1
|
Bogatu L, Turco S, Mischi M, Schmitt L, Woerlee P, Bezemer R, Bouwman AR, Korsten EHHM, Muehlsteff J. New Hemodynamic Parameters in Peri-Operative and Critical Care-Challenges in Translation. SENSORS (BASEL, SWITZERLAND) 2023; 23:2226. [PMID: 36850819 PMCID: PMC9961222 DOI: 10.3390/s23042226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Hemodynamic monitoring technologies are evolving continuously-a large number of bedside monitoring options are becoming available in the clinic. Methods such as echocardiography, electrical bioimpedance, and calibrated/uncalibrated analysis of pulse contours are becoming increasingly common. This is leading to a decline in the use of highly invasive monitoring and allowing for safer, more accurate, and continuous measurements. The new devices mainly aim to monitor the well-known hemodynamic variables (e.g., novel pulse contour, bioreactance methods are aimed at measuring widely-used variables such as blood pressure, cardiac output). Even though hemodynamic monitoring is now safer and more accurate, a number of issues remain due to the limited amount of information available for diagnosis and treatment. Extensive work is being carried out in order to allow for more hemodynamic parameters to be measured in the clinic. In this review, we identify and discuss the main sensing strategies aimed at obtaining a more complete picture of the hemodynamic status of a patient, namely: (i) measurement of the circulatory system response to a defined stimulus; (ii) measurement of the microcirculation; (iii) technologies for assessing dynamic vascular mechanisms; and (iv) machine learning methods. By analyzing these four main research strategies, we aim to convey the key aspects, challenges, and clinical value of measuring novel hemodynamic parameters in critical care.
Collapse
Affiliation(s)
- Laura Bogatu
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Simona Turco
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Massimo Mischi
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Lars Schmitt
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Pierre Woerlee
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Rick Bezemer
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Arthur R. Bouwman
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Erik H. H. M. Korsten
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Jens Muehlsteff
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| |
Collapse
|
2
|
Maurin C, Portran P, Schweizer R, Allaouchiche B, Junot S, Jacquet-Lagrèze M, Fellahi JL. Effects of methylene blue on microcirculatory alterations following cardiac surgery: A prospective cohort study. Eur J Anaesthesiol 2022; 39:333-341. [PMID: 34610607 DOI: 10.1097/eja.0000000000001611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Methylene blue is used as rescue therapy to treat catecholamine-refractory vasoplegic syndrome after cardiac surgery. However, its microcirculatory effects remain poorly documented. OBJECTIVE We aimed to study microcirculatory abnormalities in refractory vasoplegic syndrome following cardiac surgery with cardiopulmonary bypass and assess the effects of methylene blue. DESIGN A prospective open-label cohort study. SETTING 20-Bed ICU of a tertiary care hospital. PATIENTS 25 Adult patients receiving 1.5 mg kg-1 of methylene blue intravenously for refractory vasoplegic syndrome (defined as norepinephrine requirement more than 0.5 μg kg-1 min-1) to maintain mean arterial pressure (MAP) more than 65 mmHg and cardiac index (CI) more than 2.0 l min-1 m-2. MAIN OUTCOME MEASURES Complete haemodynamic set of measurements at baseline and 1 h after the administration of methylene blue. Sublingual microcirculation was investigated by sidestream dark field imaging to obtain microvascular flow index (MFI), total vessel density, perfused vessel density and heterogeneity index. Microvascular reactivity was assessed by peripheral near-infrared (IR) spectroscopy combined with a vascular occlusion test. We also performed a standardised measurement of capillary refill time. RESULTS Despite normalised CI (2.6 [2.0 to 3.8] l min-1 m-2) and MAP (66 [55 to 76] mmHg), patients with refractory vasoplegic syndrome showed severe microcirculatory alterations (MFI < 2.6). After methylene blue infusion, MFI significantly increased from 2.0 [0.1 to 2.5] to 2.2 [0.2 to 2.8] (P = 0.008), as did total vessel density from 13.5 [8.3 to 18.5] to 14.9 [10.1 to 14.7] mm mm-2 (P = 0.02) and perfused vessel density density from 7.4 [0.1 to 11.5] to 9.1 [0 to 20.1] mm mm-2 (P = 0.02), but with wide individual variation. Microvascular reactivity assessed by tissue oxygen resaturation speed also increased from 0.5 [0.1 to 1.8] to 0.7 [0.1 to 2.7]% s-1 (P = 0.002). Capillary refill time remained unchanged throughout the study. CONCLUSION In refractory vasoplegic syndrome following cardiac surgery, we found microcirculatory alterations despite normalised CI and MAP. The administration of methylene blue could improve microvascular perfusion and reactivity, and partially restore the loss of haemodynamic coherence. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04250389.
