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Open Access 01-12-2013 | Research

Near-infrared spectroscopy StO₂ monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock

Authors: Jordi Masip, Jaume Mesquida, Cecilia Luengo, Gisela Gili, Gemma Gomà, Ricard Ferrer, Jean Louis Teboul, Didier Payen, Antonio Artigas

Published in: Annals of Intensive Care | Issue 1/2013

Abstract

Background

Sepsis is a leading cause of death despite appropriate management. There is increasing evidence that microcirculatory alterations might persist independently from macrohemodynamic improvement and are related to clinical evolution. Future efforts need to be directed towards microperfusion monitoring and treatment. This study explored the utility of thenar muscle oxygen saturation (StO₂) and its changes during a transient vascular occlusion test (VOT) to measure the microcirculatory response to drotrecogin alfa (activated) (DrotAA) in septic patients.

Methods

A prospective, observational study was performed in three general intensive care units at three university hospitals. We studied 58 patients with recent onset of severe sepsis or septic shock and at least two organ dysfunctions. Thirty-two patients were treated with DrotAA and 26 were not treated because of formal contraindication. StO₂ was monitored using near-infrared spectroscopy (NIRS), and VOT was performed to obtain deoxygenation (DeOx) and reoxygenation (ReOx) slopes. Measurements were obtained before DrotAA was started and were repeated daily for a 96-hour period.

Results

Patients’ characteristics, outcome, severity, and baseline values of StO₂, DeOx, and ReOx did not differ between groups. Treated patients significantly improved DeOx and ReOx values over time, whereas control patients did not. In treated patients, ReOx improvements were correlated to norepinephrine dose reductions. Early clinical response (SOFA improvement after 48 hours of treatment) was not associated to changes in VOT-derived slopes. In the treated group, the relative improvement of DeOx within 48 hours was able to predict mortality (AUC 0.91, p < 0.01).

Conclusions

In patients with severe sepsis or septic shock, DrotAA infusion was associated with improvement in regional tissue oxygenation. The degree of DeOx amelioration after 2 days in treated patients predicted mortality with high sensitivity and specificity. Thus, StO₂ derived variables might be useful to evaluate the microcirculatory response to treatment of septic shock.

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Title: Near-infrared spectroscopy StO2 monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
Authors: Jordi Masip
Jaume Mesquida
Cecilia Luengo
Gisela Gili
Gemma Gomà
Ricard Ferrer
Jean Louis Teboul
Didier Payen
Antonio Artigas
Publication date: 01-12-2013
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2013
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/2110-5820-3-30

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Near-infrared spectroscopy StO₂ monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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