOI: 10.1097/ta.0b013e3182ab07a4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Near-infrared spectroscopy-derived tissue hemoglobin saturation (StO2) is a noninvasive measurement that reflects changes in microcirculatory tissue perfusion. Previous studies in trauma patients have shown a correlation between low StO2 levels and mortality, organ failure, and severity of injury. The goals of this study were to identify the incidence of low StO2 in the critically ill patient population of a surgical intensive care unit (SICU) and evaluate the relationship of low StO2 and clinical outcomes. METHODS We conducted a prospective cohort study at the University of Minnesota Medical Center. After institutional review board approval, 620 patients admitted to the SICU between July 2010 and July 2011 were screened for enrollment. Patients with an expected ICU length of stay of less than 24 hours were excluded. In the 490 patients who met inclusion criteria, StO2 measurements were obtained from the thenar eminence one to three times daily for the length of the ICU stay, up to 14 days. Outcome data included 28-day hospital mortality; ICU readmission; ventilator-free, ICU-free, and hospital-free days; and the need for lifesaving interventions. RESULTS The overall incidence of low StO2 (<70%) was 11% of the patients per day. Patients with at least 1 day in the SICU with an StO2 measurement of less than 70% had higher rates of ICU readmission and fewer ventilator-free, ICU-free, and hospital-free days compared with those who did not. Mortality (28-day in-hospital) trended higher for these patients but was not statistically significant. An increase in the number of days with StO2 less than 70% was also associated with fewer ventilator-free, ICU-free, and hospital-free days. CONCLUSION Low StO2 (<70%) is common and associated with poor outcomes in SICU patients. Near-infrared spectroscopy represents a potentially useful, noninvasive adjunct to monitoring of critically ill patients. LEVEL OF EVIDENCE Prognostic study, level II.
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Gruartmoner G, Mesquida J, Baigorri F. Saturación tisular de oxígeno en el paciente crítico. Med Intensiva 2014; 38:240-8. [DOI: 10.1016/j.medin.2013.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/06/2013] [Accepted: 07/12/2013] [Indexed: 01/01/2023]
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Goerlich CE, Wade CE, McCarthy JJ, Holcomb JB, Moore LJ. Validation of sepsis screening tool using StO2 in emergency department patients. J Surg Res 2014; 190:270-5. [PMID: 24713469 DOI: 10.1016/j.jss.2014.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/24/2014] [Accepted: 03/05/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sepsis is a deleterious systemic response to an infection with a high incidence of morbidity and mortality, affecting more than a million patients a year in the US. The purpose of this study was to develop a screening tool for the early identification of sepsis in emergency department patients using readily available information at triage. MATERIALS AND METHODS This prospective, observational study took place at an academic tertiary referral hospital. Over a period of 10 wk, all patients who were seen at triage were screened for study enrollment. Inclusion criteria were adult (age≥18 y) nontrauma patients and exclusion criteria were prisoners and pregnant women. Using a Spot Check StO2 device to measure StO2 value, heart rate, respiratory rate, and temperature, these values were used to generate a cumulative screening score indicating whether a patient may have sepsis. RESULTS A total of 500 patients were screened. The incidence of sepsis in the present study population was 8.4%. The screening tool yielded a sensitivity of 85.7%, a specificity of 78.4%, a positive predictive value of 26.7%, and a negative predictive value of 98.4%. CONCLUSIONS Heart rate, respiratory rate, and temperature have good diagnostic potential for the early identification of sepsis among emergency department triage personnel. Additionally, early evidence suggests StO2 may play a complementary and synergistic role in the early identification of sepsis by triage personnel.
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Affiliation(s)
- Corbin E Goerlich
- Department of Surgery, University of Texas Medical School at Houston, Center for Translational Injury Research (CeTIR), Houston, Texas
| | - Charles E Wade
- Department of Surgery, University of Texas Medical School at Houston, Center for Translational Injury Research (CeTIR), Houston, Texas
| | - James J McCarthy
- Department of Emergency Medicine, University of Texas Medical School at Houston, Center for Translational Injury Research (CeTIR), Houston, Texas
| | - John B Holcomb
- Department of Surgery, University of Texas Medical School at Houston, Center for Translational Injury Research (CeTIR), Houston, Texas
| | - Laura J Moore
- Department of Surgery, University of Texas Medical School at Houston, Center for Translational Injury Research (CeTIR), Houston, Texas.
