Initial Low Oxygen Extraction Ratio Is Related to Severe Organ Dysfunction and High In-Hospital Mortality in Severe Sepsis and Septic Shock Patients

Park, Jong‐Su; Kim, Su Jin; Lee, Sung Woo; Lee, Eui Jung; Han, Kap Su; Moon, Sung Woo; Hong, Yun Sik

doi:10.1016/j.jemermed.2015.02.038

Cited by 25 publications

(11 citation statements)

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“…Similar to the SvO 2 , StO 2 reflects the balance between regional O 2 delivery and consumption [ 6 ]. If on one hand a lower StO 2 may result from a reduced O 2 supply, an apparently stable or even higher StO 2 may depend on a reduction in O 2 extraction and consumption, which may be associated with worse outcome [ 23 ]. However, those patients who exhibited at least one StO 2 < 70 % or >90 % during their ICU stay did not have a worse outcome.…”

Section: Discussionmentioning

confidence: 99%

Near-infrared spectroscopy for assessing tissue oxygenation and microvascular reactivity in critically ill patients: a prospective observational study

et al. 2016

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BackgroundImpaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of this study was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-infrared spectroscopy (NIRS) with a vascular occlusion test (VOT).MethodsProspective observational study in critically ill adults admitted to a 12-bed intensive care unit (ICU) of a University Hospital. NIRS with a VOT (using a 40 % tissue oxygen saturation (StO2) target) was applied daily until discharge from the ICU or death. A group of healthy volunteers were evaluated in a single session. During occlusion, StO2 downslope was measured separately for the first (downslope 1) and last part (downslope 2) of the desaturation curve. The difference between downslope 2 and 1 was calculated (delta-downslope). The upslope and area of the hyperaemic phase (receive operating characteristic (ROC) area under the curve (AUC) of StO2) were calculated, reflecting microvascular reactivity. Outcomes were ICU and 90-day mortality.ResultsPatients (n = 89) had altered downslopes and upslopes compared to healthy volunteers (n = 27). Mean delta-downslope was higher in ICU non-survivors (2.8 (0.4, 3.8) %/minute versus 0.4 (−0.8, 1.8) in survivors, p = 0.004) and discriminated 90-day mortality (ROC AUC 0.72 (95 % confidence interval 0.59, 0.84)). ICU non-survivors had lower mean upslope (141 (75, 193) %/minute versus 185 (143, 217) in survivors, p = 0.016) and AUC StO2 (7.9 (4.3, 12.6) versus 14.5 (11.2, 21.3), p = 0.001). Upslope and AUC StO2 on admission were significant although weak predictors of 90-day mortality (ROC AUC = 0.68 (0.54, 0.82) and 0.70 (0.58, 0.82), respectively). AUC StO2 ≤ 6.65 (1st quartile) on admission was independently associated with higher 90-day mortality (hazard ratio 7.964 (95 % CI 2.211, 28.686)). The lowest upslope in the ICU was independently associated with survival after ICU discharge (odds ratio 0.970 (95 % CI 0.945, 0.996)).ConclusionsIn critically ill patients, NIRS with a VOT enables identification of alterations in tissue oxygen extraction capacity and microvascular reactivity that can predict mortality.Trial registrationNCT02649088, www.clinicaltrials.gov, date of registration 23rd December 2015, retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1500-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Near-infrared spectroscopy for assessing tissue oxygenation and microvascular reactivity in critically ill patients: a prospective observational study

et al. 2016

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“…Furthermore, vatinoxan improved the O 2 ER, which describes the amount of oxygen removed from blood by tissues. The oxygen extraction ratio increases in situations such as tissue hypoxia and increased metabolic oxygen demand . Thus, improved O 2 ER probably reflects better tissue perfusion in horses receiving vatinoxan.…”

Section: Discussionmentioning

confidence: 99%

Effects of vatinoxan on cardiorespiratory function and gastrointestinal motility during constant‐rate medetomidine infusion in standing horses

