Peripheral Muscle Near-Infrared Spectroscopy Variables are Altered Early in Septic Shock

Orbegozo, Diego; Su, Fuhong; Xie, Keliang; Rahmania, Lokmane; Taccone, Fabio Silvio; Backer, Daniel De; Vincent, Jean‐Louis; Créteur, Jacques

doi:10.1097/shk.0000000000000991

Cited by 15 publications

(16 citation statements)

References 36 publications

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“…New techniques such as NIRS and video-microscopy were rarely used. They are probably considered as research tools [31] , [32] and one may imagine they were not available in many ICUs from many countries.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Michard

Malbrain

Martin

et al. 2020

Anaesthesia Critical Care & Pain Medicine

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Purpose To survey haemodynamic monitoring and management practices in intensive care patients with the coronavirus disease 2019 (COVID-19). Methods A questionnaire was shared on social networks or via email by the authors and by Anaesthesia and/or Critical Care societies from France, Switzerland, Belgium, Brazil, and Portugal. Intensivists and anaesthetists involved in COVID-19 ICU care were invited to answer 14 questions about haemodynamic monitoring and management. Results Globally, 1000 questionnaires were available for analysis. Responses came mainly from Europe (n = 460) and America (n = 434). According to a majority of respondents, COVID-19 ICU patients frequently or very frequently received continuous vasopressor support (56%) and had an echocardiography performed (54%). Echocardiography revealed a normal cardiac function, a hyperdynamic state (43%), hypovolaemia (22%), a left ventricular dysfunction (21%) and a right ventricular dilation (20%). Fluid responsiveness was frequently assessed (84%), mainly using echo (62%), and cardiac output was measured in 69%, mostly with echo as well (53%). Venous oxygen saturation was frequently measured (79%), mostly from a CVC blood sample (94%). Tissue perfusion was assessed biologically (93%) and clinically (63%). Pulmonary oedema was detected and quantified mainly using echo (67%) and chest X-ray (61%). Conclusion Our survey confirms that vasopressor support is not uncommon in COVID-19 ICU patients and suggests that different haemodynamic phenotypes may be observed. Ultrasounds were used by many respondents, to assess cardiac function but also to predict fluid responsiveness and quantify pulmonary oedema. Although we observed regional differences, current international guidelines were followed by most respondents.

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Section: Discussionmentioning

confidence: 99%

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Michard

Malbrain

Martin

et al. 2020

Anaesthesia Critical Care & Pain Medicine

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“…Many studies on StO 2 changes during the VOT also deal with other concepts such as association with flow-mediated dilatation [3], strategies to protect from prolonged forearm ischemia [4], and differences in vascular function between the DOI: 10.1159/000510072 trained and untrained limbs [5]. StO 2 changes during the VOT can be used for microcirculation monitoring in healthy patients, aged population [6], patients with obesity [7], patients with coronary artery disease or high risks of cardiovascular diseases [8,9], patients who undergo a cardiopulmonary bypass [10], and patients with critical illnesses such as sepsis [11,12].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Different Near-Infrared Spectroscopy Devices for Assessing Tissue Oxygenation with a Vascular Occlusion Test in Healthy Volunteers

