Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Borrat Frigola X, Mercadal J, Tercero F, Adalia R, Arguis M, Heering C, Zavala E. Int Care Med. 2007;33(Supp 2):S47. Abstract 0170.
Introduction: In septic shock patients tissue microcirculation is altered despite an increased tissue oxygen tension (1). Microcirculatory distress could be one of the earliest stages in the progress of sepsis to multiple organ failure, and microcirculatory shunting could be an important contributing factor to this development(2). SOFA score has been suggested to clinically assess the level of organ dysfunction(3).We’ve done a prospective observational study to determine if changes in the rate of thenar muscles tissue deoxygenation during stagnant ischemia in patients with severe sepsis and septic shock are related to changes in organ dysfunction using the SOFA score.
Methods: Fourteen septic shock patients were included in a preliminary study during the first days of sepsis evolution. , Hutchinson Thenar muscle StO2 was measured noninvasively by NIRS (InSpectra Technology, USA) before and during upper limb ischemia. StO2 decrease (downslope) after limb ischemia were analyzed during first and fifth day after ICU admission. Changes in StO2downslope, SOFA score, cardiac output, lactate and the use of vasoactive drugs between first and fifth days were recorded.
Results: We found good correlation between ÄStO2downslope and ÄSOFA between the first and the fifth day. (Spearman’s rho = -0,693; p<0,01). Our results are in accordance with those reported by Pareznik(4) wich correlated isolated values of StO2 with SOFA in septic shock patients but moreover we show that changes in both variables during evolution are also correlated.
Conclusion: In septic shock patients, thenar muscle ÄStO2downslope is well correlated with changes in ÄSOFA, a clinically accepted tool to measure organ dysfunction evolution during sepsis. ÄStO2downslope monitoring could be not only a good marker of microcirculatory state but also a good indicator of organ dysfunction evolution during sepsis and consequently a potentially therapeutic objective.
Reference(s):
1) Sair M, Etherington PJ, Peter Winlove C, et al. Crit. Care Med. 2001;29:1343-1348.
2) Ince C, Sinaasappel M. Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 1999; 27(7): 1369-77.
3) Ferreira FL, Vincent JL et al. Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients JAMA 2001; 286(14): 1754-58.
4) Pareznik R, Podbregar M et al. Changes in muscle tissue oxygenation during stagnant ischemia in septic patients. Intensive Care Med 2005.