Near-infrared spectroscopy during stagnant ischemia estimates central venous oxygen saturation and mixed venous oxygen saturation discrepancy in patients with severe left heart failure and additional sepsis/septic shock

Abstract

IntroductionDiscrepancies of 5-24% between superior vena cava oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) have been reported in patients with severe heart failure. Thenar muscle tissue oxygenation (StO2) measured with near-infrared spectroscopy (NIRS) during arterial occlusion testing decreases slower in sepsis/septic shock patients (lower StO2 deoxygenation rate). The StO2 deoxygenation rate is influenced by dobutamine. The aim of this study was to determine the relationship between the StO2 deoxygenation rate and the ScvO2-SvO2 discrepancy in patients with severe left heart failure and additional sepsis/septic shock treated with or without dobutamine.MethodsFifty-two patients with severe left heart failure due to primary heart disease with additional severe sepsis/septic shock were included. SvO2 and ScvO2 were compared to the thenar muscle StO2 before and during arterial occlusion.ResultsSvO2 correlated significantly with ScvO2 (Pearson correlation 0.659, P = 0.001), however, Bland Altman analysis showed a clinically important difference between both variables (ScvO2-SvO2 mean 72 ± 8%, ScvO2-SvO2 difference 9.4 ± 7.5%). The ScvO2-SvO2 difference correlated with plasma lactate (Pearson correlation 0.400, P = 0.003) and the StO2 deoxygenation rate (Pearson correlation 0.651, P = 0.001). In the group of patients treated with dobutamine, the ScvO2-SvO2 difference correlated with plasma lactate (Pearson correlation 0.389, P = 0.011) and the StO2 deoxygenation rate (Pearson correlation 0.777, P = 0.0001).ConclusionsIn patients with severe heart failure with additional severe sepsis/septic shock the ScvO2-SvO2 discrepancy presents a clinical problem. In these patients the skeletal muscle StO2 deoxygenation rate is inversely proportional to the difference between ScvO2 and SvO2; dobutamine does not influence this relationship. When using ScvO2 as a treatment goal, the NIRS measurement may prove to be a useful non-invasive diagnostic test to uncover patients with a normal ScvO2 but potentially an abnormally low SvO2.Trial RegistrationNCT00384644 ClinicalTrials.Gov.

Skeletal Muscle Oxygen Saturation (StO2) Measured by Near-Infrared Spectroscopy in the Critically Ill Patients

“…Some authors explored the correlation of StO 2 with parameters of global oxygenation, such as central venous oxygen saturation (ScvO 2 ) [51–55], demonstrating that low StO 2 values (i.e., StO 2 < 75% when measured on the thenar eminence) specifically predict extremely low ScvO 2 values [15, 51, 52]. However, the sensitivity of StO 2 variables to detect these situations of global hypoperfusion is considerably low, and therefore the absolute StO 2 value has been proposed as an initial tool to rapidly and noninvasively detect hypoperfusion states, but only while other more sensitive variables are not available [23, 51, 52].…”

Near infrared spectroscopy for evaluation of skeletal muscle tissue oxygenation in different types of shock

“…(57) The hypothesis that the slower skeletal muscle StO2 deoxygenation rate (more disturbed tissue oxygen extraction) is proportional to the ScvO2-SvO2 difference in patients with severe heart failure with additional sepsis/septic shock, was confirmed by our more recent study. (58) We showed that these patients had a clinically considerable ScvO2-SvO2 discrepancy. Monitoring ScvO2 is a simpler and cheaper assessment of global DO2 to oxygen consumption ratio, but its use as a treatment goal in patients with severe heart failure, with additional sepsis/septic shock, is questionable.…”

Oxyneurography: A new technique for the measurement of nerve oxygenation

“…NIRS was introduced in the 1970s by Jöbsis2 to study cerebral and myocardial blood flow. The technique is currently used in clinical testing to investigate muscle,3 breast tumors,4, 5 cerebral tissue,6, 7 peripheral and cerebrovascular disease,8, 9 and congestive heart failure 10. The advantages of the NIRS technique are its non‐invasiveness, ease of application, and low signal–noise during exercise.…”