Collapse
Affiliation(s)
- Carole Maurin
- From the Service d'Anesthésie Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel (CM, PP, RS, MJ-L, J-LF), Service d'Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon (BA), APCSe, Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon (SJ) and Laboratoire CarMeN, Inserm U1060, Université Claude Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France (MJ-L, J-LF)
| | | | | | | | | | | | | |
Collapse
|
3
|
Hutchings SD, Watchorn J, McDonald R, Jeffreys S, Bates M, Watts S, Kirkman E. Quantification of stroke volume in a simulated healthy volunteer model of traumatic haemorrhage; a comparison of two non-invasive monitoring devices using error grid analysis alongside traditional measures of agreement. PLoS One 2021; 16:e0261546. [PMID: 34941918 PMCID: PMC8699736 DOI: 10.1371/journal.pone.0261546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Haemorrhage is a leading cause of death following traumatic injury and the early detection of hypovolaemia is critical to effective management. However, accurate assessment of circulating blood volume is challenging when using traditional vital signs such as blood pressure. We conducted a study to compare the stroke volume (SV) recorded using two devices, trans-thoracic electrical bioimpedance (TEB) and supra-sternal Doppler (SSD), against a reference standard using trans- thoracic echocardiography (TTE). Methods A lower body negative pressure (LBNP) model was used to simulate hypovolaemia and in half of the study sessions lower limb tourniquets were applied as these are common in military practice and can potentially affect some haemodynamic monitoring systems. In order to provide a clinically relevant comparison we constructed an error grid alongside more traditional measures of agreement. Results 21 healthy volunteers aged 18–40 were enrolled and underwent 2 sessions of LBNP, with and without lower limb tourniquets. With respect to absolute SV values Bland Altman analysis showed significant bias in both non-tourniquet and tourniquet strands for TEB (-42.5 / -49.6 ml), rendering further analysis impossible. For SSD bias was minimal but percentage error was unacceptably high (35% / 48%). Degree of agreement for dynamic change in SV, assessed using 4 quadrant plots showed a seemingly acceptable concordance rate for both TEB (86% / 93%) and SSD (90% / 91%). However, when results were plotted on an error grid, constructed based on expert clinical opinion, a significant minority of measurement errors were identified that had potential to lead to moderate or severe patient harm. Conclusion Thoracic bioimpedance and suprasternal Doppler both demonstrated measurement errors that had the potential to lead to clinical harm and caution should be applied in interpreting the results in the detection of early hypovolaemia following traumatic injury.
Collapse
Affiliation(s)
- Sam D. Hutchings
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- * E-mail:
| | - Jim Watchorn
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rory McDonald
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Su Jeffreys
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Mark Bates
- Defence Science and Technology Laboratory, Porton Down, Wiltshire, United Kingdom
| | - Sarah Watts
- Defence Science and Technology Laboratory, Porton Down, Wiltshire, United Kingdom
| | - Emrys Kirkman
- Defence Science and Technology Laboratory, Porton Down, Wiltshire, United Kingdom
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Current goals of resuscitation in septic shock are mainly a fixed volume of fluids and vasopressors to correct hypotension and improve tissue perfusion indicated by decreasing lactate levels. RECENT FINDINGS Abnormal peripheral perfusion by objective and subjective parameters are associated with increased mortality in various phases of the treatment of critically ill patients including patients with septic shock. Ongoing resuscitation in septic shock patients with normal peripheral perfusion is not associated with improved outcome, rather with increased mortality. Mitigation of fluid resuscitation by using parameters of peripheral perfusion in septic shock seems to be safe. SUMMARY Septic shock patients with normal peripheral perfusion represent a different clinical phenotype of patients that might benefit from limited resuscitation efforts. Parameters of peripheral perfusion could be used to guide the individualization of patients with septic shock.
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation. RECENT FINDINGS Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the deterioration of microcirculatory perfusion. However, in many cases the restoration of adequate macrocirculatory parameters is frequently not associated with improvement in microcirculatory perfusion. This relates not only to the cause of shock, where there are some differences between different forms of shock, but also to the type of treatment. SUMMARY The improvement in macrohemodynamics during the resuscitation is not consistently followed by subsequent changes in the microcirculation. This may result in both over-resuscitation and under-resuscitation leading to increased morbidity and mortality. In this article the principles of coherence and the monitoring of the microcirculation are reviewed.
Collapse
|
6
|
Bakker J, Hernandez G. Can Peripheral Skin Perfusion Be Used to Assess Organ Perfusion and Guide Resuscitation Interventions? Front Med (Lausanne) 2020; 7:291. [PMID: 32656220 PMCID: PMC7324549 DOI: 10.3389/fmed.2020.00291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
Although the definition of septic shock is straightforward, the physiological response to inadequate hemodynamics in patients with septic shock is variable. Therefore, the clinical recognition is limited not only by the patient's response but also by the clinical parameters we can use at the bedside. In this short overview we will argue that the state of the peripheral perfusion can help to identify and to treat patients with septic shock.
