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Grotowska M, Gozdzik W. Intraoperative intravenous infusion of lidocaine increases total and small vessel densities of sublingual microcirculation: a randomized prospective pilot study. J Int Med Res 2023; 51:3000605231209820. [PMID: 37940618 PMCID: PMC10637181 DOI: 10.1177/03000605231209820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE Multiple organ failure can occur as a result of postoperative complications. Research has indicated that the underlying mechanism of organ dysfunction is a microcirculation disorder. Because of its antioxidant and anti-inflammatory properties, lidocaine has the potential to improve microvascular blood flow. This study was performed to assess the effect of intraoperative intravenous lidocaine infusion on the microcirculation and determine the incidence of postoperative complications. METHODS In this prospective randomized double-blind pilot study, 12 patients scheduled for abdominal surgery were randomly allocated to receive an intraoperative infusion of either 1% lidocaine or the same volume of 0.9% sodium chloride solution. The microcirculation was monitored using sidestream dark-field imaging and the vascular occlusion test combined with near-infrared spectroscopy. RESULTS Lidocaine significantly increased the total vascular density and small vessel density after 2 hours of infusion, with preservation of 99% to 100% of the capillary perfusion in both groups. No patients developed organ failure. CONCLUSIONS An increase in vessel density may be beneficial in major abdominal surgeries because it is associated with better tissue perfusion and oxygen delivery. However, this finding requires further investigation in patients with increased surgical risk. Overall, this study indicates that lidocaine has potential to improve microvascular perfusion.Research Registry number: 9549 (https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650ffd27b3f547002bd7635f/).
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Affiliation(s)
- Małgorzata Grotowska
- Clinical Department of Anesthesiology and Intensive Therapy, University Hospital in Wroclaw, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Gozdzik
- Clinical Department of Anesthesiology and Intensive Therapy, University Hospital in Wroclaw, Wroclaw Medical University, Wroclaw, Poland
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Cousin N, Goutay J, Girardie P, Favory R, Drumez E, Mathieu D, Poissy J, Parmentier E, Duburcq T. Effects of high oxygen tension on healthy volunteer microcirculation. Diving Hyperb Med 2022; 52:260-270. [PMID: 36525683 PMCID: PMC10017198 DOI: 10.28920/dhm52.4.260-270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Previous studies have highlighted hyperoxia-induced microcirculation modifications, but few have focused on hyperbaric oxygen (HBO) effects. Our primary objective was to explore hyperbaric hyperoxia effects on the microcirculation of healthy volunteers and investigate whether these modifications are adaptative or not. METHODS This single centre, open-label study included 15 healthy volunteers. Measurements were performed under five conditions: T0) baseline value (normobaric normoxia); T1) hyperbaric normoxia; T2) hyperbaric hyperoxia; T3) normobaric hyperoxia; T4) return to normobaric normoxia. Microcirculatory data were gathered via laser Doppler, near-infrared spectroscopy and transcutaneous oximetry (PtcO₂). Vascular-occlusion tests were performed at each step. We used transthoracic echocardiography and standard monitoring for haemodynamic investigation. RESULTS Maximal alterations were observed under hyperbaric hyperoxia which led, in comparison with baseline, to arterial hypertension (mean arterial pressure 105 (SD 12) mmHg vs 95 (11), P < 0.001) and bradycardia (55 (7) beats·min⁻¹ vs 66 (8), P < 0.001) while cardiac output remained unchanged. Hyperbaric hyperoxia also led to microcirculatory vasoconstriction (rest flow 63 (74) vs 143 (73) perfusion units, P < 0.05) in response to increased PtcO₂ (104.0 (45.9) kPa vs 6.3 (2.4), P < 0.0001); and a decrease in laser Doppler parameters indicating vascular reserve (peak flow 125 (89) vs 233 (79) perfusion units, P < 0.05). Microvascular reactivity was preserved in every condition. CONCLUSIONS Hyperoxia significantly modifies healthy volunteer microcirculation especially during HBO exposure. The rise in PtcO₂ promotes an adaptative vasoconstrictive response to protect cellular integrity. Microvascular reactivity remains unaltered and vascular reserve is mobilised in proportion to the extent of the ischaemic stimulus.
