Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 5/2009

Open Access 01-10-2009 | Research

Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients

Authors: Alexandre Lima, Jasper van Bommel, Tim C Jansen, Can Ince, Jan Bakker

Published in: Critical Care | Special Issue 5/2009

Login to get access

Abstract

Introduction

The prognostic value of continuous monitoring of tissue oxygen saturation (StO2) during early goal-directed therapy of critically ill patients has not been investigated. We conducted this prospective study to test the hypothesis that the persistence of low StO2 levels following intensive care admission is related to adverse outcome.

Methods

We followed 22 critically ill patients admitted with increased lactate levels (>3 mmol/l). Near-infrared spectroscopy (NIRS) was used to measure the thenar eminence StO2 and the rate of StO2 increase (RincStO2) after a vascular occlusion test. NIRS dynamic measurements were recorded at intensive care admission and each 2-hour interval during 8 hours of resuscitation. All repeated StO2 measurements were further compared with Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II and hemodynamic physiological variables: heart rate (HR), mean arterial pressure (MAP), central venous oxygen saturation (ScvO2) and parameters of peripheral circulation (physical examination and peripheral flow index (PFI)).

Results

Twelve patients were admitted with low StO2 levels (StO2 <70%). The mean scores for SOFA and APACHE II scores were significantly higher in patients who persisted with low StO2 levels (n = 10) than in those who exhibited normal StO2 levels (n = 12) at 8 hours after the resuscitation period (P < 0.05; median (interquartile range): SOFA, 8 (7 to 11) vs. 5 (3 to 8); APACHE II, 32(24 to 33) vs. 19 (15 to 25)). There was no significant relationship between StO2 and mean global hemodynamic variables (HR, P = 0.26; MAP, P = 0.51; ScvO2, P = 0.11). However, there was a strong association between StO2 with clinical abnormalities of peripheral perfusion (P = 0.004), PFI (P = 0.005) and RincStO2 (P = 0.002). The persistence of low StO2 values was associated with a low percentage of lactate decrease (P < 0.05; median (interquartile range): 33% (12 to 43%) vs. 43% (30 to 54%)).