Collapse
Affiliation(s)
- Jan Bakker
- Department of Pulmonary and Critical Care, Bellevue Hospital, NYU Langone, New York, NY, United States.,Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, NY, United States.,Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Pontificia Universidad Católica de Chile, Department of Intensive Care, Santiago, Chile
| | - Glenn Hernandez
- Pontificia Universidad Católica de Chile, Department of Intensive Care, Santiago, Chile
| |
Collapse
|
7
|
The Effect of Fluid Loading and Hypertonic Saline Solution on Cortical Cerebral Microcirculation and Glycocalyx Integrity. J Neurosurg Anesthesiol 2020; 31:434-443. [PMID: 30015696 DOI: 10.1097/ana.0000000000000528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fluid loading and hyperosmolar solutions can modify the cortical brain microcirculation and the endothelial glycocalyx (EG). This study compared the short-term effects of liberal fluid loading with a restrictive fluid intake followed by osmotherapy with hypertonic saline (HTS) on cerebral cortical microcirculation and EG integrity in a rabbit craniotomy model. METHODS The experimental rabbits were allocated randomly to receive either <2 mL/kg/h (group R, n=14) or 30 mL/kg/h (group L, n=14) of balanced isotonic fluids for 1 hour. Then, the animals were randomized to receive 5 mL/kg intravenous infusion of either 3.2% saline (group HTS, n=14) or 0.9% saline (group normal saline, n=13) in a 20-minute infusion. Microcirculation in the cerebral cortex based on sidestream dark-field imaging, a morphologic index of glycocalyx damage to sublingual and cortical brain microcirculation (the perfused boundary region), and serum syndecan-1 levels were evaluated. RESULTS Lower cortical brain perfused small vessel density (P=0.0178), perfused vessel density (P=0.0286), and total vessel density (P=0.0447) were observed in group L, compared with group R. No differences were observed between the HTS and normal saline groups after osmotherapy. Cerebral perfused boundary region values (P=0.0692) and hematocrit-corrected serum syndecan-1 levels (P=0.0324) tended to be higher in group L than in group R animals. CONCLUSIONS Liberal fluid loading was associated with altered cortical cerebral microcirculation and EG integrity parameters. The 3.2% saline treatment did not affect cortical cerebral microcirculation or EG integrity markers.
Collapse
|
8
|
|
9
|
Gingold BM, Killos MB, Griffith E, Posner L. Measurement of peripheral muscle oxygen saturation in conscious healthy horses using a near-infrared spectroscopy device. Vet Anaesth Analg 2019; 46:789-795. [PMID: 31562027 DOI: 10.1016/j.vaa.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/29/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Maintaining adequate muscle tissue oxygenation is of paramount importance during equine general anesthesia. The objectives of this study were to assess the feasibility, reliability and repeatability of near-infrared spectroscopy (NIRS) muscle oximetry using the Inspectra m650 in conscious healthy adult horses. STUDY DESIGN Prospective, observational study. ANIMALS A group of 30 healthy client-owned adult horses admitted to the equine hospital between July 2017 and July 2018. METHODS The probe of an Inspectra m650 NIRS tissue oximeter was placed on the hairless surface of five muscle sites (omotransversarius, triceps long head, extensor carpi ulnaris, vastus lateralis and lateral digital extensor) on the left side of the body of each standing, unsedated horse. Each site had muscle oxygenation (StO2) recordings measured in triplicate and statistical modeling used to assess the reading reliability and repeatability within and between muscle sites. RESULTS The readings acquired at the vastus lateralis and extensor carpi ulnaris muscle sites had highly repeatable values [mean (90% confidence interval): StO2, 95% (93.8%, 96.5%) and 93% (91.6%, 93.9%), respectively; intraclass correlation coefficients, 0.92 and 0.80, respectively]. These two sites also had high reliability (represented by the percentage of successful readings; 70% and 86%, respectively). CONCLUSIONS AND CLINICAL RELEVANCE The use of NIRS muscle oxygenation technology is a clinically feasible means to assess tissue oxygenation in horses. The vastus lateralis and extensor carpi ulnaris muscle sites provided the most reliable and repeatable readings when using the Inspectra m650 machine in horses.