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Association between static and dynamic thenar near-infrared spectroscopy and mortality in patients with sepsis: a systematic review and meta-analysis. J Trauma Acute Care Surg 2014; 76:226-33. [PMID: 24368385 DOI: 10.1097/ta.0b013e3182a9221f] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oxygen delivery and consumption disturbances are frequently seen with critically illness, potentially leading to pathologic changes in tissue oxygenation (StO2). Near-infrared spectroscopy (NIRS) is a potentially useful method to monitor StO2, but the role of NIRS in prognostication of septic patients is uncertain. The aim of this study was to systematically review the literature and evaluate static and dynamic NIRS in patients with sepsis. METHODS This is a systematic review and meta-analysis of publications between 1966 and 2013. The MEDLINE and EMBASE databases were searched for studies on StO2 in patients with severe sepsis or septic shock. Meta-analysis was limited to studies about static and dynamic variables derived from NIRS in patients with sepsis. The association between StO2, reperfusion slope (Rres), occlusion slope, and maximum StO2 minus basal StO2 (ΔStO2) and prognosis in septic patients was evaluated. RESULTS The search identified 20 articles (962 participants; 717 with severe sepsis or septic shock, and 245 healthy controls). Compared with healthy controls, septic patients had lower levels of StO2 (78.27% [4.91%] vs. 82.02% [3.57%], p = 0.012), Rres (2.75% [0.63%] vs. 5.19% [2.86%] per second, p = 0.003), and ΔStO2 (7.86% [0.11%] vs. 12.53% [2.65%], p = 0.011). Survivors from sepsis presents higher levels of StO2 (81.68% [4.68%] vs. 74.54% [5.31%], p = 0.02) and Rres (3.37% [0.44%] vs. 2.16% [0.51%] per second, p = 0.016). CONCLUSION Septic patients have lower levels of StO2, Rres and ΔStO2, and survivors from sepsis present higher levels of StO2 and Rres compared with nonsurvivors. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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Macdonald SPJ, Brown SGA. Near-infrared spectroscopy in the assessment of suspected sepsis in the emergency department. Emerg Med J 2013; 32:404-8. [PMID: 24154943 DOI: 10.1136/emermed-2013-202956] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/06/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS The conventional approach to sepsis resuscitation involves early interventions targeting global oxygenation and macro-haemodynamic variables such as central venous and systemic arterial pressures. There is increasing recognition of the importance of microcirculatory changes in shock states, including sepsis, and the relationship of these to outcome. Near-infrared spectroscopy (NIRS) is a recently developed non-invasive technology that measures tissue oxygen saturations (StO2), which may be an indirect measure of the adequacy of the microcirculation. StO2 measurements, therefore, have the potential to identify patients who are at risk of progressing to organ dysfunction and could be used to guide resuscitation. This article reviews the current state of knowledge of NIRS in the setting of sepsis, examining its application, validity and prognostic value. METHODS A search of the relevant literature was performed using Medline, Embase and Cochrane databases, and a qualitative analysis was undertaken. RESULTS A limited number of observational studies, mostly conducted among patients with severe sepsis, have shown that NIRS may correlate with severity of illness but demonstrate a variable relationship between StO2 and outcome. CONCLUSIONS Outstanding questions still remain as to whether NIRS can help to risk-stratify patients with suspected sepsis in the emergency department and the utility of StO2 as a resuscitation target.
