Skeletal muscle oxygen saturation estimates mixed venous oxygen saturation in patients with severe left heart failure

Podbregar, Matej; Možina, Hugon

doi:10.1186/cc5433

Cited by 19 publications

(27 citation statements)

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“…[19][20][21] This effect has also been observed by others. 22 These differences at lower ScVO 2 raise the possibility that adjunct measurement of StO 2 may be prognostic or have a role in the management of this patient subset.…”

Section: Discussionmentioning

confidence: 97%

Tissue Oxygenation Does Not Predict Central Venous Oxygenation in Emergency Department Patients With Severe Sepsis and Septic Shock

Napoli

Machan²,

Forcada³

et al. 2010

Academic Emergency Medicine

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Objectives: This study sought to determine whether tissue oxygenation (StO 2 ) could be used as a surrogate for central venous oxygenation (ScVO 2 ) in early goal-directed therapy (EGDT). Methods:The study enrolled a prospective convenience sample of patients aged ‡18 years with sepsis and systolic blood pressure <90 mm Hg after 2 L of normal saline or lactate >4 mmol, who received a continuous central venous oximetry catheter. StO 2 and ScVO 2 were measured at 15-minute intervals. Data were analyzed using a random coefficients model, correlations, and Bland-Altman plots.Results: There were 284 measurements in 40 patients. While a statistically significant relationship existed between StO 2 and ScVO 2 (F(1,37) = 10.23, p = 0.002), StO 2 appears to systematically overestimate at lower ScVO 2 and underestimate at higher ScVO 2 . This was reflected in the fixed effect slope of 0.49 (95% confidence interval [CI] = 0.266 to 0.720) and intercept of 34 (95% CI = 14.681 to 50.830), which were significantly different from 1 and 0, respectively. The initial point correlation (r = 0.5) was fair, but there was poor overall agreement (bias = 4.3, limits of agreement = )20.8 to 29.4).Conclusions: Correlation between StO 2 and ScVO 2 was fair. The two measures trend in the same direction, but clinical use of StO 2 in lieu of ScVO 2 is unsubstantiated due to large and systematic biases. However, these biases may reflect real physiologic states. Further research may investigate if these measures could be used in concert as prognostic indicators.ACADEMIC EMERGENCY MEDICINE 2010; 17:349-352 ª

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Section: Discussionmentioning

confidence: 97%

Tissue Oxygenation Does Not Predict Central Venous Oxygenation in Emergency Department Patients With Severe Sepsis and Septic Shock

Napoli

Machan²,

Forcada³

et al. 2010

Academic Emergency Medicine

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“…[25,26]. 25 mm InSpectra probe (source-detector separation 25 mm, penetration depth 23 mm, and 95% signal threshold) was used [22,23]. Probe was moved over the thenar prominence in order to localize the maximum StO 2 and then fixed with InSpectra Shield.…”

Section: Subjectsmentioning

confidence: 99%

“…After measuring resting StO 2 for 30 seconds, VOT was performed as described earlier [22,23]. In short, testing arm was subjected to ischemia by inflating a blood pressure tourniquet, placed around the forearm, to a pressure of 250 mmHg for 3 minutes and then rapidly released.…”

Section: Skeletal Muscle Nearmentioning

confidence: 99%

“…Near infrared spectroscopy (NIRS) has been used to assess peripheral microvascular function in a variety of clinical settings [19][20][21][22][23]. Illuminating an infrared band of 680-800 nm NIRS exploits the difference in absorption spectra between the oxygenated and deoxygenated hemoglobin and partly myoglobin and thus assesses the balance between local arterial supply and cellular oxygen consumption within the muscle tissue.…”

Section: Introductionmentioning

confidence: 99%

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Use of Near Infrared Spectroscopy to Asses Remote Ischemic Preconditioning in Skeletal Muscle

2013

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Remote ischemic preconditioning (IPC) is a procedure during which brief periods of ischemia protect distant organ from ischemiareperfusion injury. Appling IPC on an upper arm, this phenomenon has been demonstrated in several studies. Skeletal muscle tissue oxygenation at rest (StO 2 ) and StO 2 deoxygenation rate during vascular occlusion can be measured using near infrared spectroscopy (NIRS). We aimed to investigate the effects of remote upper arm IPC on StO 2 and flow-mediated dilatation (FMD) in healthy male volunteers. In a randomized controlled crossover trial, resting StO 2 , StO 2 deoxygenation rate, and FMD were measured on testing arm at baseline and after 60 minutes. After basal measurements IPC protocol on a contralateral arm was performed. StO 2 deoxygenation rate was significantly lower after remote, the IPC cycles in comparison to deoxygenation rate at baseline (9.7 ± 2.6 versus 7.5 ± 2.5%, = 0.002). Comparison of deoxygenation rates showed a significant difference between the IPC and the control protocol ( = 5.512, = 0.003). No differences were observed in FMD before and after remote IPC and in the control protocol. In healthy young adults, remote IPC reduces StO 2 deoxygenation rate but has no significant impact on FMD. NIRS technique offers a novel approach to asses skeletal muscle adaptation in response to remote ischemic stimuli.