Collapse
Affiliation(s)
- Benjamin Mc Gingold
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
| | - Maria B Killos
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Emily Griffith
- Department of Statistics, College of Sciences, North Carolina State University, Raleigh, NC, USA
| | - Lysa Posner
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| |
Collapse
|
10
|
Microvascular reactivity, assessed by near-infrared spectroscopy and a vascular occlusion test, is associated with patient outcomes following cardiac surgery: A prospective observational study. Eur J Anaesthesiol 2019; 35:356-364. [PMID: 29084009 DOI: 10.1097/eja.0000000000000731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Microvascular dysfunction in patients admitted to the ICU following cardiac surgery may be related to perioperative complications and increased resource utilisation even in the presence of acceptable systemic haemodynamic variables. OBJECTIVES To assess the relationship between microvascular impairment using peripheral near-infrared spectroscopy at ICU admission and 6 h postadmission and the duration of mechanical ventilatory support, length of stay in ICU and in hospital. DESIGN Prospective, observational cohort study. SETTING Single-centre, tertiary-level cardiac ICU. PATIENTS Sixty-nine adult patients following elective cardiac surgery excluding patients with on-going extracorporeal support or in whom tissue haemoglobin oxygen saturation (StO2) measurements were not feasible. MAIN OUTCOME MEASURES Thenar and forearm StO2 in response to a vascular occlusion test to calculate desaturation and reperfusion slopes. A logistic regression model was used to ascertain the associations between StO2, desaturation and reperfusion slopes as well as cardiac index, mean arterial pressure, arterial lactate concentrations and prolonged (≥75th percentile) duration of mechanical ventilation, ICU length of stay and hospital length of stay. RESULTS A reduced reperfusion slope at ICU admission was associated independently with prolonged mechanical ventilation at thenar (OR 0.08; 95% CI [0.02 to 0.47], P = 0.003) and forearm [OR 0.2 (0.04 to 0.59), P = 0.006] sites. Similarly, a reduced Rres was associated with prolonged ICU LOS at both thenar [OR 0.3 (0.13 to 0.77), P = 0.007] and forearm [OR 0.2 (0.05 to 0.62), P = 0.007] sites at ICU0 h, as well as ICU6 h [OR 0.2 (0.05 to 0.66), P = 0.004 and OR 0.05 (0.008 to 0.34), P = 0.002]. An increased Rdes was associated with prolonged hospital LOS at the thenar eminence at ICU0 h [OR 1.9 (1.4 to 2.3), P = 0.004] and ICU6 h [OR 6.7 (2.0 to 23), P = 0.002] as well as the forearm at ICU0 h [OR 1.5 (1.3 to 1.9), P = 0.004] and ICU6 h [OR 1.6 (1.3 to 2.1), P = 0.004]. CONCLUSION In the early postoperative period following cardiac surgery, changes in thenar and forearm tissue oxygenation variables are associated with patient resource utilisation outcomes.
Collapse
|
11
|
Effects of Hypertonic Saline and Sodium Lactate on Cortical Cerebral Microcirculation and Brain Tissue Oxygenation. J Neurosurg Anesthesiol 2018; 30:163-170. [PMID: 28338505 DOI: 10.1097/ana.0000000000000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hyperosmolar solutions have been used in neurosurgery to modify brain bulk. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of hypertonic saline (HTS) and sodium lactate (HTL) on cerebral cortical microcirculation and brain tissue oxygenation in a rabbit craniotomy model. METHODS Rabbits (weight, 1.5 to 2.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3.75 mL/kg intravenous infusion of either 3.2% HTS (group HTS, n=9), half-molar sodium lactate (group HTL, n=10), or normal saline (group C, n=9). Brain tissue partial pressure of oxygen (PbtO2) and microcirculation in the cerebral cortex using sidestream dark-field imaging were evaluated before, 20 and 40 minutes after 15 minutes of hyperosmolar solution infusion. Global hemodynamic data were recorded, and blood samples for laboratory analysis were obtained at the time of sidestream dark-field image recording. RESULTS No differences in the microcirculatory parameters were observed between the groups before and after the use of osmotherapy. Brain tissue oxygen deteriorated over time in groups C and HTL, this deterioration was not significant in the group HTS. CONCLUSIONS Our findings suggest that equivolemic, equiosmolar HTS and HTL solutions equally preserve perfusion of cortical brain microcirculation in a rabbit craniotomy model. The use of HTS was better in preventing the worsening of brain tissue oxygen tension.