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Affiliation(s)
- Stephen P J Macdonald
- Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, Western Australia, Australia Department of Emergency Medicine, Armadale Health Service, Armadale, Western Australia, Australia
| | - Simon G A Brown
- Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, Western Australia, Australia Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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Leichtle SW, Kaoutzanis C, Brandt MM, Welch KB, Purtill MA. Tissue oxygen saturation for the risk stratification of septic patients. J Crit Care 2013; 28:1111.e1-5. [PMID: 24011754 DOI: 10.1016/j.jcrc.2013.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/15/2013] [Accepted: 07/23/2013] [Indexed: 01/27/2023]
Abstract
PURPOSE Peripheral tissue oxygen saturation (Sto2) has shown promise as an early indicator of tissue hypoperfusion and as a risk stratification tool in various forms of shock. The purpose of this study was to determine if Sto2 would predict admission to an intensive (ICU) or progressive care unit in patients with early signs of sepsis. METHODS In this prospective observational study, a rapid response team measured Sto2 levels in patients screening positive for sepsis. Using a logistic regression model, the value of Sto2 as a predictor for ICU admission within 72 hours of the initial assessment was determined. RESULTS The 31 (47%) of 66 patients who required ICU admission within 72 hours of evaluation had a significantly lower Sto2 value (median, 78% vs 81%; P = .05). All patients with Sto2 less than 70% required ICU admission. A 1-point increase in Sto2 was associated with a 7% decrease in the odds of requiring ICU admission, and the area under the curve for Sto2 was 0.64 (0.51-0.77, P = .01). CONCLUSIONS Low Sto2 levels in patients screening positive for sepsis are associated with an increased risk of ICU admission, but their reliability as a predictor is rather low. An Sto2 below 70% might be an interesting cutoff value for further study.
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Affiliation(s)
- Stefan W Leichtle
- Section of Surgical Critical Care, St Joseph Mercy Health System, Ann Arbor, MI 48106, USA.
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Van Haren RM, Ryan ML, Thorson CM, Namias N, Livingstone AS, Proctor KG. Bilateral near-infrared spectroscopy for detecting traumatic vascular injury. J Surg Res 2013; 184:526-32. [DOI: 10.1016/j.jss.2013.03.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/14/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
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Skeletal muscle oxygen saturation (StO2) measured by near-infrared spectroscopy in the critically ill patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:502194. [PMID: 24027757 PMCID: PMC3763593 DOI: 10.1155/2013/502194] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/16/2013] [Indexed: 12/22/2022]
Abstract
According to current critical care management guidelines, the overall hemodynamic optimization process seeks to restore macrocirculatory oxygenation, pressure, and flow variables. However, there is increasing evidence demonstrating that, despite normalization of these global parameters, microcirculatory and regional perfusion alterations might occur, and persistence of these alterations has been associated with worse prognosis. Such observations have led to great interest in testing new technologies capable of evaluating the microcirculation. Near-infrared spectroscopy (NIRS) measures tissue oxygen saturation (StO2) and has been proposed as a noninvasive system for monitoring regional circulation. The present review aims to summarize the existing evidence on NIRS and its potential clinical utility in different scenarios of critically ill patients.
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Tissue oxygen saturation changes during intramedullary nailing of lower-limb fractures. J Trauma Acute Care Surg 2012; 74:123-7. [PMID: 23271086 DOI: 10.1097/ta.0b013e3182788e6c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The systemic complications of acute intramedullary nailing (IMN) in trauma patients are well known. There are no reliable methods available to predict these adverse outcomes. Noninvasive near-infrared spectroscopy (NIRS) allows measurement of oxygen saturation within muscle tissue (StO2) and quantification of the potential metabolic and microcirculatory effects of IMN in real time. The aim of this study was to characterize tissue oxygenation changes occurring during reamed IMN. METHODS Patients undergoing reamed IMN for fixation of a tibia or femur fracture and patients having an open reduction and internal fixation of the ankle (to control for potential effects of anesthesia) had a noninvasive NIRS probe attached to the thenar eminence of the hand. Tissue oxygenation was monitored continuously throughout the operation and digitally recorded for later analysis. Vascular occlusion tests, an established technique with the NIRS device, were performed before canal opening and after nail insertion (at equivalent times in the control group), to establish the presence and nature of changes in systemic microcirculation occurring during the duration of the operation. RESULTS Tissue oxygenation data were collected on 23 patients undergoing 26 