Conclusions

We found that patients who consistently exhibited low StO2 levels following an initial resuscitation had significantly worse organ failure than did patients with normal StO2 values, and found that StO2 changes had no relationship with global hemodynamic variables.
Literature
1.
Chien LC, Lu KJ, Wo CC, Shoemaker WC: Hemodynamic patterns preceding circulatory deterioration and death after trauma. J Trauma 2007, 62: 928-932. 10.1097/01.ta.0000215411.92950.72CrossRefPubMed
2.
Poeze M, Solberg BC, Greve JW, Ramsay G: Monitoring global volume-related hemodynamic or regional variables after initial resuscitation: what is a better predictor of outcome in critically ill septic patients? Crit Care Med 2005, 33: 2494-2500. 10.1097/01.CCM.0000185642.33586.9DCrossRefPubMed
3.
Lima A, Bakker J: Noninvasive monitoring of peripheral perfusion. Intensive Care Med 2005, 31: 1316-1326. 10.1007/s00134-005-2790-2CrossRefPubMed
4.
Creteur J: Muscle StO 2 in critically ill patients. Curr Opin Crit Care 2008, 14: 361-366. 10.1097/MCC.0b013e3282fad4e1CrossRefPubMed
5.
Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL: The prognostic value of muscle StO 2 in septic patients. Intensive Care Med 2007, 33: 1549-1556. 10.1007/s00134-007-0739-3CrossRefPubMed
6.
Gomez H, Torres A, Polanco P, Kim HK, Zenker S, Puyana JC, Pinsky MR: Use of non-invasive NIRS during a vascular occlusion test to assess dynamic tissue O 2 saturation response. Intensive Care Med 2008, 34: 1600-1607. 10.1007/s00134-008-1145-1CrossRefPubMed
7.
Skarda DE, Mulier KE, Myers DE, Taylor JH, Beilman GJ: Dynamic near-infrared spectroscopy measurements in patients with severe sepsis. Shock 2007, 27: 348-353. 10.1097/01.shk.0000239779.25775.e4CrossRefPubMed
8.
Taylor DE, Simonson SG: Use of near-infrared spectroscopy to monitor tissue oxygenation. New Horiz 1996, 4: 420-425.PubMed
9.
McKinley BA, Marvin RG, Cocanour CS, Moore FA: Tissue hemoglobin O 2 saturation during resuscitation of traumatic shock monitored using near infrared spectrometry. J Trauma 2000, 48: 637-642. 10.1097/00005373-200004000-00009CrossRefPubMed
10.
Ikossi DG, Knudson MM, Morabito DJ, Cohen MJ, Wan JJ, Khaw L, Stewart CJ, Hemphill C, Manley GT: Continuous muscle tissue oxygenation in critically injured patients: a prospective observational study. J Trauma 2006, 61: 780-788. 10.1097/01.ta.0000239500.71419.58CrossRefPubMed
11.
Cohn SM, Nathens AB, Moore FA, Rhee P, Puyana JC, Moore EE, Beilman GJ: Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma 2007, 62: 44-54. 10.1097/TA.0b013e31802eb817CrossRefPubMed
12.
Schriger DL, Baraff L: Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med 1988, 17: 932-935. 10.1016/S0196-0644(88)80675-9CrossRefPubMed
13.
Lima AP, Beelen P, Bakker J: Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 2002, 30: 1210-1213. 10.1097/00003246-200206000-00006CrossRefPubMed
14.
Galvin EM, Niehof S, Verbrugge SJ, Maissan I, Jahn A, Klein J, van Bommel J: Peripheral flow index is a reliable and early indicator of regional block success. Anesth Analg 2006, 103: 239-243. 10.1213/01.ane.0000220947.02689.9fCrossRefPubMed
15.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36: 296-327. 10.1097/01.CCM.0000298158.12101.41CrossRefPubMed
16.
Hasdai D, Holmes DR Jr, Califf RM, Thompson TD, Hochman JS, Pfisterer M, Topol EJ: Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO Investigators. Global utilization of streptokinase and tissue-plasminogen activator for occluded coronary arteries. Am Heart J 1999, 138: 21-31. 10.1016/S0002-8703(99)70241-3CrossRefPubMed
17.
Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, Harnden A, Mant D, Levin M: Clinical recognition of meningococcal disease in children and adolescents. The Lancet 2006, 367: 397-403. 10.1016/S0140-6736(06)67932-4CrossRef
18.
Evans JA, May J, Ansong D, Antwi S, Asafo-Adjei E, Nguah SB, Osei-Kwakye K, Akoto AO, Ofori AO, Sambian D, Sylverken J, Busch W, Timmann C, Agbenyega T, Horstmann RD: Capillary refill time as an independent prognostic indicator in severe and complicated malaria. J Pediatr 2006, 149: 676-681. 10.1016/j.jpeds.2006.07.040CrossRefPubMed
19.
Lima A, Jansen T, van Bommel J, Ince C, Bakker J: The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med 2008, 37: 934-938. 10.1097/CCM.0b013e31819869dbCrossRef
20.
Lima A, Ince C, Bakker J: Use of tissue oxygenation saturation in association with skin temperature as an indicator of the peripheral tissue perfusion in critically ill patients [abstract]. Crit Care 2009, 13: s236. 10.1186/cc7400CrossRef
21.
Bakker J: Lactate: may I have your votes please? Intensive Care Med 2001, 27: 6-11. 10.1007/s001340000797CrossRefPubMed
22.
Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL: Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996, 171: 221-226. 10.1016/S0002-9610(97)89552-9CrossRefPubMed
23.
Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC: Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004, 32: 1637-1642. 10.1097/01.CCM.0000132904.35713.A7CrossRefPubMed
24.
Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, Bennett ED: Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001, 27: 74-83. 10.1007/s001340051352CrossRefPubMed
25.
Roumen RM, Redl H, Schlag G, Sandtner W, Koller W, Goris RJ: Scoring systems and blood lactate concentrations in relation to the development of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients. J Trauma 1993, 35: 349-355. 10.1097/00005373-199309000-00004CrossRefPubMed
26.
Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM: Multiple organ failure in trauma patients. J Trauma 2003, 55: 608-616. 10.1097/01.TA.0000092378.10660.D1CrossRefPubMed
27.
Kaplan LJ, McPartland K, Santora TA, Trooskin SZ: Start with a subjective assessment of skin temperature to identify hypoperfusion in intensive care unit patients. J Trauma 2001, 50: 620-627. 10.1097/00005373-200104000-00005CrossRefPubMed
Metadata
Title
Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients
Authors
Alexandre Lima
Jasper van Bommel
Tim C Jansen
Can Ince
Jan Bakker
Publication date
01-10-2009
Publisher
BioMed Central
Published in
Critical Care / Issue Special Issue 5/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8011

Other articles of this Special Issue 5/2009

Critical Care 5/2009 Go to the issue

Research

Characterization of tissue oxygen saturation and the vascular occlusion test: influence of measurement sites, probe sizes and deflation thresholds

Research

Assessment of tissue oxygen saturation during a vascular occlusion test using near-infrared spectroscopy: the role of probe spacing and measurement site studied in healthy volunteers

Research

Microcirculatory changes and skeletal muscle oxygenation measured at rest by non-infrared spectroscopy in patients with and without diabetes undergoing haemodialysis

Research

Cardiac troponin and skeletal muscle oxygenation in severe post-partum haemorrhage

Research

Simultaneous multi-depth assessment of tissue oxygen saturation in thenar and forearm using near-infrared spectroscopy during a simple cardiovascular challenge

Research

Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome?