Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Payen D, Damoisel C, Heyer L, Luengo C, Kerever S, Losser MR. Crit Care Med. 2007;35(12, Abstract Supplement):A271. Abstract 975.
Introduction: Hypothesis: To assess in septic shock patients the outcome predictive value of thenar hemoglobin saturation (StO2) items monitored at day 0, using near infrared spectrometry technique (NIRS).
Methods: In a prospective cohort of 40 septic shock patients, following data were collected within day 0 of septic shock: clinical data and scores (SOFA at 24hrs), macro-hemodynamic (SvO2 (mixed venous), blood pressure (BP), Heart Rate (HR), Cardiac Output (CO), StO2 and routine lab items (lactate, pH). NIRS parameters: basal StO2, surrogate of tissue oxygen consumption (slope for StO2 decay after brachial artery occlusion) and vascular reserve (slope of StO2 increase after reperfusion; S release; normal value 610±140 %/min) were serially collected. Adequacy of systemic hemodynamic and local tissue perfusion relation was assessed by the gradient StO2 - SvO2. Statistics: median ± Q1-Q2; univariate analysis model.
Results: SvO2 and StO2 did not correlate; StO2 - SvO2 gradient had no predictive value for outcome. SOFA score (9±3 vs 14±3, p=0.001), S release (236±133 vs 100±38, p = 0.007) and lactate (3.1±1.4 vs 7.2±2.7, p =0.0002) differed between survivors and dead patients at day 0. Only a S release over a threshold of 250 predicted outcome at day 7 (survival 100% vs 72%, p = 0.04) and at day 14 (100% vs 65%, p = 0.02).
Conclusions: Baseline StO2 and SvO2 are independent variables in human septic shock. S release value at admission might be as good as the SOFA score to predict outcome.