IMN. (mean [SD] age, 36 [19] years; median Injury Severity Score [ISS], 9; interquartile range, 9-12). The control group consisted of 19 patients (mean [SD] age, 41 [18] years; ISS, 4). Remote muscle tissue desaturated significantly faster after IMN compared with the control operation (mean [SD] difference in IMN desaturation rate, 1.8% per minute [2.6% per minute]; mean [SD] difference in control group desaturation rate, -0.6% per minute [1.5% per minute]; p = 0.014). Near infrared-derived muscle oxygen consumption (NIR VO(2)) was significantly increased during the course of IMN compared with the control (mean [SD] difference in IMN NIR VO(2), 19.9 [32.1]; mean [SD] difference in control NIR VO(2), -4.2 [17.9]; p = 0.041). CONCLUSION IMN causes significant remote microcirculatory changes. The responsiveness of the microcirculation could be a predictor of secondary organ dysfunction. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Lipcsey M, Woinarski NC, Bellomo R. Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care. Ann Intensive Care 2012; 2:11. [PMID: 22569165 PMCID: PMC3488540 DOI: 10.1186/2110-5820-2-11] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 03/26/2012] [Indexed: 01/20/2023] Open
Abstract
Near infrared spectroscopy of the thenar eminence (NIRSth) is a noninvasive bedside method for assessing tissue oxygenation. The NIRS probe emits light with several wavelengths in the 700- to 850-nm interval and measures the reflected light mainly from a predefined depth. Complex physical models then allow the measurement of the relative concentrations of oxy and deoxyhemoglobin, and thus tissue saturation (StO2), as well as an approximation of the tissue hemoglobin, given as tissue hemoglobin index. Here we review of current knowledge of the application of NIRSth in anesthesia and intensive care. We performed an analytical and descriptive review of the literature using the terms “near-infrared spectroscopy” combined with “anesthesia,” “anesthesiology,” “intensive care,” “critical care,” “sepsis,” “bleeding,” “hemorrhage,” “surgery,” and “trauma” with particular focus on all NIRS studies involving measurement at the thenar eminence. We found that NIRSth has been applied as clinical research tool to perform both static and dynamic assessment of StO2. Specifically, a vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischemia. StO2 changes during such induced ischemia-reperfusion yield information on oxygen consumption and microvasculatory reactivity. Some evidence suggests that StO2 during VOT can detect fluid responsiveness during surgery. In hypovolemic shock, StO2 can help to predict outcome, but not in septic shock. In contrast, NIRS parameters during VOT increase the diagnostic and prognostic accuracy in both hypovolemic and septic shock. Minimal data are available on static or dynamic StO2 used to guide therapy. Although the available data are promising, further studies are necessary before NIRSth can become part of routine clinical practice.
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Affiliation(s)
- Miklos Lipcsey
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
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Lima A, van Genderen ME, Klijn E, Bakker J, van Bommel J. Peripheral vasoconstriction influences thenar oxygen saturation as measured by near-infrared spectroscopy. Intensive Care Med 2012; 38:606-11. [PMID: 22349421 PMCID: PMC3307997 DOI: 10.1007/s00134-012-2486-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 01/03/2012] [Indexed: 01/04/2023]
Abstract
Purpose Near-infrared spectroscopy has been used as a noninvasive monitoring tool for tissue oxygen saturation (StO2) in acutely ill patients. This study aimed to investigate whether local vasoconstriction induced by body surface cooling significantly influences thenar StO2 as measured by InSpectra model 650. Methods Eight healthy individuals (age 26 ± 6 years) participated in the study. Using a cooling blanket, we aimed to cool the entire body surface to induce vasoconstriction in the skin without any changes in central temperature. Thenar StO2 was noninvasively measured during a 3-min vascular occlusion test using InSpectra model 650 with a 15-mm probe. Measurements were analyzed for resting StO2 values, rate of StO2 desaturation (RdecStO2, %/min), and rate of StO2 recovery (RincStO2, %/s) before, during, and after skin cooling. Measurements also included heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), stroke volume (SV), capillary refill time (CRT), forearm-to-fingertip skin-temperature gradient (Tskin-diff), perfusion index (PI), and tissue hemoglobin index (THI). Results In all subjects MAP, CO, SV, and core temperature did not change during the procedure. Skin cooling resulted in a significant decrease in StO2 from 82% (80–87) to 72% (70–77) (P < 0.05) and in RincStO2 from 3.0%/s (2.8–3.3) to 1.7%/s (1.1–2.0) (P < 0.05). Similar changes in CRT, Tskin-diff, and PI were also observed: from 2.5 s (2.0–3.0) to 8.5 s (7.2–11.0) (P < 0.05), from 1.0°C (−1.6–1.8) to 3.1°C (1.8–4.3) (P < 0.05), and from 10.0% (9.1–11.7) to 2.5% (2.0–3.8), respectively. The THI values did not change significantly. Conclusion Peripheral vasoconstriction due to body surface cooling could significantly influence noninvasive measurements of thenar StO2 using InSpectra model 650 with 15-mm probe spacing.