Collapse
|
12
|
Ince C, Boerma EC, Cecconi M, De Backer D, Shapiro NI, Duranteau J, Pinsky MR, Artigas A, Teboul JL, Reiss IKM, Aldecoa C, Hutchings SD, Donati A, Maggiorini M, Taccone FS, Hernandez G, Payen D, Tibboel D, Martin DS, Zarbock A, Monnet X, Dubin A, Bakker J, Vincent JL, Scheeren TWL. Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine. Intensive Care Med 2018; 44:281-299. [DOI: 10.1007/s00134-018-5070-7] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/17/2018] [Indexed: 12/17/2022]
|
13
|
Veenstra G, Pranskunas A, Skarupskiene I, Pilvinis V, Hemmelder MH, Ince C, Boerma EC. Ultrafiltration rate is an important determinant of microcirculatory alterations during chronic renal replacement therapy. BMC Nephrol 2017; 18:71. [PMID: 28219329 PMCID: PMC5319109 DOI: 10.1186/s12882-017-0483-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/09/2017] [Indexed: 02/05/2023] Open
Abstract
Background Hemodialysis (HD) with ultrafiltration (UF) in chronic renal replacement therapy is associated with hemodynamic instability, morbidity and mortality. Sublingual Sidestream Dark Field (SDF) imaging during HD revealed reductions in microcirculatory blood flow (MFI). This study aims to determine underlying mechanisms. Methods The study was performed in the Medical Centre Leeuwarden and the Lithuanian University of Health Sciences. Patients underwent 4-h HD session with linear UF. Nine patients were subject to combinations of HD and UF: 4 h of HD followed by 1 h isolated UF and 4 h HD with blood-volume-monitoring based UF. Primary endpoint: difference in MFI before and after intervention. During all sessions monitoring included blood pressure, heartrate and SDF-imaging. Trial registration number: NCT01396980. Results Baseline characteristics were not different between the two centres as within the HD/UF modalities. MFI was not different before and after HD with UF. Total UF did not differ between modalities. Median MFI decreased significantly during isolated UF [2.8 (2.5–2.9) to 2.5 (2.2–2.8), p = 0.03]. Baseline MFI of each UF session was correlated with MFI after the intervention (rs = 0.52, p = 0.006). Conclusion During HD with UF or isolated HD we observed no changes in MFI. This indicates that non-flow mediated mechanisms are of unimportance. During isolated UF we observed a reduction in MFI in conjunction with a negative intravascular fluid balance. The correlation between MFI before and after intervention suggests that volume status at baseline is a factor in microvascular alterations. In conclusion we observed a significant decrease of sublingual MFI, related to UF rate during chronic renal replacement therapy.
Collapse
Affiliation(s)
- Gerke Veenstra
- Medical Center Leeuwarden, P.O. Box 888, Leeuwarden, 8934 AD, The Netherlands. .,Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands. .,Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.
| | | | | | - Vidas Pilvinis
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Marc H Hemmelder
- Medical Center Leeuwarden, P.O. Box 888, Leeuwarden, 8934 AD, The Netherlands
| | - Can Ince
- Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands.,Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands
| | - E Christiaan Boerma
- Medical Center Leeuwarden, P.O. Box 888, Leeuwarden, 8934 AD, The Netherlands
| |
Collapse
|
14
|
Bakker J. Lactate levels and hemodynamic coherence in acute circulatory failure. Best Pract Res Clin Anaesthesiol 2016; 30:523-530. [PMID: 27931655 DOI: 10.1016/j.bpa.2016.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022]
Abstract
In this review, the relationship between changes in macrohemodynamics during the development and treatment of acute circulatory failure is discussed in the context of coherence with microcirculation and changes in lactate. In models of circulatory failure, coherence between changes in macrocirculatory and microcirculatory perfusion and coherence with subsequent changes in lactate levels are more or less preserved. However, in patients, particularly those with septic shock, these relationships are much less clear. As many factors influence the effect of circulatory failure and infection on microcirculation and on lactate levels, this should not be surprising. Resuscitation should therefore aim at adequate tissue perfusion where systemic hemodynamics, microcirculatory perfusion parameters, and lactate levels should be used in their relevant context. This results in treating the individual patient as an n = 1 experiment.
Collapse
Affiliation(s)
- Jan Bakker
- Columbia University Medical Center, Division of Pulmonary, Allergy, and Critical Care Medicine, 622 West 168th St, Room PH 8E-101, Office: PH 8-109, New York, NY 10032, USA; New York University, Department of Pulmonary and Critical Care, 462 First Avenue, New York, NY 10016, USA; Erasmus MC University Medical Center, Department of Intensive Care Adults, PO Box 2040-Room H-625, 3000 CA Rotterdam, Netherlands; Pontificia Universidad Católica de Chile, Department of Intensive Care, Diagonal Paraguay 362, 8330024 Santiago, Chile.
| |
Collapse
|
15
|
Hemodynamic coherence in critically ill pediatric patients. Best Pract Res Clin Anaesthesiol 2016; 30:499-510. [PMID: 27931653 DOI: 10.1016/j.bpa.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 10/24/2016] [Indexed: 01/22/2023]
Abstract
Differences in physiology and pathophysiology make the treatment of developing, critically ill children particularly challenging as compared to that of adults. Significant differences in the cardiovascular system of neonates and children in size, weight, body proportions, and metabolism should be considered. Hemodynamic monitoring is crucial for early warning of pending deterioration and to guide therapy. Current monitoring is limited to the macrocirculation, but an adequately functioning macrocirculation does not guarantee a well-functioning microcirculation. Research in children revealed loss of hemodynamic coherence, i.e., microcirculatory alterations despite normal systemic hemodynamics. Implementing the framework of hemodynamic coherence in microcirculatory monitoring in children can aid physicians in titrating therapy on both macrocirculatory and microcirculatory effects to assure optimal oxygen delivery. Monitoring the microcirculation at the bedside requires further technical development. Although more research is necessary to validate the concept of hemodynamic coherence in children, the possibilities of applying this concept in children seem promising.
