Abstract
Objective
To determine changes in the rate of thenar muscles tissue deoxygenation during stagnant ischemia in patients with severe sepsis and septic shock.
Design and setting
Prospective observational study in the medical ICU of a general hospital.
Patients and participants
Consecutive patients admitted to ICU with septic shock (n=6), severe sepsis (n=6), localized infection (n=3), and healthy volunteers (n=15).
Interventions
Upper limb ischemia was induced by rapid automatic pneumatic cuff inflation around upper arm.
Measurements and results
Thenar muscle tissue oxygen saturation (StO2) was measured continuously by near-infrared spectroscopy before and during upper limb ischemia. StO2 before intervention was comparable in patients with septic shock, severe sepsis, or localized infection and healthy volunteers (89 [65, 92]% vs. 82 [72, 91]% vs. 87 [85, 92]% vs. 83 [79, 93]%, respectively; p>0.1). The rate of StO2 decrease during stagnant ischemia after initial hemodynamic stabilization was slower in septic shock patients than in those with severe sepsis or localized infection and in controls (–7.0 [–3.6, –11.0] %/min vs. –10.4 [–7.8, –13.3] %/min vs. –19.5 [–12.3, –23.3] vs. –37.4 [–27.3, –56.2] %/min, respectively; p=0.041). At ICU discharge the rate of StO2 decrease did not differ between the septic shock, severe sepsis, and localized infection groups (–17.0 [–9.3, –28.9] %/min vs. –19.9 [–13.3, –23.6] %/min vs. –23.1 [–20.7, –26.2] %/min, respectively), but remained slower than in controls (p<0.01). The rate of StO2 decrease was correlated with Sequential Organ Failure Assessment (SOFA) score (r=0.739, p<0.001).
Conclusions
After hemodynamic stabilization thenar muscle tissue oxygen saturation during stagnant ischemia decreases slower in septic shock patients than in patients with severe sepsis or localized infection and in healthy volunteers. During ICU stay and improvement of sepsis the muscle tissue deoxygenation rate increases in survivors of both septic shock and severe sepsis and was correlated with SOFA score.
Similar content being viewed by others
References
Brun-Buisson C, Meshaka P, Pinton P, Vallet B (2004) EPISEPSIS Study Group. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med 30:580–588
Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group. JAMA 278:234–240
Ince C, Sinaasappel M (1999) Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 27:1369–1377
Rosser DM, Stidwill RP, Jacobson D, Singer M (1995) Oxygen tension in the bladder epithelium increased in both high and low output endotoxemic sepsis. J Appl Physiol 79:1878–1882
Boekstegers P, Weidenhofer S, Pilz G, Werdan K (1991) Peripherial oxygen availability within skeletal muscle in sepsis and septic shock: comparison to limited infection and cardiogenic shock. Infection 19:317–323
Kreymann G, Grosser S, Buggisch P, Gottschall C, Matthaei S, Greten H (1993) Oxygen consumption and resting metabolic rate in sepsis, sepsis syndrome, and septic shock. Crit Care Med 21:1012–1019
Singer M, DeSantis V, Vitale D, Jeffcoate W (2004) Multiorgan failure is an adaptive, endocrine-mediated, metabolic response to overwhelming systemic inflammation. Lancet 364:545–547
Fink MP (2002) Cytopathic hypoxia: Is oxygen use impaired in sepsis as a result of an acquired intrinsic derangement in cellular respiration? Crit Care Clin 18:165–175
Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M (2002) Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 360:219–223
Boushel R, Piantadosi CA (2000) Near-infrared spectroscopy for monitoring muscle oxygenation. Acta Physiol Scand 168:615–622
Wahr JA, Tremper KK, Samra S, Delpy DT (1996) Near-infrared spectroscopy: theory and applications. J Cardiothorac Vasc Anesth 10:406–418
Pareznik R, Voga G, Knezevic R, Podbregar M (2004) Improvement of muscle tissue deoxygenation during stagnant ischemia in survivors from severe sepsis. Intensive Care Med 30 [Suppl 1]:S144, 554
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655
Vincent JL, Moreno R, Takala J, Willatts S, De Medonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710
Simonson SG, Welty-Wolf K, Huang YT, Griebel JA, Caplan MS, Fracica PJ, Piantadosi CA (1994) Altered mitochondrial redox responses in gram negative septic shock in primates. Circ Shock 43:34–43
Duhaylongsod FG, Griebel JA, Bacon DS, Wolfe WG, Piantadosi CA (1993) Effects of muscle contraction on cytochrome a,a3 redox state. J Appl Physiol 75:790–7
Girardis M, Rinaldi L, Busani S, Flore I, Mauro S, Pasetto A (2003) Muscle perfusion and oxygen consumption by near-infrared spectroscopy in septic shock and non-septic patients. Intensive Care Med 29:1173–1176
Sair M, Etherington PJ, Winlove P, Ewans TW (2001) Tissue oxygenation and perfusion in patients with systemic sepsis. Crit Care Med 29:1343–1349
Singer M, Brealey D (1999) Mitochondrial dysfunction in sepsis. Biochem Soc Symp 66:149–66
Praagman M, Veeger HEJ, Chadwick EKJ, Colier WNJM, van der Helm FCT (2003) Muscle oxygen consumption, determined by NIRS, in relation to external force and EMG. J Biomech 36:905–912
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Parežnik, R., Knezevic, R., Voga, G. et al. Changes in muscle tissue oxygenation during stagnant ischemia in septic patients. Intensive Care Med 32, 87–92 (2006). https://doi.org/10.1007/s00134-005-2841-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-005-2841-8