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Affiliation(s)
- Alexandre Lima
- Department of Intensive Care Adults, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Prognostic implications of tissue oxygen saturation in human septic shock. Intensive Care Med 2012; 38:592-7. [PMID: 22310873 DOI: 10.1007/s00134-012-2491-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 12/11/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE To analyze the prognostic value of tissue oxygen saturation (StO(2)) in septic shock patients with restored mean arterial pressure (MAP). METHODS This was a prospective observational study of patients admitted to the ICU in the early phase of septic shock, after restoration of MAP. Demographic data, severity score, hemodynamics, blood lactate, acid-base status, and StO(2) were measured at inclusion followed by a transient vascular occlusion test (VOT) to obtain the StO(2)-deoxygenation (DeOx) and StO(2)-reoxygenation (ReOx) rates. Sequential organ failure assessment (SOFA) score was measured at inclusion and after 24 h. RESULTS Thirty-three patients were studied. StO(2) was 76 ± 10%, DeOx -12.2 ± 4.2%/min, and ReOx 3.02 ± 1.70%/s. MAP showed a significant correlation with VOT-derived slopes (r = -0.4, p = 0.04 for DeOx; and r = 0.55, p < 0.01 for ReOx). After 24 h, 17 patients (52%) had improved SOFA scores. Patients who did not improve their SOFA showed less negative DeOx values at inclusion. The association between DeOx and SOFA evolution was not affected by MAP. Both DeOx and ReOx impairment correlated with longer ICU stay (r = 0.44, p = 0.05; and r = -0.43, p = 0.05, respectively). CONCLUSIONS In a population of septic shock patients with restored MAP, impaired DeOx was associated with no improvement in organ failures after 24 h. Decrements in DeOx and ReOx were associated with longer ICU stay. DeOx and ReOx were linked to MAP, and thus, their interpretation needs to be made relative to MAP.
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Sadaka F, Aggu-Sher R, Krause K, O'Brien J, Armbrecht ES, Taylor RW. The effect of red blood cell transfusion on tissue oxygenation and microcirculation in severe septic patients. Ann Intensive Care 2011; 1:46. [PMID: 22067279 PMCID: PMC3256106 DOI: 10.1186/2110-5820-1-46] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/08/2011] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Microcirculation plays a vital role in the development of multiple organ failure in severe sepsis. The effects of red blood cell (RBC) transfusions on these tissue oxygenation and microcirculation variables in early severe sepsis are not well defined. METHODS This is a prospective, observational study of patients with severe sepsis requiring RBC transfusions of one to two units of non-leukoreduced RBCs for a hemoglobin < 7.0, or for a hemoglobin between 7.0 and 9.0 with lactic acidosis or central venous oxygen saturation < 70%. This study took place in a 54-bed, medical-surgical intensive care unit of a university-affiliated hospital. Thenar tissue oxygen saturation was measured by using a tissue spectrometer on 21 patients, and a vaso-occlusive test was performed before and 1 hour after transfusion. The sublingual microcirculation was assessed with a Sidestream Dark Field device concomitantly on 11 of them. RESULTS RBC transfusion resulted in increase in hemoglobin (7.23 (± 0.87) to 8.75 (± 1.06) g/dl; p < 0.001). RBC transfusion did not globally affect near-infrared spectrometry (NIRS)-derived variables. However, percent change in muscle oxygen consumption was negatively correlated with baseline (r = - 0.679, p = 0.001). There was no statistically significant correlation between percent change in vascular reactivity and baseline (p = 0.275). There was a positive correlation between percent change in oxygen consumption and percent change in vascular reactivity (r = 0.442, p = 0.045). In the 11 patients, RBC transfusion did not globally affect NIRS-derived variables or SDF-derived variables. There was no statistically significant correlation between percent change in small vessel perfusion and baseline perfusion (r = -0.474, p = 0.141), between percent change in small vessel flow and baseline flow (r = -0.418, p = 0.201), or between percent change in small vessel perfusion and percent change in small vessel flow (r = 0.435, p = 0.182). CONCLUSIONS In a small sample population, muscle tissue oxygen consumption, microvascular reactivity and sublingual microcirculation were globally unaltered by RBC transfusion in severe septic patients. However, muscle oxygen consumption improved in patients with low baseline and deteriorated in patients with preserved baseline. Future research with larger samples is needed to further examine the association between RBC transfusion and outcomes of patients resuscitated early in severe sepsis, with an emphasis on elucidating the potential contribution of microvascular factors.
