The association of near-infrared spectroscopy-derived tissue oxygenation measurements with sepsis syndromes, organ dysfunction and mortality in emergency department patients with sepsisReport as inadecuate




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Critical Care

, 15:R223

First Online: 22 September 2011Received: 10 April 2011Revised: 12 July 2011Accepted: 22 September 2011

Abstract

IntroductionNear-infrared spectroscopy NIRS noninvasively measures peripheral tissue oxygen saturation StO2. NIRS may be utilized along with a vascular occlusion test, in which limb blood flow is temporarily occluded and released, to quantify a tissue bed-s rate of oxygen exchange during ischemia and recovery. The objective of this study was to test the hypothesis that NIRS-derived StO2 measures StO2 initial, StO2 occlusion and StO2 recovery identify patients who are in shock and at increased risk of organ dysfunction Sequential Organ Failure Assessment SOFA score ≥ 2 at 24 hours and dying in the hospital.

MethodsThis prospective, observational study comprised a convenience sample of three cohorts of adult patients age > 17 years at three urban university emergency departments: 1 a septic shock cohort systolic blood pressure < 90 after fluid challenge; the -SHOCK- cohort, n = 58, 2 a sepsis without shock cohort the -SEPSIS- cohort, n = 60 and emergency department patients without infection n = 50. We measured the StO2 initial, StO2 occlusion and StO2 recovery slopes for all patients. Outcomes were sepsis syndrome severity, organ dysfunction SOFA score at 24 hours and in-hospital mortality.

ResultsAmong the 168 patients enrolled, mean initial StO2 was lower in the SHOCK cohort than in the SEPSIS cohort 76% vs 81%, with an impaired occlusion slope -10.2 and 5.2%-minute vs -13.1 and 4.4%-minute and an impaired recovery slope 2.4 and 1.6%-second vs 3.9 and 1.7%-second P < 0.001 for all. The recovery slope was well-correlated with SOFA score at 24 hours -0.35; P < 0.001, with a promising area under the curve AUC for mortality of 0.81. The occlusion slope correlation with SOFA score at 24 hours was 0.21 P < 0.02, with a fair mortality AUC of 0.70. The initial StO2 was significantly but less strongly correlated with SOFA score at 24 hours -0.18; P < 0.04, with a poor mortality AUC of 0.56.

ConclusionsNIRS measurements for the StO2 initial, StO2 occlusion and StO2 recovery slope were abnormal in patients with septic shock compared to sepsis patients. The recovery slope was most strongly associated with organ dysfunction and mortality. Further validation is warranted.

Trial registrationNCT01062685

AbbreviationsAUCarea under the curve

EDemergency department

NIRSnear infrared spectroscopy

ROCreceiver operating characteristic curve

SOFASequential Organ Failure Assessment

StO2tissue oxygen saturation.

Electronic supplementary materialThe online version of this article doi:10.1186-cc10463 contains supplementary material, which is available to authorized users.

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Author: Nathan I Shapiro - Ryan Arnold - Robert Sherwin - Jennifer O-Connor - Gabriel Najarro - Sam Singh - David Lundy - Teresa 

Source: https://link.springer.com/



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