Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Kierzek G, Coste J, Jactat T, Dumas F, Boizat S, Yordanov Y, Baud M. Int Care Med. 2008;34(Supp 1):S22. Abstract 0069.
Introduction: Near-infrared spectroscopy (NIRS) is a non-invasive technique that allows to assess the tissue oxygenation by measuring the tissue HbO2 (%STO2) saturation. Pre-clinical and clinical studies using this technique have shown its usefulness in models of haemorrhagic or septic shocks resuscitation (1–3). We hypothesize that NIRS can be used as an early, noninvasive indicator of triage in the emergency department (ED).
Methods: Prospective study in an Emergency Department (45 000 visits per year); inclusion criteria: all patients visiting the ED during the time the study is being carried out. Each patient, after information has been provided and consent given for inclusion in the study during their appointment, is evaluated right from the initial nurse consultation and orientation (within 10 minutes of admission) over and above all other parameters (StO2, blood pressure (BP), HR, SpO2, Temp). The NIRS probe was applied to the right thenar eminence for 1 minute and data was collected and stored for analysis.
Results: 856 patients have had their STO2 measured. Out of these patients, 72 and 12 were admitted to hospital and ICU respectively, and 772 were not. STO2 was found independently associated with admission to ICU (OR = 3.15 per 10 points decrease, 95% confidence interval: 1.28–7.74, OR adjusted for age, SpO2, temperature and BP using polytomous logistic regression). However, the association was curvilinear rather than linear.
Conclusion: StO2 can be easily achieved in ED by the initial nurse as soon as the patient is admitted. In multivariate analysis, the most serious patients who will eventually be admitted in ICU or in ressuscitation unit have shown lower STO2 values than out-going patients. This new parameter could then allow an improved sorting of the patients and so at a very early stage (Golden hours of the sepsis for example), of all types of patients in ED.
Reference(s): 1 Rhee P. Crit Care Med 1997. 2 Beilman GJ Shock 1999 3 Skarda DE Shock 2007.
Grant Acknowledgement: Research grant from Hutchinson Technology (France).