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Affiliation(s)
- Farid Sadaka
- St. John's Mercy Medical Center, St. Louis University, St. Louis, MO, USA
| | - Ravi Aggu-Sher
- St. John's Mercy Medical Center, St. Louis University, St. Louis, MO, USA
| | - Katie Krause
- St. John's Mercy Medical Center, St. Louis University, St. Louis, MO, USA
| | - Jacklyn O'Brien
- St. John's Mercy Medical Center, St. Louis University, St. Louis, MO, USA
| | - Eric S Armbrecht
- St. John's Mercy Medical Center, St. Louis University, St. Louis, MO, USA
| | - Robert W Taylor
- St. John's Mercy Medical Center, St. Louis University, St. Louis, MO, USA
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Thenar oxygen saturation and invasive oxygen delivery measurements in critically ill patients in early septic shock. Shock 2011; 35:456-9. [PMID: 21192279 DOI: 10.1097/shk.0b013e3182094ab9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This prospective study was aimed to test the hypothesis that tissue hemoglobin oxygen saturation (StO₂) measured noninvasively using near-infrared spectroscopy is a reliable indicator of global oxygen delivery (DO₂) measured invasively using a pulmonary artery catheter (PAC) in patients with septic shock. The study setting was a 26-bed medical-surgical intensive care unit at a university hospital. Subjects were adult patients in septic shock who required PAC hemodynamic monitoring for resuscitation. Interventions included transient ischemic challenge on the forearm. After blood pressure normalization, hemodynamic and oximetric PAC variables and, simultaneously, steady-state StO₂ and its changes from ischemic challenge (deoxygenation and reoxygenation rates) were measured. Fifteen patients were studied. All the patients had a mean arterial pressure above 65 mmHg. The DO₂ index (iDO₂) range in the studied population was 215 to 674 mL O₂/min per m. The mean mixed venous oxygen saturation value was 61% ± 10%, mean cardiac index was 3.4 ± 0.9 L/min per m, and blood lactate level was 4.6 ± 2.7 mmol/L. Steady-state StO₂ significantly correlated with iDO₂, arterial and venous O₂ content, and O₂ extraction ratio. A StO₂ cutoff value of 75% predicted iDO₂ below 450, with a sensitivity of 0.9 and a specificity of 0.9. In patients in septic shock and normalized MAP, low StO₂ reflects extremely low iDO₂. Steady-state StO₂ does not correlate with moderately low iDO₂, indicating poor sensitivity of StO₂ to rule out hypoperfusion.
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Should We Monitor ScVO(2) in Critically Ill Patients? Cardiol Res Pract 2011; 2012:370697. [PMID: 21941671 PMCID: PMC3177360 DOI: 10.1155/2012/370697] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/08/2011] [Accepted: 07/25/2011] [Indexed: 01/20/2023] Open
Abstract
Hemodynamic monitoring has become a real challenge in the intensive care unit. As an integrative parameter for oxygen supply/demand, venous oxygen saturation (SvO2) provided by pulmonary artery catheterization is one of the most popular parameters to assess the adequacy of cardiac output. However, technical limitations and potential iatrogenic complications constitute important limits for a widespread use. Regular central venous catheters coupled with a fiberoptic lumen for central venous oxygen saturation (ScvO2) monitoring have been proposed as a surrogate for SvO2 monitoring. The purpose of the present article is to review the physiological backgrounds of circulation, the pathophysiology of circulatory failure and subsequent venous oxygen saturation alterations, and finally the merits and the limits of the use of ScvO2 in different clinical situations.