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Affiliation(s)
- Nicolas Cousin
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Julien Goutay
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Patrick Girardie
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Raphaël Favory
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Elodie Drumez
- Unité de méthodologie - biostatistique et data management, CHU Lille, Lille, France
| | - Daniel Mathieu
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Julien Poissy
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Erika Parmentier
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Thibault Duburcq
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
- Corresponding author: Dr Thibault Duburcq, Centre Hospitalier Universitaire de Lille, Hôpital Roger Salengro - Centre de réanimation, Avenue du Professeur Emile Laine , 59037 LILLE Cedex, France,
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Haertel F, Reisberg D, Peters M, Nuding S, Schulze PC, Werdan K, Ebelt H. Predicting the Need for Renal Replacement Therapy Using a Vascular Occlusion Test and Tissue Oxygen Saturation in Patients in the Early Phase of Multiorgan Dysfunction Syndrome. J Clin Med 2022; 11:jcm11051420. [PMID: 35268511 PMCID: PMC8911273 DOI: 10.3390/jcm11051420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Acute kidney injury (AKI) is associated with an increased mortality in critically ill patients, especially in patients with multiorgan dysfunction syndrome (MODS). In daily clinical practice, the grading of AKI follows the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. In most cases, a relevant delay occurs frequently between the onset of AKI and detectable changes in creatinine levels as well as clinical symptoms. The aim of the present study was to examine whether a near infrared spectroscopy (NIRS)-based, non-invasive ischemia–reperfusion test (vascular occlusion test (VOT)) together with unprovoked (under resting conditions) tissue oxygen saturation (StO2) measurements, contain prognostic information in the early stage of MODS regarding the developing need for renal replacement therapy (RRT). Methods: Within a period of 18 months, patients at the medical intensive care unit of a tertiary university hospital with newly developed MODS (≤24 h after diagnosis, APACHE II score ≥20) were included in our study. The VOT occlusion slope (OS) and recovery slope (RS) were recorded in addition to unprovoked StO2. StO2 was determined non-invasively in the area of the thenar muscles using a bedside NIRS device. The VOT was carried out by inflating a blood pressure cuff on the upper arm. AKI stages were determined by the changes in creatinine levels, urinary output, and/or the need for RRT according to KDIGO. Results: 56 patients with MODS were included in the study (aged 62.5 ± 14.4 years, 40 men and 16 women, APACHE II score 34.5 ± 6.4). Incidences of the different AKI stages were: no AKI, 16.1% (n = 9); AKI stage I, 19.6% (n = 11); AKI stage II, 25% (n = 14); AKI stage III, 39.3% (n = 22). Thus, 39.3% of the patients (n = 22) developed the need for renal replacement therapy (AKI stage III). These patients had a significantly higher mortality over 28 days (RRT, 72% (n = 16/22) vs. no RRT, 44% (n = 15/34); p = 0.03). The mean unprovoked StO2 of all patients at baseline was 81.7 ± 11.1%, and did not differ between patients with or without the need for RRT. Patients with RRT showed significantly weaker negative values of the OS (−9.1 ± 3.7 vs. −11.7 ± 4.1%/min, p = 0.01) and lower values for the RS (1.7 ± 0.9 vs. 2.3 ± 1.6%/s, p = 0.02) compared to non-dialysis patients. Consistent with these results, weaker negative values of the OS were found in higher AKI stages (no AKI, −12.7 ± 4.1%/min; AKI stage I, −11.5 ± 3.0%/min; AKI stage II, −11.1 ± 3.3%/min; AKI stage III, −9.1 ± 3.7%/min; p = 0.021). Unprovoked StO2 did not contain prognostic information regarding the AKI stages. Conclusions: The weaker negative values of the VOT parameter OS are associated with an increased risk of developing AKI and RRT, and increased mortality in the early phase of MODS, while unprovoked StO2 does not contain prognostic information in that regard.
