Changes in muscle tissue oxygenation during stagnant ischemia in septic patients

Parežnik, Roman; Knezevic, Rajko; Voga, Gorazd; Podbregar, Matej

doi:10.1007/s00134-005-2841-8

Cited by 124 publications

(92 citation statements)

References 18 publications

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“…In particular, the descending slope of StO 2 reflects oxygen diffusion from microvessels to cells during stagnant ischemia (i.e. when metabolic demand and oxygen consumption are equivalent) [15]. Ascending slope of StO 2 represents the reperfusion phase after an ischemic challenge and depends on the ratio between oxygen delivery and oxygen consumption (DO 2 /VO 2 ), microvascular recruitment, and compliance.…”

Section: Near-infrared Spectroscopymentioning

confidence: 99%

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

Tujjar

Gaudio

Tofani

et al. 2016

J Clin Monit Comput

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Near-infrared spectroscopy (NIRS) has been used to detect in vivo microvascular alterations by means of a vascular occlusion test. We sought to analyse by NIRS the microcirculatory profile of patients undergoing prolonged tourniquet-induced bloodless condition for extremity surgery, and compare the results with time of ischemia and comorbidities. We conducted a prospective observational study on 42 patients undergoing upper limb surgery. Regional anaesthesia was achieved and ischemia was induced by a tourniquet cuffed at 250 mmHg. The probe of a NIRS monitor (InSpectra 325, Hutchiston, USA) was placed on the brachial muscle, and muscle oxygen saturation (StO 2 ) was recorded continuously before anaesthesia, during and after surgery. The following variables were recorded: baseline StO 2 , StO 2 desaturation slope during occlusion (dSlope, units/s), resaturation rate following ischemia (RR, units/s), hyperaemic peak (peak, units), and duration of the hyperaemic period following ischemia (hyperaemic time, s). Values of dSlope were similar among all patients. RR and hyperaemic time were significantly correlated with the duration of ischemia, but not with comorbidities [p = 0.007 CI (-35.64 to -13.1), and p \ 0.001 CI (0.049-0.159), respectively]. Grouping patients by duration of ischemia (30, 60, or 90 min), we found a significant decrease in RR after 60 and 90 min (p \ 0.001 and p = 0.03, respectively). Hyperaemic peak was lower in the 90 min group (83.9 ± 6.8 vs.91.2 ± 5.7 %, p = 0.02) whereas the hyperaemic time was significantly increased (595 ± 136 vs. 429 ± 107 min, p \ 0.001). Alterations of skeletal muscle microcirculation were correlated with the duration of ischemia, but not with comorbidities. We observed an initial impairment of the microcirculatory recovery at 90 min of ischemia.

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Section: Near-infrared Spectroscopymentioning

confidence: 99%

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

Tujjar

Gaudio

Tofani

et al. 2016

J Clin Monit Comput

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“…The observation that their baseline values of tissue saturation in muscles are reduced [39,40] has not been confirmed in other studies [41,42]. Pareznik and co-workers [42] have demonstrated that the rate of tissue saturation decreases during the flow arrest in the limb was lower in septic shock patients than in the remaining patients, which was explained by impaired abilities of oxygen extraction and its consumption in tissues. In survivors, the restoration of the rate of saturation decreases during the VOT was observed.…”

Section: Use Of Oximetry For Evaluation Of Microcirculation and Oxygementioning

confidence: 90%

Tissue oximetry in anaesthesia and intensive care

Biedrzycka¹,

Lango²

2016

Anaesthesiol Intensive Ther

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Conventional monitoring during surgery and intensive care is not sufficiently sensitive to detect acute changes in vital organs perfusion, while its good quality is critical for maintaining their function. Disturbed vital organ perfusion may lead to the development of postoperative complications, including neurological sequel and renal failure. Nearinfra-red spectroscopy (NIRS) represents one of up-to-date techniques of patient monitoring which is commonly used for the assessment of brain oximetry in thoracic aorta surgery, and -increasingly more often -in open-heart surgery. Algorithms for maintaining adequate brain saturation may result in a decrease of neurological complications and cognitive dysfunction following cardiac surgery. The assessment of kidney and visceral perfusion with tissue oximetry is gaining increasing interest during pediatric cardiac surgery. Attempts at decreasing complications by the use of brain oximetry during carotid endarterectomy, as well as thoracic and abdominal surgery demonstrated conflicting results. In recent years NIRS technique was proposed as a tool for muscle perfusion assessment under short term ischemia and reperfusion, referred to as vascular occlusion test (VOT). This monitoring extension allows for the identification of early disturbances in tissue perfusion. Results of recent studies utilizing VOT suggest that the muscle saturation decrease rate is reduced in septic shock patients, while decreased speed of saturation recovery on reperfusion is related to disturbed microcirculation. Being non-invasive and feasible technique, NIRS offers an improvement of preoperative risk assessment in cardiac surgery and promises more comprehensive intraoperative and ICU patient monitoring allowing for better outcome.

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“…There is mounting evidence about the microcirculatory derangement in the critically ill mainly in septic shock [53]. Due to the endothelial dysfunction [54], glycocalyx layer degradation [55] and pathological cell-endothelial interactions [56], a condition termed 'microcirculatory shock' can develop, which can be defined as 'the failure of microcirculation to support tissue perfusion and oxygenation, despite normal systemic hemodynamics' [57]. Under physiological circumstances, a dens capillary system forms the microcirculation, with low heterogeneity in perfusion.…”

Section: Microcirculationmentioning

confidence: 99%

Multimodal individualized concept of hemodynamic monitoring

Molnár

Szabó

Németh

2017

Current Opinion in Anaesthesiology

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Purpose of reviewTo discuss the pathophysiological rationale of advanced hemodynamic monitoring in the critically ill and also to highlight the importance of a multimodal, individualized approach. Recent findingsThere are several clinical studies and animal experiments evaluating, which hemodynamic endpoint should be the best target during fluid management. Recent systematic reviews and meta-analyses also investigated the effects of advanced hemodynamic endpoints targeted hemodynamic management on outcome mainly in high-risk surgical patients. Although most of these studies report positive results, this knowledge does not seem to affect our everyday practice. According to large international surveys, most physicians still rely on inappropriate indices. One of the reasons could be that target values applied in these studies can be misleading in the individual patient. Therefore, we describe the concept of an individualized approach, in which normalizing the components of oxygen delivery are put in the context of the patients' individual response by evaluating components of oxygen consumption, and organ perfusion. SummaryAdvanced hemodynamic monitoring-based management provides a number of benefits, which could be better tailored for the patients' actual needs by putting this into a multimodal, individualized approach.

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Changes in muscle tissue oxygenation during stagnant ischemia in septic patients

Cited by 124 publications

References 18 publications

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

Tissue oximetry in anaesthesia and intensive care

Multimodal individualized concept of hemodynamic monitoring

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