Dynamic Near-Infrared Spectroscopy Measurements in Patients With Severe Sepsis

Abstract

This study evaluated near-infrared spectroscopy (NIRS)-derived measurements in hemodynamically stable patients with severe sepsis, as compared with similar measurements in healthy age-matched volunteers. Prospective, preliminary, observational study in a surgical intensive care unit and clinical research center at a university health center. We enrolled 10 patients with severe sepsis and 9 healthy age-matched volunteers. For patients with severe sepsis, we obtained pulmonary artery catheter and laboratory values three times daily for 3 days and oxygen consumption values via metabolic cart once daily for 3 days. For healthy volunteers, we obtained all noninvasive measurements during a single session. We found lower values in patients with severe sepsis (versus healthy volunteers), in tissue oxygen saturation (StO2), in the StO2 recovery slope, in the tissue hemoglobin index, and in the total tissue hemoglobin increase on venous occlusion. Patients with severe sepsis had longer StO2 recovery times and lower NIRS-derived local oxygen consumption values versus healthy volunteers. In our preliminary study, NIRS provides a noninvasive continuous method to evaluate peripheral tissue oxygen metabolism in hemodynamically stable patients with severe sepsis. Further research is needed to demonstrate whether these values apply to broader populations of patients with systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock.

Microcirculatory abnormalities in patients with severe influenza A (H1N1) infection

“…14,15,25,26 In our small series of patients, the microcirculation was moderately to severely compromised, in line with previous studies of patients with severe sepsis and septic shock. 14,22,23 For example, Creteur et al 22 reported NIRS ascending slope values of 2.3 ± 1.3%Ásec -1 in patients with septic shock, a value similar to our findings. Skarda et al 23 found NirVO 2 values of 97 ± 36 U, again in the range seen in our patients.…”

“…14,22,23 For example, Creteur et al 22 reported NIRS ascending slope values of 2.3 ± 1.3%Ásec -1 in patients with septic shock, a value similar to our findings. Skarda et al 23 found NirVO 2 values of 97 ± 36 U, again in the range seen in our patients. In addition, the proportion of perfused small vessels assessed by SDF imaging was 65% (53.1-68.9%) in patients with septic shock, similar to that reported by Sakr et al 14 As in sepsis, we observed a significant correlation between the microcirculatory abnormalities detected by the two methods (SDF imaging and NIRS) and the severity of disease as assessed by SOFA and APACHE II scores.…”

“…Finally, the difference between the maximal StO 2 and THI following the reperfusion and the baseline values of these variables were computed as DStO 2 and DTHI. 23 …”

Near-Infrared Spectroscopy in the Monitoring of Adult Traumatic Brain Injury: A Review

“…In clinical observations involving patients in severe cardiovascular compromise, the THI (alongside other NIRS based parameters) has been demonstrated to be an effective reflection of tissue perfusion blood volume when correlated with established invasive parameters. 26,27 Evidence for the Use of NIRS in TBI As discussed earlier in this review, currently the most popular uses for cerebral NIRS in adult clinical practice are within the context of cardiac and vascular surgery, in which close monitoring of cerebral perfusion is required during periods of cardiopulmonary bypass. These situations most frequently involve normal cerebral anatomy and autoregulation.…”

Red Blood Cell Transfusion in Sepsis: A Review

“…The specific effect of transfusion was not evaluated in this study, however, as the investigation was designed to assess the overall bundle rather than its component parts. Using Near Infrared Spectroscopy (NIRS) or Sidestream Dark Field (SDF), several investigators have reported that microcirculation is markedly altered in sepsis, that these alterations are more severe in nonsurvivors than in survivors, that persistent microvascular alterations are associated with development of multiple organ failure and death, and that microvascular alterations are the most sensitive and specific predictor of outcome in septic patients [91][92][93][94][95][96][97].…”