Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock

Abstract

After initial septic shock resuscitation, StO(2) measured around the knee is a strong predictive factor of 14-day mortality.

Is the macrocirculation really dissociated from the microcirculation in septic shock?

“…The cause/effect relationship between these alterations is complex and not completely understood. In progressive septic shock with clear systemic hypoperfusion criteria, as represented by an abnormal skin perfusion or mottling [11], it is safe to assume the presence of severe underlying microcirculatory alterations. However, the treatment strategy is not modified, since the first major clinical responsibility is to rule out whether these abnormalities, either at the systemic or microcirculatory level, are still flow-sensitive.…”

Exploration of skin perfusion in cirrhotic patients with septic shock

“…Seventy-five patients with septic shock without liver cirrhosis were admitted to ICU during the same period and were included in two previously published studies, assessing the prognosis value of the mottling score and the StO 2 [11,15]. Data on these patients were used as controls for assessment of the mottling score and StO 2 evolution during the first 24 h after admission to ICU.…”

“…Macrocirculation was assessed using mean arterial pressure, heart rate, central venous pressure and the cardiac output (measured by trans-thoracic echocardiography). Microcirculatory dysfunction and organ perfusion were assessed by arterial lactate levels, lactate clearance, urinary output, ScvO 2 , mottling score [11], and thenar and knee StO 2 [15]. The mottling score was previously described and validated in patients with septic shock without cirrhosis [11].…”

“…Leone et al showed that StO 2 measured in the thenar eminence was a prognostic factor in septic patients after initial resuscitation [14]. Our group recently assessed StO 2 measured in the knee area, where mottling preferentially develops, and showed that 6 h after the septic shock onset, knee StO 2 was a stronger predictor of 14-day death than thenar StO 2 [15].…”

Pourquoi ne fais-je pas de monitoring hémodynamique ?

“…Rappelons qu'au cours du choc septique, l'index cardiaque n'a pas été identifié comme un facteur pronostique. Autrement dit, dans de nombreux essais, l'index cardiaque n'était pas différent entre les survivants et les non-survivants à J14 [29][30][31] ou J28 [32]. Même au cours du choc cardiogénique, l'index cardiaque n'apparaît pas non plus comme un facteur pronostique ; par contre, les paramètres d'hypoperfusion tissulaire (comme l'oligurie, l'altération de la conscience ou les extrémités froides) le sont [33].…”