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Affiliation(s)
- Franz Haertel
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Correspondence: ; Tel.: +49-3641-9324-554
| | - Diana Reisberg
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Pädiatrie, Ameos Klinikum Aschersleben, Eislebener Str. 7A, 06449 Aschersleben, Germany
| | - Martin Peters
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin, Helios Klinikum Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | - Sebastian Nuding
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Krankenhaus “St. Elisabeth”, Mauerstr. 5, 06110 Halle (Saale), Germany
| | - P. Christian Schulze
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
| | - Karl Werdan
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
| | - Henning Ebelt
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Katholisches Krankenhaus “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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Mesquida J, Caballer A, Cortese L, Vila C, Karadeniz U, Pagliazzi M, Zanoletti M, Pacheco AP, Castro P, García-de-Acilu M, Mesquita RC, Busch DR, Durduran T. Peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:381. [PMID: 34749792 PMCID: PMC8575160 DOI: 10.1186/s13054-021-03803-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
Background COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. Methods This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). Results Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. Conclusion Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477. Retrospectively registered 30 December 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03803-2.
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Affiliation(s)
- Jaume Mesquida
- Àrea de Crítics, Parc Taulí Hospital Universitari, Parc Taulí, 1, 08208, Sabadell, Spain.
| | - A Caballer
- Àrea de Crítics, Parc Taulí Hospital Universitari, Parc Taulí, 1, 08208, Sabadell, Spain
| | - L Cortese
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - C Vila
- Servei de Medicina Intensiva, Parc Salut Mar Hospital, Barcelona, Spain
| | - U Karadeniz
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - M Pagliazzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - M Zanoletti
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | | | - P Castro
- Medical Intensive Care Unit, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - M García-de-Acilu
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - R C Mesquita
- Institute of Physics, University of Campinas, Campinas, Brazil
| | - D R Busch
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - T Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Performance Assessment of a Commercial Continuous-Wave Near-Infrared Spectroscopy Tissue Oximeter for Suitability for Use in an International, Multi-Center Clinical Trial. SENSORS 2021; 21:s21216957. [PMID: 34770264 PMCID: PMC8587042 DOI: 10.3390/s21216957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 01/17/2023]
Abstract
Despite the wide range of clinical and research applications, the reliability of the absolute oxygenation measurements of continuous wave near-infrared spectroscopy sensors is often questioned, partially due to issues of standardization. In this study, we have compared the performances of 13 units of a continuous wave near-infrared spectroscopy device (PortaMon, Artinis Medical Systems, NL) to test their suitability for being used in the HEMOCOVID-19 clinical trial in 10 medical centers around the world. Detailed phantom and in vivo tests were employed to measure the precision and reproducibility of measurements of local blood oxygen saturation and total hemoglobin concentration under different conditions: for different devices used, different operators, for probe repositioning over the same location, and over time (hours/days/months). We have detected systematic differences between devices when measuring phantoms (inter-device variability, <4%), which were larger than the intra-device variability (<1%). This intrinsic variability is in addition to the variability during in vivo measurements on the forearm muscle resulting from errors in probe positioning and intrinsic physiological noise (<9%), which was also larger than the inter-device differences (<3%) during the same test. Lastly, we have tested the reproducibility of the protocol of the HEMOCOVID-19 clinical trial; that is, forearm muscle oxygenation monitoring during vascular occlusion tests over days. Overall, our conclusion is that these devices can be used in multi-center trials but care must be taken to characterize, follow-up, and statistically account for inter-device variability.
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Valeanu L, Bubenek-Turconi SI, Ginghina C, Balan C. Hemodynamic Monitoring in Sepsis-A Conceptual Framework of Macro- and Microcirculatory Alterations. Diagnostics (Basel) 2021; 11:1559. [PMID: 34573901 PMCID: PMC8469937 DOI: 10.3390/diagnostics11091559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/22/2021] [Accepted: 08/26/2021] [Indexed: 12/29/2022] Open
Abstract
Circulatory failure in sepsis is common and places a considerable burden on healthcare systems. It is associated with an increased likelihood of mortality, and timely recognition is a prerequisite to ensure optimum results. While there is consensus that aggressive source control, adequate antimicrobial therapy and hemodynamic management constitute crucial determinants of outcome, discussion remains about the best way to achieve each of these core principles. Sound cardiovascular support rests on tailored fluid resuscitation and vasopressor therapy. To this end, an overarching framework to improve cardiovascular dynamics has been a recurring theme in modern critical care. The object of this review is to examine the nature of one such framework that acknowledges the growing importance of adaptive hemodynamic support combining macro- and microhemodynamic variables to produce adequate tissue perfusion.
