Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Vorwerk C. Emerg Med J. 2009;26(Suppl 1):6.
Introduction: Sepsis remains a diagnostic and therapeutic challenge. Current sepsis management guidance centres on invasive monitoring methods which are neither appropriate for every patient nor feasible in an array of clinical settings. Tissue oxygenation saturation measurement is a novel method to gain, non-invasively, information on local tissue oxygenation (normal range 80±5%). It has shown initial promising results in trauma patients, but it is not known whether it would be useful in septic ED patients.
Objective: To determine the relationship between tissue oxygen saturation (StO2) in ED patients with severe sepsis or septic shock and 30 days in-hospital mortality.
Methods: A diagnostic cohort study of adult ED patients with the clinical diagnosis of severe sepsis or septic shock. StO2 measurements were commenced as soon as possible after the patient’s arrival in the ED. The measurements continued throughout the patient’s stay in ED while receiving normal treatment. A follow-up measurement was obtained after 24 h of treatment. All patients were followed up for 30 days or until hospital discharge, whichever came first.
Results: A total of 49 patients were included of which 24 (49%) died. There was no difference in mean StO2 on ED arrival between survivors and non-survivors (72% vs 72%; p=0.97). Following ED treatment, the mean StO2 of survivors normalised to 78% (p=0.006) while there was no change in non-survivors. This difference in mean StO2 remained after 24 h of treatment (survivors 79% vs non-survivors 73%; p=0.06). There was no difference in SpO2, heart rate or systolic blood pressure between survivors and non-survivors on ED arrival or departure.
Conclusion: The results of this study suggest that normalisation of tissue oxygenation in ED patients with severe sepsis or septic shock is related to mortality. A larger study may be needed to confirm these findings before a future therapeutic trial can be justified.