Collapse
|
16
|
Butler E, Chin M, Aneman A. Peripheral Near-Infrared Spectroscopy: Methodologic Aspects and a Systematic Review in Post-Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2016; 31:1407-1416. [PMID: 27876185 DOI: 10.1053/j.jvca.2016.07.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ethan Butler
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Melissa Chin
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia
| | - Anders Aneman
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia; University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.
| |
Collapse
|
17
|
Guye ML, Motamed C, Chemam S, Leymarie N, Suria S, Weil G. Remote peripheral tissue oxygenation does not predict postoperative free flap complications in complex head and neck cancer surgery: A prospective cohort study. Anaesth Crit Care Pain Med 2016; 36:27-31. [PMID: 27320053 DOI: 10.1016/j.accpm.2016.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients undergoing free flap reconstruction after head and neck cancer may develop free flap complications. In the perioperative period, haemoglobin content and oxygen tissue saturation (StO2) measured directly on the free flap reflect peripheral tissue oxygenation. However, in this type of surgery, StO2 cannot always be applied directly or proximate to the free flap. The aim of this study was to assess the possible value of StO2 measured at the thenar eminence and other 24hour perioperative factors on free flap complications. METHODS Inclusion criteria corresponded to patients with head and neck cancer with free flap surgery in whom direct StO2 could not be monitored on the flap nor in its peripheral area. Patient characteristics and intraoperative data, such as haemoglobin and fluid management, were prospectively collected. StO2 was measured remotely on the thenar eminence. Data were collected for 24hours and free flap complications were recorded for up to 15days after surgery. Patients were thereafter classified into two groups: with or without free flap complications and the data were compared in consequence. RESULTS Forty consecutive patients were prospectively included. Ten patients had postoperative free flap complications and were compared to the 30 other patients without complications. The haemoglobin level at the reperfusion of the flap: (AUC 0.80 [0.65-0.91], threshold 9.9g/dL, P<0.001) and body mass index [BMI] (AUC 0.80 [0.64-0.72], threshold 24.5kg/m2, P<0.01) were significantly related to complications. CONCLUSION In head and neck complex oncologic reconstructive surgery, haemoglobin and BMI were the most sensitive tools for predicting postoperative free flap complications, while thenar eminence StO2 was not.
Collapse
Affiliation(s)
- Marie-Laurence Guye
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Cyrus Motamed
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - Sarah Chemam
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Nicolas Leymarie
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Stéphanie Suria
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Grégoire Weil
- Department of anesthesiology and plastic surgery, Gustave-Roussy Cancer Institute, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| |
Collapse
|
18
|
|
19
|
|
20
|
Weber M, Milstein D, Ince C, Roovers J. Is pelvic organ prolapse associated with altered microcirculation of the vaginal wall? Neurourol Urodyn 2015; 35:764-70. [DOI: 10.1002/nau.22805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/21/2015] [Indexed: 11/10/2022]
Affiliation(s)
- M.A. Weber
- Department of Obstetrics and Gynaecology; Academic Medical Center; Amsterdam The Netherlands
| | - D.M.J. Milstein
- Department of Oral & Maxillofacial Surgery; Academic Medical Center; Amsterdam The Netherlands
| | - C. Ince
- Department of Translational Physiology; Academic Medical Center; Amsterdam The Netherlands
| | - J.P.W.R. Roovers
- Department of Obstetrics and Gynaecology; Academic Medical Center; Amsterdam The Netherlands
| |
Collapse
|
21
|
Dostal P, Schreiberova J, Dostalova V, Dostalova V, Tyll T, Paral J, Abdo I, Cihlo M, Astapenko D, Turek Z. Effects of hypertonic saline and mannitol on cortical cerebral microcirculation in a rabbit craniotomy model. BMC Anesthesiol 2015; 15:88. [PMID: 26055873 PMCID: PMC4459466 DOI: 10.1186/s12871-015-0067-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/28/2015] [Indexed: 11/12/2022] Open
Abstract
Background Hyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of mannitol and hypertonic saline (HTS) on cerebral cortical microcirculation in a rabbit craniotomy model. Methods Rabbits (weight, 2.0–3.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3.75 ml/kg intravenous infusion of either 3.2 % HTS (group HTS, n = 8) or 20 % mannitol (group MTL, n = 8). Microcirculation in the cerebral cortex was evaluated using sidestream dark-field (SDF) imaging before and 20 min after the end of the 15-min HTS infusion. Global hemodynamic data were recorded, and blood samples for laboratory analysis were obtained at the time of SDF image recording. Results No differences in the microcirculatory parameters were observed between the groups before the use of osmotherapy. After osmotherapy, lower proportions of perfused small vessel density (P = 0.0474), perfused vessel density (P = 0.0457), and microvascular flow index (P = 0.0207) were observed in the MTL group compared with those in the HTS group. Conclusions Our findings suggest that an equivolemic, equiosmolar HTS solution better preserves perfusion of cortical brain microcirculation compared to MTL in a rabbit craniotomy model.
