Abstract
Objective
To validate thenar oxygen saturation (StO2) measured by near-infrared spectroscopy (NIRS) as a noninvasive estimation of central venous saturation (ScvO2) in septic patients.
Design
Prospective observational study.
Setting
A 26-bed medical–surgical intensive care unit at a university-affiliated hospital.
Patients
Patients consecutively admitted to the ICU in the early phase of severe sepsis and septic shock, after normalization of blood pressure with fluids and/or vasoactive drugs.
Measurements
We recorded demographic data, severity score, hemodynamic data, and blood lactate, as well as ScvO2, and StO2 measured simultaneously on inclusion. Patients were divided into two groups according to ScvO2 values: group A, with ScvO2 < 70%, and group B, with ScvO2 ≥ 70%.
Results
Forty patients were studied. StO2 was significantly lower in group A than in group B (74.7 ± 13.0 vs. 83.3 ± 6.2, P 0.018). No differences in age, severity score, hemodynamics, vasoactive drugs, or lactate were found between groups. Simultaneously measured ScvO2 and StO2 showed a significant Pearson correlation (r = 0.39, P 0.017). For a StO2 value of 75%, sensitivity was 0.44, specificity 0.93, positive predictive value 0.92, and negative predictive value 0.52 for detecting ScvO2 values lower than 70%.
Conclusions
StO2 correlates with ScvO2 in normotensive patients with severe sepsis or septic shock. We propose a StO2 cut-off value of 75% as a specific, rapid, noninvasive first step for detecting patients with low ScvO2 values. Further studies are necessary to analyze the role of noninvasive StO2 measurement in future resuscitation algorithms.
References
Reinhart K, Kuhn HJ, Hartog C, Bredle DL (2004) Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 30:1572–1578
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. New Engl J Med 345:1368–1377
Taylor DE, Simonson SG (1996) Use of near-infrared spectroscopy to monitor tissue oxygenation. New Horiz 4:420–425
Boushel R, Piantadosi CA (2000) Near-infrared spectroscopy for monitoring muscle oxygenation. Acta Physiol Scand 168:615–622
Crookes BA, Cohn SM, Bloch S, Amortegui J, Manning R, Li P, Proctor MS, Hallal A, Blackbourne LH, Benjamin R, Soffer D, Habib F, Schulman CI, Duncan R, Proctor KG (2005) Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma 58:806–816
Beilman GJ, Groehler KE, Lazaron V, Ortner JP (1999) NIRS measurement of regional tissue oxyhemoglobin saturation during hemorrhagic shock. Shock 12:196–200
Mckinley BA, Marvin RG, Cocanour CS, Moore FA (2000) Tissue hemoglobin oxygen saturation during resuscitation of traumatic shock monitored using NIRS. J Trauma 48:637–642
Cohn S, Crookes BA, Proctor KG (2003) Near-infrared spectroscopy in resuscitation. J Trauma 54:S199–S202
Chaisson NF, Kirschner RA, Deyo DJ, Lopez JA, Prough DS, Kramer GC (2003) Near-infrared spectroscopy-guided closed-loop resuscitation of hemorrhage. J Trauma 54:S183–S192
Crookes BA, Cohn SM, Burton EA, Nelson J, Proctor KG (2004) Noninvasive muscle oxygenation to guide fluid resuscitation after traumatic shock. Surgery 135:662–670
Taylor JH, Mulier KE, Myers DE, Beilman GJ (2005) Use of near-infrared spectroscopy in early determination of irreversible hemorrhagic shock. J Trauma 58:1119–1125
Mesquida J, Masip J, Sabatier C, Gili G, Baigorri F, Artigas A (2006) Oxygen tissular saturation measured by NIRS in patients admitted to the intensive care unit. Intensive Care Med (Suppl) 32:S167
Mesquida J, Masip J, Gili G, Sabatier C, Baigorri F, Artigas A (2008) Tissue oxygen saturation measured by near-infrared spectroscopy as a non-invasive predictor of low central venous oxygen saturation: a useful parameter in our resuscitation algorithm? AJRCCM 177:A366
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256
Bewick V, Cheek L, Ball J (2004) Statistics review 13: receiver operating characteristics curves. Crit Care 8:508–512
Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL (2007) The prognostic value of muscle StO2 in septic patients. Intensive Care Med 33:1549–1556
Skarda DE, Mulier KE, Myers DE, Taylor JH, Beilman GJ (2007) Dynamic near-infrared spectroscopy measurements in patients with severe sepsis. Shock 27:348–353
Pareznik R, Knezevic R, Voga G, Podbregar M (2006) Changes in muscle tissue oxygenation during stagnant ischemia in septic patients. Intensive Care Med 32:87–92
Podbregar M, Mozina H (2007) Skeletal muscle oxygen saturation does not estimate mixed venous oxygen saturation in patients with severe left heart failure and additional severe sepsis or septic shock. Crit Care 11:R6
Soller BR, Ryan KL, Rickards CA, Cooke WH, Yang Y, Soyemi OO, Crookes BA, Heard SO, Convertino VA (2008) Oxygen saturation determined from deep muscle, not thenar tissue, is an early indicator of central hypovolemia in humans. Crit Care Med 36:176–182
Acknowledgments
The authors thank Dr. R. Fernandez for his careful review of the manuscript. We also express special thanks to Ana Villagra for her helpful comments.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mesquida, J., Masip, J., Gili, G. et al. Thenar oxygen saturation measured by near infrared spectroscopy as a noninvasive predictor of low central venous oxygen saturation in septic patients. Intensive Care Med 35, 1106–1109 (2009). https://doi.org/10.1007/s00134-009-1410-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-009-1410-y