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Affiliation(s)
- Liana Valeanu
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, “Prof. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania; (L.V.); (S.-I.B.-T.)
- Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy “Carol Davila”, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Serban-Ion Bubenek-Turconi
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, “Prof. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania; (L.V.); (S.-I.B.-T.)
- Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy “Carol Davila”, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Carmen Ginghina
- 3rd Department of Cardiology, “Prof. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania;
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Cosmin Balan
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, “Prof. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania; (L.V.); (S.-I.B.-T.)
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Prognostic Value of Tissue Oxygen Saturation Using a Vascular Occlusion Test in Patients in the Early Phase of Multiorgan Dysfunction Syndrome. Shock 2020; 51:706-712. [PMID: 30052575 DOI: 10.1097/shk.0000000000001225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is a common disease pattern in intensive care units which is associated with an increased mortality. The aim of this study was to investigate whether a near-infrared spectroscopy (NIRS)-based noninvasive ischemia-reperfusion test (vascular occlusion test) using the parameter of tissue oxygen saturation (StO2) contains prognostic information for patients in the early phase of MODS. METHODS Within a period of 18 months between 2010 and 2012, 56 patients who newly developed MODS (≤24 h after diagnosis, Acute Physiology and Chronic Health Evaluation [APACHE] II score ≥20, subgroups: cardiogenic MODS [cMODS] and septic MODS [sMODS]) were included into the study. The StO2 was determined non-invasively in the area of the thenar muscles using a bedside NIRS device, InSpectra Tissue Spectrometer Model 650 (Hutchinson Technology Inc., Hutchinson, MN). The VOT was carried out by inflating a blood pressure cuff on the upper arm 30 mmHg above systolic blood pressure for 5 min. The parameters occlusion slope (OS) and recovery slope (RS) were recorded. RESULTS Fifteen patients with cMODS and 41 patients with sMODS were included in the study (age: 62.5 ± 14.4 years, 40 men and 16 women, APACHE II score: 34.6 ± 6.4). Twenty-eight-day-mortality was 55.4% (cMODS: 7 out of 15 patients, sMODS: 24 out of 41 patients). The measurement of StO2 while applying the VOT at baseline showed an OS of -11.7 ± 3.7%/min and an RS of 2.2 ± 1.5%/s. Survivors had significantly better values compared with non-survivors at baseline regarding OS (-12.8 ± 3.5%/min vs. -9.8 ± 3.4%/min; P = 0.016) and RS (2.6 ± 1.7%/s vs. 1.6 ± 1.0%/s; P = 0.022). Receiver-operating characteristic (ROC) curves show that the area under the curve (AUC) for OS was found to be significantly related to 28-day mortality (AUC: 0.7; 95% confidence interval [CI]: 0.56-0.85; P = 0.01). However, using both univariate and multivariate binary logistic regression models, RS was significantly associated with increased 28-day mortality (OR [univariate model]: 1.21 [95% CI: 1.1-1.8]; OR [multivariate model]: 1.23 [95% CI: 1.1-1.3]). CONCLUSIONS Impaired values of the VOT-parameters OS and RS are associated with an increased 28-day mortality in patients in the early phase of MODS.