Chung

Jang

et al. 2020

J Vasc Res

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Near-infrared spectroscopy devices can measure peripheral tissue oxygen saturation (StO 2). This study aims to compare StO 2 using INVOS ® and different O3™ settings (O3 25:75 and O3 30:70). Twenty adults were recruited. INVOS ® and O3™ probes were placed simultaneously on 1 side of forearm. After baseline measurement, the vascular occlusion test was initiated. The baseline value, rate of deoxygenation and reoxygenation, minimum and peak StO 2 , and time from cuff release to peak value were measured. The parameters were compared using ANOVA and Kruskal-Wallis tests. Bonferroni's correction and Mann-Whitney pairwise comparison were used for post hoc analysis. The agreement between StO 2 of devices was evaluated using Bland-Altman plots. IN-VOS ® baseline value was higher (79.7 ± 6.4%) than that of O3 25:75 and O3 30:70 (62.4 ± 6.0% and 63.7 ± 5.5%, respectively, p < 0.001). The deoxygenation rate was higher with IN-VOS ® (10.6 ± 2.1%/min) than with O3 25:75 and O3 30:70 (8.4 ± 2.2%/min, p = 0.006 and 7.5 ± 2.1%/min, p < 0.001). The minimum and peak StO 2 were higher with INVOS ®. No significant difference in the reoxygenation rate was found between the devices and settings. The time to reach peak after cuff deflation was faster with INVOS ® (both p < 0.001). Other parameters were similar. There were no differences between the different O3™ settings. There were differences in StO 2 measurements between the devices, and these devices should not be interchanged. Differences were not observed between O3™ device settings.

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“…During acute inflammation, both conduit artery vasodilatory capacity, as measured by flow-mediated dilation (FMD) of the brachial artery (16,22), and resistance artery reactivity to vasodilatory drugs (6,21,31) are reduced in young adults. Microvascular reactivity is also reduced during severe inflammation, such as sepsis (10,29); however, no previous studies have investigated the effects of modest acute inflammation, similar to those during bouts of illness, on the microvasculature. Investigating each segment of the arterial tree would provide insight into whether the vascular dysfunction is uniform throughout the arterial tree or if a segment, such as the microvasculature, is able to maintain functionality despite reductions in upstream vascular function.…”

Section: Introductionmentioning

confidence: 99%

No effect of fitness on brachial or forearm vascular function during acute inflammation in young adults

Schroeder

Hilgenkamp

Lefferts

et al. 2019

American Journal of Physiology-Regulatory, Integrative and Comp

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Acute inflammation is associated with increased risk of cardiovascular events and impaired vasodilatory capacity. Vasodilatory capacity can be measured in different segments of the arterial tree; however, it is unknown if the effects of acute inflammation are vascular segment-specific or if inflammation-induced dysfunction can be attenuated by factors that modulate cardiovascular risk, such as high cardiorespiratory fitness. The purpose of this study was to determine the effect of acute inflammation and fitness on conduit artery, resistance artery, and microvascular function in healthy, young adults. Vascular function was assessed at baseline and 24 h after a typhoid vaccination in 11 low-fit (5 male, 24 yr of age, 34.5 ± 2.9 ml·kg−1·min−1 peak O2 uptake (V̇o2peak)] and 12 high-fit (7 male, 27 yr of age, 56.4 ± 9.7 ml·kg−1·min−1 V̇o2peak) young adults. Vascular assessments included flow-mediated dilation (FMD) of the brachial artery, forearm reactive hyperemia (RH) via venous occlusion plethysmography, and near-infrared spectroscopy (NIRS) during a 5-min arterial occlusion. Acute inflammation was evident with increases in IL-6 and C-reactive protein ( P < 0.01), and mean arterial pressure did not change ( P = 0.33). FMD was lower in the high-fit group, yet it was reduced in both groups at 24 h, even after controlling for shear ( P < 0.05). No effect of acute inflammation was observed for RH or NIRS ( P > 0.05). Acute inflammation had nonuniform effects on vascular function throughout the arterial tree in young adults, and fitness did not alter the vascular response. This suggests that cardiorespiratory fitness may not protect the vasculature during acute inflammation in young adults in the absence of age- or disease-related decline in vascular function.

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Peripheral Muscle Near-Infrared Spectroscopy Variables are Altered Early in Septic Shock

Abstract: The muscle NIRS Asc slope after a VOT is altered earlier than global markers of tissue hypoperfusion during sepsis. This simple noninvasive test can detect early changes in peripheral perfusion in sepsis.

Cited by 15 publications

References 36 publications

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Evaluation of Different Near-Infrared Spectroscopy Devices for Assessing Tissue Oxygenation with a Vascular Occlusion Test in Healthy Volunteers

No effect of fitness on brachial or forearm vascular function during acute inflammation in young adults

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