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Abstract
BACKGROUND Near-infrared spectroscopy has moved from a research tool to a widely used clinical monitor in the critically ill pediatric patient over the last decade. The physiological and clinical evidence supporting this technology in practice is reviewed here. METHODOLOGY A search of MEDLINE and PubMed was conducted to find validation studies, controlled trials, and other reports of near-infrared spectroscopy use in children and adults in the clinical setting. Guidelines published by the American Heart Association, the American Academy of Pediatrics, and the International Liaison Committee on Resuscitation were reviewed including further review of references cited. RESULTS The biophysical properties of near-infrared spectroscopy devices allow measurement of capillary-venous oxyhemoglobin saturation in tissues a few centimeters beneath the surface sensor with validated accuracy in neonates, infants, and small patients. The biologic basis for the relationship of capillary-venous oxyhemoglobin saturation to cerebral injury has been described in animal and human studies. Normal ranges for cerebral and somatic capillary-venous oxyhemoglobin saturation have been described for normal newborns and infants and children with congenital heart disease and other disease states. The capillary-venous oxyhemoglobin saturation from both cerebral and somatic regions has been used to estimate mixed venous saturation and to predict biochemical shock, multiorgan dysfunction, and mortality in different populations. The relationship of cerebral capillary-venous oxyhemoglobin saturation to neuroimaging and functional assessment of outcome is limited but ongoing. Although there are numerous conflicting reports in small populations, expert opinion would suggest that special use may exist for near-infrared spectroscopy in patients with complex circulatory anatomy, with extremes of physiology, and in whom extended noninvasive monitoring is useful. CONCLUSIONS Class II, level B evidence supports the conclusion that near-infrared spectroscopy offers a favorable risk-benefit profile and can be effective and beneficial as a hemodynamic monitor for the care of critically patients.
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Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med 2010; 36:1813-25. [DOI: 10.1007/s00134-010-2005-3] [Citation(s) in RCA: 266] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 07/14/2010] [Indexed: 11/25/2022]
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Tissue hemoglobin index: a non-invasive optical measure of total tissue hemoglobin. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13 Suppl 5:S2. [PMID: 19951386 PMCID: PMC2786104 DOI: 10.1186/cc8000] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The tissue hemoglobin index (THI) is a hemoglobin signal strength metric provided on the InSpectra StO2 Tissue Oxygenation Monitor, Model 650. There is growing interest regarding the physiologic meaning of THI and whether a clinically useful correlation between THI and blood hemoglobin concentration exists. A series of in vitro and in vivo experiments was performed to evaluate whether THI has potential utility beyond its primary purpose of helping InSpectra device users optimally position a StO2 sensor over muscle tissue. METHODS The THI and tissue hemoglobin oxygen saturation (StO2) were measured using the InSpectra StO2 Tissue Oxygenation Monitor, Model 650, with a 15 mm optical sensor. A THI normal reference range was established in the thenar eminence (hand) for 434 nonhospitalized human volunteers. In 30 subjects, the thenar THI was also evaluated during 5-minute arterial and venous blood flow occlusions, and with blood volume exsanguination in the hand induced with an Esmarch bandage. In addition, correlation of the THI to blood total hemoglobin concentration (Hbt) was studied in five pigs whose Hbt was isovolumetrically diluted from 13 to 4 g/dl systemically and 0.5 g/dl locally in the hind limb. The sensitivity and specificity of the THI to measure tissue hemoglobin concentration (THC) were characterized in vitro using isolated blood tissue phantoms. RESULTS In human thenar tissue, the average THI was 14.1 +/- 1.6 (mean +/- standard deviation). The THI extrapolated to 100% blood volume exsanguination was 3.7 +/- 2.0 units presumably from myoglobin. On average, the THI increased 1.5 +/- 1.0 units with venous occlusion and decreased 4.0 +/- 2.0 units with arterial occlusion. In porcine hind limbs, the THI weakly correlated with Hbt (r2 = 0.26) while DeltaTHI during venous occlusion had a stronger correlation (r2 = 0.62). In vitro tests indicated that THI strongly correlated (r2 > 0.99) to phantom THC and was insensitive to StO2 changes. CONCLUSIONS Steady-state THI values do not reliably indicate Hbt. The THI is a reproducible quantitative index for THC, and THI trends can discriminate between arterial or venous blood flow occlusions. The THI magnitude permits the estimation of myoglobin's contribution to StO2.
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