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“…Of note, the StO 2 will vary according to the site used for a given patient at a given time. A correlation between central venous oxygen saturation (ScvO 2 ) and StO 2 has been challenged (31)(32) . Dynamic testing with a three minutes ischemic period with a tourniquet gives more interesting information than basal measurement of StO 2 .…”

Section: Clinical Utility Sepsismentioning

confidence: 99%

Microcirculatory assessment in daily clinical practice - not yet ready but not too far!

Salgado

Favory

Backer

2010

Einstein (São Paulo)

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Shock is characterized by an alteration in tissue perfusion that may lead to tissue hypoxia. Recent guidelines recommend aggressive and early resuscitation therapy, but mortality rate is still unacceptably high. Unfortunately, traditional clinical surrogates used to guide resuscitation therapy poorly correlate with microcirculatory blood flow, a key determinant of tissue perfusion. New techniques that directly assess microcirculatory perfusion at the bedside have emerged as a complement to traditional macrohemodynamic parameters. These techniques have been supported by several studies showing microcirculatory alterations in different clinical settings. In addition, these microcirculatory alterations are related with outcome and persist regardless of arterial pressure normalization, being a better predictor of organ dysfunction and mortality than global hemodynamic and laboratory parameters. These findings allowed the concept of "microcirculatory-goal directed therapy", which is now in its preliminary phase, as the impact of many interventions still needs to be assessed. Finally, microcirculation assessment has also been explored in other medical fields such as perioperative, systemic arterial hypertension, heart failure, and hyperviscosity syndromes. In this review, we shortly present the characteristics of microcirculation and the main determinants of capillary blood flow, and we discuss advantages and limitations of some recently available techniques to evaluate microcirculation at the bedside, and how they could be useful for the general clinician in daily practice.Keywords: Shock; Resuscitation; Microcirculation/pathophysiology; Hemodynamics/physiology; Multiple organ failure/pathophysiology; Prognosis ReSUMOO choque é caracterizado por uma alteração na perfusão tecidual que pode levar à hipóxia tecidual. Diretrizes recentes recomendam uma terapia de ressuscitação hemodinâmica precoce e agressiva nos estados de choque, mas a taxa de mortalidade ainda é inaceitavelmente alta. Os parâmetros clínicos habituais usados para orientar a terapia de reanimação correlacionam-se mal com o fluxo sanguíneo capilar, um determinante essencial da perfusão tecidual. Novas técnicas que avaliam diretamente a perfusão da microcirculação à beira do leito surgem como um complemento aos parâmetros macro-hemodinâmicos tradicionais. Estas técnicas foram testadas em vários estudos que mostraram alterações microcirculatórias em diferentes situações clínicas de choque. Além disso, estas alterações microcirculatórias estão relacionadas ao prognóstico, e persistem independentemente da normalização da pressão arterial, sendo um melhor preditor de disfunção orgânica e mortalidade do que os parâmetros hemodinâmicos globais e laboratoriais. Estes achados permitiram lançar o conceito de "terapia dirigida por parâmetros microcirculatórios", atualmente em fase preliminar, uma vez que o impacto de muitas intervenções ainda precisa ser avaliado. Finalmente, a avaliação da microcirculação também foi explorada em outras áreas que não o choq...

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Skeletal muscle oxygen saturation estimates mixed venous oxygen saturation in patients with severe left heart failure

Cited by 19 publications

References 0 publications

Tissue Oxygenation Does Not Predict Central Venous Oxygenation in Emergency Department Patients With Severe Sepsis and Septic Shock

Tissue Oxygenation Does Not Predict Central Venous Oxygenation in Emergency Department Patients With Severe Sepsis and Septic Shock

Use of Near Infrared Spectroscopy to Asses Remote Ischemic Preconditioning in Skeletal Muscle

Microcirculatory assessment in daily clinical practice - not yet ready but not too far!

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