Muscle oxygenation as an indicator of shock severity in patients with suspected severe sepsis or septic shock

Schenkman, Kenneth A.; Carlbom, David; Bulger, Eileen M.; Ciesielski, Wayne A.; Fisk, Dana M.; Sheehan, Kellie; Asplund, Karin M.; Shaver, Jeremy M.; Arakaki, Lorilee S. L.

doi:10.1371/journal.pone.0182351

Cited by 10 publications

(10 citation statements)

References 26 publications

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“…Our findings are consistent with previous studies showing that peripheral blood flow variables may be altered in different experimental and clinical shock conditions [6,33,34]. In this regard, a recent study with adult patients presenting to the ED with suspected sepsis diagnosis, used a similar noninvasive optical device to measure the muscle oxygenation (MOx) and found that MOx could stratify patients in mild and moderate shock, defined by degrees of systemic hemodynamic variables and lactate levels [35]. Our study expands these previous observations demonstrating that changes in NIRS-derived variables assessed early in a mixed ICU population can detect the presence of shock.…”

Section: Discussionsupporting

confidence: 91%

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Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods

Filho

Chaves

Assunção

et al. 2019

J Clin Monit Comput

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Microvascular dysfunction has been associated with adverse outcomes in critically ill patients, and the current concept of hemodynamic incoherence has gained attention. Our objective was to perform a comprehensive analysis of microcirculatory perfusion parameters and to investigate the best variables that could discriminate patients with and without circulatory shock during early intensive care unit (ICU) admission. This prospective observational study comprised a sample of 40 adult patients with and without circulatory shock (n = 20, each) admitted to the ICU within 24 h. Peripheral clinical [capillary refill time (CRT), peripheral perfusion index (PPI), skin-temperature gradient (Tskin-diff)] and laboratory [arterial lactate and base excess (BE)] perfusion parameters, in addition to near-infrared spectroscopy (NIRS)-derived variables were simultaneously assessed. While lactate, BE, CRT, PPI and Tskin-diff did not differ significantly between the groups, shock patients had lower baseline tissue oxygen saturation (StO 2 ) [81 (76-83) % vs. 86 (76-90) %, p = 0.044], lower StO 2 min [50 (47-57) % vs. 55 (53-65) %, p = 0.038] and lower StO 2 max [87 (80-92) % vs. 93 (90-95) %, p = 0.017] than patients without shock. Additionally, dynamic NIRS variables [recovery time (r = 0.56, p = 0.010), descending slope (r = − 0.44, p = 0.05) and ascending slope (r = − 0.54, p = 0.014)] and not static variable [baseline StO 2 (r = − 0.24, p = 0.28)] exhibited a significant correlation with the administered dose of norepinephrine. In our study with critically ill patients assessed within the first twenty-four hours of ICU admission, among the perfusion parameters, only NIRS-derived parameters could discriminate patients with and without shock.

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Section: Discussionsupporting

confidence: 91%

“…Compared with other techniques, the advantages of NIRS are its noninvasiveness, real-time continuous monitoring, with a relatively inexpensive and small device that is easy to use [35]. However, the utility of NIRS in the management of critically ill patients is still a matter of debate.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods

Filho

Chaves

Assunção

et al. 2019

J Clin Monit Comput

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“…Several non‐invasive monitoring techniques measuring tissue oxygenation or cardiac output have been investigated as tools for identifying patients at risk of adverse outcome but none have been extensively validated to date. Dynamic monitoring and trends analysis rather than static SIRS thresholds in the ED may help identify high risk patients prior to visible clinical deterioration .…”

Section: Risk Stratification For Adverse Outcomesmentioning

confidence: 99%

“…The concept of generating computational sepsis biomarkers combining continuous physiological data coupled with machine learning and data mining methods presents unique opportunities for the future. 69 Several non-invasive monitoring techniques measuring tissue oxygenation 70,71 or cardiac output 72 have been investigated as tools for identifying patients at risk of adverse outcome but none have been extensively validated to date. Dynamic monitoring and trends analysis rather than static SIRS thresholds in the ED may help identify high risk patients prior to visible clinical deterioration.…”

Section: Monitoring Of Patients With Sepsis (In Ed and Beyond)mentioning

confidence: 99%

Review article: Sepsis in the emergency department – Part 2: Investigations and monitoring

Shetty

Macdonald

Keijzers

et al. 2018

Emerg Medicine Australasia

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Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials. Routine laboratory investigations such as creatinine, bilirubin, platelet count and lactate are now critical elements in the diagnosis of sepsis and septic shock. With no biomarker sufficiently validated to rule out bacterial infection in the ED, there remains substantial interest in biomarkers representing various pathogenic pathways. New technologies for screening multiple genes and proteins are identifying unique network 'signatures' of clinical interest. Other future directions include rapid detection of bacterial DNA in blood, genes for antibiotic resistance and EMR-based computational biomarkers that collate multiple information sources. Reliable, cost-effective tests, validated in the ED to promptly and accurately identify sepsis, and to guide initial antibiotic choices, are important goals of current research efforts.

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“…Studies have revealed a good correlation between tissue oxygen saturation monitoring and clinical evaluation of sepsis or septic shock [14][15].…”

Section: Introductionmentioning

confidence: 99%

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

Feng

Huang

et al. 2020

Preprint

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Background Patients with septic shock are prone to have impaired cerebral autoregulation and to have an imbalance in cerebral oxygen metabolism. Transcranial doppler (TCD) and tissue oxygen saturation monitoring were performed to observe the changes in cerebral hemodynamic indices of the middle cerebral artery, and in cerebral and peripheral tissue oxygen saturation (StO 2 ) to identify risk factors for sepsis-associated delirium (SAD). Methods Patients with septic shock that were admitted to the Department of Critical Care Medicine of Xiangya Hospital of Central South University from May 2018 to March 2019 were prospectively enrolled, which were divided into an SAD group and a non-SAD group according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Both groups were compared with respect to patient characteristics, blood gas analysis indexes, organ function indicators, cerebral hemodynamic index, cerebrovascular automatic regulation function (transient hyperemia response rate, THRR index), the changes in regional cerebral oxygen saturation, and peripheral tissue oxygen saturation. Results The incidence of SAD was 39% (20/51). The overall 28-day mortality rate was 43% (22/51). Compared with the non-SAD group, patients in the SAD group required a longer mechanical ventilation time (5 days [95% confidence interval (CI) 2, 6] vs 1day [95% CI 1, 4], p=0.015) and ICU stay (9 days [95% CI 5, 20] vs 5 days [95% CI 3, 9], p=0.042) and has a higher 28-day mortality rate(65% vs 29%, p=0.011).Multivariate regression analysis showed that the THRR index (OR=5.770, 95% CI:1.222-27.255; p=0.027)and mean value of regional cerebral oxygen saturation (rSO 2 ) <55% (OR=3.864, 95% CI:1.026-14.550;p=0.046) were independent risk factors for SAD. Conclusions SAD has a high incidence in septic patients and is associated with poor prognosis. Our results provide a clinical basis for improving early detection and treatment of SAD.

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Muscle oxygenation as an indicator of shock severity in patients with suspected severe sepsis or septic shock

Cited by 10 publications

References 26 publications

Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods

Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods

Review article: Sepsis in the emergency department – Part 2: Investigations and monitoring

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

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