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Tam E, Bruseghini P, Capelli C, Baraldo M, Chiamulera C, Zandonai T. Effects of nicotine on microvascular responsiveness after nicotine satiety versus overnight nicotine abstinence. Vasc Med 2020; 25:223-225. [PMID: 32202231 DOI: 10.1177/1358863x20906029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Enrico Tam
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Bruseghini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Carlo Capelli
- Department of Physical Performances, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Cristiano Chiamulera
- Neuropsychopharmacology Lab, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Thomas Zandonai
- Department of Experimental Psychology, Mind, Brain and Behaviour Research Centre, Faculty of Psychology, University of Granada, Granada, Spain.,Alicante Institute for Health and Biomedical Research, ISABIAL-FISABIO Foundation, Neuropharmacology on Pain, Miguel Hernández University, Elche, Alicante, Spain
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Feldmann A, Schmitz R, Erlacher D. Near-infrared spectroscopy-derived muscle oxygen saturation on a 0% to 100% scale: reliability and validity of the Moxy Monitor. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-11. [PMID: 31741352 PMCID: PMC7003144 DOI: 10.1117/1.jbo.24.11.115001] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/24/2019] [Indexed: 05/31/2023]
Abstract
Near-infrared spectroscopy (NIRS) to monitor muscle oxygen saturation (SmO2) is rapidly expanding into applied sports settings. However, the technology is limited due to its inability to convey quantifiable values. A test battery to assess reliability and validity of a 0% to 100% scale modeled by a commercially available NIRS device was established. This test battery applies a commonly used technique, the arterial occlusion method (AOM) to assess repeatability, reproducibility, and face validity. A total of 22 participants completed the test battery to scrutinize the 0% to 100% scale provided by the device. All participants underwent repeated AOM tests in passive and active conditions. The SmO2 minimum and SmO2 maximum values were obtained from the AOM and were used in the subsequent analysis. Repeatability and reproducibility were tested for equivalency and Bland-Altman plots were generated. Face validity was assessed by testing SmO2 values against an a priori; defined threshold for mixed venous blood during AOM response. The device exhibits an appropriately functional 0% to 100% scale that is reliable in terms of repeatability and reproducibility. Under the conditions applied in the test battery design, the device is considered valid for application in sports.
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Affiliation(s)
- Andri Feldmann
- University of Bern, Institute of Sport Science, Bern, Switzerland
| | | | - Daniel Erlacher
- University of Bern, Institute of Sport Science, Bern, Switzerland
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Near-infrared spectroscopy for assessing microcirculation during laparoscopic gynaecological surgery under combined spinal-general anaesthesia or general anaesthesia alone: a randomised controlled trial. J Clin Monit Comput 2019; 34:943-953. [DOI: 10.1007/s10877-019-00406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/19/2019] [Indexed: 12/26/2022]
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Agarwal R, Chaudhry B, Jansen K, O'Sullivan J, Hudson M, Allen J, Coats L. Tissue oxygen saturation assessment of microvascular perfusion in adults with Fontan palliation and comparator groups using vascular optical spectrophotometry: a pilot study. Physiol Meas 2019; 40:06NT01. [PMID: 31051474 DOI: 10.1088/1361-6579/ab1f1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The Fontan operation greatly improves survival for single ventricle congenital heart disease patients but creates a physiology that leads to long-term multi-organ dysfunction. A non-invasive screening tool that can identify impending decline is sought. The objective of this pilot study was to assess the microcirculation in Fontan-palliated patients by measuring tissue oxygen saturation (StO2) in superficial and deeper tissues. APPROACH Three patient cohorts were studied: Fontan group (n = 8) and two patient control groups, liver disease group (n = 8) and tetralogy of Fallot group (n = 9). 22 healthy controls were also examined. Superficial and deeper StO2 was measured at the forearm, thenar eminence, index and ring fingers of both arms using the LEA O2C spectrophotometry device. MAIN RESULTS Superficial StO2 was reduced in Fontan patients compared to healthy controls (p = 0.002) and tetralogy patients (p = 0.016), but not compared to the liver group (p = 0.313). Deeper StO2 was similar between groups (p = 0.112). The gap between deeper and superficial StO2 was raised in Fontan patients compared to healthy controls (p = 0.001) and tetralogy patients (p = 0.037), but not compared to the liver group (p = 0.504). There was no clinically relevant difference in StO2 between the left and right arms, and the variation in StO2 according to measurement site was similar between the four groups. SIGNIFICANCE Vascular optical spectrophotometry is a feasible non-invasive measure of micro-circulatory function that can easily be performed in the clinic setting and may have utility in patients with Fontan circulations. Further, we provide important normal range data in the healthy control population which can be used to design future studies.