Collapse
Affiliation(s)
- Pavel Dostal
- Department of Anesthesia and Intensive Care Medicine, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Jitka Schreiberova
- Department of Anesthesia and Intensive Care Medicine, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Vlasta Dostalova
- Department of Anesthesia and Intensive Care Medicine, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Vlasta Dostalova
- Department of Anesthesia and Intensive Care Medicine, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Tomas Tyll
- Department of Anesthesia and Intensive Care Medicine, Charles University, 1st Faculty of Medicine Prague, Military University Hospital Prague, Prague, Czech Republic.
| | - Jiri Paral
- Department of Military Surgery, Faculty of Military Health Sciences, Hradec Kralove, University of Defence, Brno, Czech Republic.
| | - Islam Abdo
- Department of Anesthesia and Intensive Care Medicine, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Miroslav Cihlo
- Department of Neurosurgery, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - David Astapenko
- Department of Anesthesia and Intensive Care Medicine, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Zdenek Turek
- Department of Anesthesia and Intensive Care Medicine, Charles University, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| |
Collapse
|
22
|
Koning NJ, Atasever B, Vonk AB, Boer C. Changes in Microcirculatory Perfusion and Oxygenation During Cardiac Surgery With or Without Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2014; 28:1331-40. [DOI: 10.1053/j.jvca.2013.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Indexed: 12/19/2022]
|
23
|
Veenstra G, Scheenstra B, Koopmans M, Kingma WP, Buter H, Boerma EC. Microcirculatory perfusion derangements during continuous hemofiltration with fixed dose of ultrafiltration in stabilized intensive care unit patients. J Crit Care 2014; 29:478-81. [PMID: 24642165 DOI: 10.1016/j.jcrc.2014.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/27/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a well-known complication in critically ill patients. Little is known about the timing and the ultrafiltration dose after initial resuscitation. In vivo microscopy of the microcirculation has been suggested as alternative for the assessment of volume status. Previous studies contribute to the understanding that intravascular hypovolemia is reflected by microcirculatory blood flow changes not detected by conventional methods. The aim of our study was to assess microcirculatory blood flow changes during negative fluid balance ultrafiltration in patients with oliguric AKI. MATERIALS AND METHODS Patients with oliguric AKI on renal replacement therapy were included after hemodynamic stabilization. Target was a predefined negative fluid balance; subsequently, a stepwise decrease in amount of substitution fluid was achieved. The data were recorded at baseline and after each change. RESULTS Fifteen patients were included in the study. Microcirculatory blood flow index did not change significantly between baseline and endpoint (2.90 [2.87-3.00] vs 2.90 [2.75-3.00], P=.57). During treatment, heart rate decreased from 96 (80-111) to 94 (79-110) beats per minute (P=.01), without a significant change in mean arterial blood pressure (80 [68-95 mm Hg] vs 79 [65-91 mm Hg], P=.5). CONCLUSION Microcirculatory blood flow is not altered by reduced substitution during renal replacement therapy.
Collapse
Affiliation(s)
- G Veenstra
- Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands.
| | - B Scheenstra
- Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands
| | - M Koopmans
- Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands
| | - W P Kingma
- Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands
| | - H Buter
- Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands
| | - E C Boerma
- Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands
| |
Collapse
|
24
|
Zöllei E, Bertalan V, Németh A, Csábi P, László I, Kaszaki J, Rudas L. Non-invasive detection of hypovolemia or fluid responsiveness in spontaneously breathing subjects. BMC Anesthesiol 2013; 13:40. [PMID: 24188480 PMCID: PMC3829671 DOI: 10.1186/1471-2253-13-40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 11/01/2013] [Indexed: 02/06/2023] Open
Abstract
Background In the assessment of hypovolemia the value of functional hemodynamic monitoring during spontaneous breathing is debated. The aim of our study was to investigate in spontaneously breathing subjects the changes in hemodynamic parameters during graded central hypovolemia and to test whether slow patterned breathing improved the discriminative value of stroke volume (SV), pulse pressure (PP), and their variations (SVV, PPV). In addition, we tested the alterations in labial microcirculation. Methods 20 healthy volunteers participated in our study. Central hypovolemia was induced by lower body negative pressure (LBNP). Continuous signals of ECG, non-invasive blood pressure and central venous pressure were recorded. During baseline and each stage of LBNP the labial microcirculation was investigated by orthogonal polarization spectral imaging, 3 minute periods of patterned breathing at 6 and 15/min respiratory rate were performed, and central venous blood gas analysis was done. Data from baseline and those of different LBNP levels were compared by analysis of variance and those of different breathing rates by t-test. Finally, we performed ROC analysis to assess the discriminative values of SV, PP, SVV and PPV. Results Moderate central hypovolemia induced by LBNP caused significant, clinically relevant falls in PP (p < 0.05) and SV and central venous oxygen saturation (ScvO2) (p < 0.001). The proportion of perfused vessels (p < 0.001) and microvascular flow index decreased (p < 0.05). PPV increased (p < 0.001), however the magnitude of fluctuations was greater during slow patterned breathing (p < 0.001). SVV increased only during slow patterned breathing (p < 0.001). ROC analysis confirmed the best predictive value for SV (at 56 ml cut-off AUC 0.97, sensitivity 94%, specificity 95%). Slow patterned breathing improved the discriminative value of SVV (p = 0.0023). Conclusions Functional hemodynamic monitoring with slow patterned breathing to control spontaneous respiration may be worthy for further study in different populations for the assessment of hypovolemia and the prediction of volume responsiveness.