Tapio

Raekallio

Mykkänen

et al. 2019

Equine Veterinary Journal

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Summary Background Medetomidine suppresses cardiovascular function and reduces gastrointestinal motility in horses mainly through peripheral α2‐adrenoceptors. Vatinoxan, a peripheral α2‐antagonist, has been shown experimentally to alleviate the adverse effects of some α2‐agonists in horses. However, vatinoxan has not been investigated during constant‐rate infusion (CRI) of medetomidine in standing horses. Objectives To evaluate effects of vatinoxan on cardiovascular function, gastrointestinal motility and on sedation level during CRI of medetomidine. Study design Experimental, randomised, blinded, cross‐over study. Methods Six healthy horses were given medetomidine hydrochloride, 7 μg/kg i.v., without (MED) and with (MED+V) vatinoxan hydrochloride, 140 μg/kg i.v., followed by CRI of medetomidine at 3.5 μg/kg/h for 60 min. Cardiorespiratory variables were recorded and borborygmi and sedation levels were scored for 120 min. Plasma drug concentrations were measured. The data were analysed using repeated measures ANCOVA and paired t‐tests as appropriate. Results Initially heart rate (HR) was significantly lower and mean arterial blood pressure (MAP) significantly higher with MED compared with MED+V. For example at 10 min HR (mean ± s.d.) was 26 ± 2 and 31 ± 5 beats/minute (P = 0.04) and MAP 129 ± 15 and 103 ± 13 mmHg (P<0.001) respectively. At 10 min, cardiac index was lower (P = 0.02) and systemic vascular resistance higher (P = 0.001) with MED than with MED+V. Borborygmi were reduced after MED; this effect was attenuated by vatinoxan (P<0.001). All horses were sedated with medetomidine, but the mean sedation scores were reduced with MED+V until 20 min (6.8 ± 0.8 and 4.5 ± 1.5 with MED and MED+V, respectively, at 10 min, P = 0.001). Plasma concentration of dexmedetomidine was significantly lower in the presence of vatinoxan (P = 0.01). Main limitations Experimental study with healthy, unstimulated animals. Conclusions Vatinoxan administered i.v. with a loading dose of medetomidine improved cardiovascular function and gastrointestinal motility during medetomidine CRI in healthy horses. Sedation was slightly yet significantly reduced during the first 20 min.. The Summary is available in Portuguese – see Supporting Information

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“…A significant proportion of patients in the ICU present with multiple comorbidities (i.e., shock, sepsis, trauma, and surgery) which place them at higher risk of MOF. An imbalance between oxygen supply and demand may cause hypoxia, initiating a series of cellular derangements that include lactic acid production, microcirculatory and mitochondrial dysfunction, all of which may drive organ failure in critical patients [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, a highly frequent component of AKI is a reduction in renal blood flow, which, when restored, may trigger ischemia-reperfusion injury (IRI) [ 1 , 6 ]. IRI in the kidney has been shown to increase levels of ROS, altering mitochondrial pathways, leading to ATP depletion, cytosolic calcium release, caspase activation, and oxidative-damage-targeting lipids, DNA and proteins, ultimately driving cell death.…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury and Organ Dysfunction: What Is the Role of Uremic Toxins?

Prado

Pazos-Pérez

Méndez-Landa

et al. 2021

Toxins

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Acute kidney injury (AKI), defined as an abrupt increase in serum creatinine, a reduced urinary output, or both, is experiencing considerable evolution in terms of our understanding of the pathophysiological mechanisms and its impact on other organs. Oxidative stress and reactive oxygen species (ROS) are main contributors to organ dysfunction in AKI, but they are not alone. The precise mechanisms behind multi-organ dysfunction are not yet fully accounted for. The building up of uremic toxins specific to AKI might be a plausible explanation for these disturbances. However, controversies have arisen around their effects in organs other than the kidney, because animal models usually depict AKI as a kidney-specific injury. Meanwhile, humans present AKI frequently in association with multi-organ failure (MOF). Until now, medium-molecular-weight molecules, such as inflammatory cytokines, have been proven to play a role in endothelial and epithelial injury, leading to increased permeability and capillary leakage, mainly in pulmonary and intestinal tissues.

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Initial Low Oxygen Extraction Ratio Is Related to Severe Organ Dysfunction and High In-Hospital Mortality in Severe Sepsis and Septic Shock Patients

Cited by 25 publications

References 14 publications

Near-infrared spectroscopy for assessing tissue oxygenation and microvascular reactivity in critically ill patients: a prospective observational study

Near-infrared spectroscopy for assessing tissue oxygenation and microvascular reactivity in critically ill patients: a prospective observational study

Effects of vatinoxan on cardiorespiratory function and gastrointestinal motility during constant‐rate medetomidine infusion in standing horses

Acute Kidney Injury and Organ Dysfunction: What Is the Role of Uremic Toxins?

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