Collapse
Affiliation(s)
- Eva Zöllei
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis u, 6, Szeged 6725, Hungary.
| | | | | | | | | | | | | |
Collapse
|
25
|
Central Venous-to-Arterial CO2 Gap Is a Useful Parameter in Monitoring Hypovolemia-Caused Altered Oxygen Balance: Animal Study. Crit Care Res Pract 2013; 2013:583598. [PMID: 24069537 PMCID: PMC3773396 DOI: 10.1155/2013/583598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 07/10/2013] [Accepted: 07/19/2013] [Indexed: 01/20/2023] Open
Abstract
Monitoring hypovolemia is an everyday challenge in critical care, with no consensus on the best indicator or what is the clinically relevant level of hypovolemia. The aim of this experiment was to determine how central venous oxygen saturation (ScvO2) and central venous-to-arterial carbon dioxide difference (CO2 gap) reflect hypovolemia-caused changes in the balance of oxygen delivery and consumption. Anesthetized, ventilated Vietnamese minipigs (n = 10) were given a bolus followed by a continuous infusion of furosemide. At baseline and then in five stages hemodynamic, microcirculatory measurements and blood gas analysis were performed. Oxygen extraction increased significantly, which was accompanied by a significant drop in ScvO2 and a significant increase in CO2 gap. There was a significant negative correlation between oxygen extraction and ScvO2 and significant positive correlation between oxygen extraction and CO2 gap. Taking ScvO2 < 73% and CO2 gap >6 mmHg values together to predict an oxygen extraction >30%, the positive predictive value is 100%; negative predicted value is 72%. Microcirculatory parameters, capillary perfusion rate and red blood cell velocity, decreased significantly over time. Similar changes were not observed in the sham group. Our data suggest that ScvO2 < 73% and CO2 gap >6 mmHg can be complementary tools in detecting hypovolemia-caused imbalance of oxygen extraction.
Collapse
|
26
|
van Genderen ME, Bartels SA, Lima A, Bezemer R, Ince C, Bakker J, van Bommel J. Peripheral Perfusion Index as an Early Predictor for Central Hypovolemia in Awake Healthy Volunteers. Anesth Analg 2013; 116:351-6. [DOI: 10.1213/ane.0b013e318274e151] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
27
|
Lightweight noninvasive trauma monitor for early indication of central hypovolemia and tissue acidosis. J Trauma Acute Care Surg 2012; 73:S106-11. [DOI: 10.1097/ta.0b013e318260a928] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Lipcsey M, Woinarski NC, Bellomo R. Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care. Ann Intensive Care 2012; 2:11. [PMID: 22569165 PMCID: PMC3488540 DOI: 10.1186/2110-5820-2-11] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 03/26/2012] [Indexed: 01/20/2023] Open
Abstract
Near infrared spectroscopy of the thenar eminence (NIRSth) is a noninvasive bedside method for assessing tissue oxygenation. The NIRS probe emits light with several wavelengths in the 700- to 850-nm interval and measures the reflected light mainly from a predefined depth. Complex physical models then allow the measurement of the relative concentrations of oxy and deoxyhemoglobin, and thus tissue saturation (StO2), as well as an approximation of the tissue hemoglobin, given as tissue hemoglobin index. Here we review of current knowledge of the application of NIRSth in anesthesia and intensive care. We performed an analytical and descriptive review of the literature using the terms “near-infrared spectroscopy” combined with “anesthesia,” “anesthesiology,” “intensive care,” “critical care,” “sepsis,” “bleeding,” “hemorrhage,” “surgery,” and “trauma” with particular focus on all NIRS studies involving measurement at the thenar eminence. We found that NIRSth has been applied as clinical research tool to perform both static and dynamic assessment of StO2. Specifically, a vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischemia. StO2 changes during such induced ischemia-reperfusion yield information on oxygen consumption and microvasculatory reactivity. Some evidence suggests that StO2 during VOT can detect fluid responsiveness during surgery. In hypovolemic shock, StO2 can help to predict outcome, but not in septic shock. In contrast, NIRS parameters during VOT increase the diagnostic and prognostic accuracy in both hypovolemic and septic shock. Minimal data are available on static or dynamic StO2 used to guide therapy. Although the available data are promising, further studies are necessary before NIRSth can become part of routine clinical practice.
Collapse
Affiliation(s)
- Miklos Lipcsey
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
| | | | | |
Collapse
|