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Affiliation(s)
- Raksheeth Agarwal
- Newcastle University Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, NE1 3BZ, United Kingdom
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Kanick SC, Schneider PA, Klitzman B, Wisniewski NA, Rebrin K. Continuous monitoring of interstitial tissue oxygen using subcutaneous oxygen microsensors: In vivo characterization in healthy volunteers. Microvasc Res 2019; 124:6-18. [PMID: 30742844 PMCID: PMC6570499 DOI: 10.1016/j.mvr.2019.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/19/2022]
Abstract
Measurements of regional tissue oxygen serve as a proxy to monitor local perfusion and have the potential to guide therapeutic decisions in multiple clinical disciplines. Transcutaneous oximetry (tcpO2) is a commercially available noninvasive technique that uses an electrode to warm underlying skin tissue and measure the resulting oxygen tension at the skin surface. A novel approach is to directly measure interstitial tissue oxygen using subcutaneous oxygen microsensors composed of a biocompatible hydrogel carrier platform with embedded oxygen sensing molecules. After initial injection of the hydrogel into subcutaneous tissue, noninvasive optical measurements of phosphorescence-based emissions at the skin surface are used to sense oxygen in the subcutaneous interstitial space. The object of the present study was to characterize the in vivo performance of subcutaneous microsensors and compare with transcutaneous oximetry (tcpO2). Vascular occlusion tests were performed on the arms of 7 healthy volunteers, with repeated tests occurring 1 to 10 weeks after sensor injection, yielding 95 total tests for analysis. Comparative analysis characterized the response of both devices to decreases in tissue oxygen during occlusion and to increases in tissue oxygen following release of the occlusion. Results indicated: (I) time traces returned by microsensors and tcpO2 were highly correlated, with the median (interquartile range) correlation coefficient of r = 0.93 (0.10); (II) both microsensors and tcpO2 sensed a statistically significant decrease in normalized oxygen during occlusion (p < 0.001 for each device); (III) microsensors detected faster rates change (p < 0.001) and detected overshoot during recovery more frequently (38% vs. 4% of tests); (IV) inter-measurement analysis showed no correlation of baseline values between microsensors and tcpO2 (r = 0.03), but comparison of integrated oxygen dynamics showed similar variation in the normalized response to occlusion between devices (p = 0.06), (V) intra-measurement analysis revealed that microsensors detect greater physiological fluctuations than tcpO2 (p < 0.001) and may provide enhanced sensitivity to processes such as vasomotion. Additionally, the functional response of microsensors was not significantly different across time groupings (per month) post-injection (p = 0.61). Although the compared devices have differences in the mechanisms used to sense oxygen, these findings demonstrate that subcutaneous oxygen microsensors measure changes in interstitial tissue oxygen in human subjects in vivo.
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Affiliation(s)
| | | | - Bruce Klitzman
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University, Durham, NC, USA
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13
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Mesquida J, Espinal C, Saludes P, Cortés E, Pérez-Madrigal A, Gruartmoner G. Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (P cvaCO 2/C avO 2) reflects microcirculatory oxygenation alterations in early septic shock. J Crit Care 2019; 53:162-168. [PMID: 31247515 DOI: 10.1016/j.jcrc.2019.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/16/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To explore the relationship between central venous-to-arterial carbon dioxide difference (PcvaCO2), PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) and the microcirculatory status, evaluated by using near-infrared spectroscopy, in septic shock patients. METHODS Observational study in a 30-bed mixed ICU. Fifty septic shock patients within the first 24 h of ICU admission were studied. After restoration of mean arterial pressure, hemodynamic, metabolic and microcirculatory parameters were simultaneously evaluated. Local tissue oxygen saturation (StO2), and local hemoglobin index (THI) were measured on the thenar eminence by means of near-infrared spectroscopy. A transient vascular occlusion test was performed in order to obtain StO2 deoxygenation rate (DeO2), local oxygen consumption (nirVO2), and reoxgenation rate (ReO2). RESULTS At inclusion, increased PcvaCO2 values were associated with lower StO2 and THI, whereas increased PcvaCO2/CavO2 values were associated with lower DeO2, nirVO2, and ReO2. Multiple regression models confirmed the association between PcvaCO2/CavO2 and nirVO2, while PcvaCO2 was only related to CI, and not to microcirculatory parameters. CONCLUSIONS In a population of early septic shock patients, increases in PcvaCO2 and PcvaCO2/CavO2 reflected different alterations at the microcirculatory level. While PcvaCO2 was related to global flow, the PcvaCO2/CavO2 ratio was associated to impaired local oxygen utilization and diminished microvascular reactivity.
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Affiliation(s)
- J Mesquida
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - C Espinal
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - P Saludes
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - E Cortés
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain.
| | - A Pérez-Madrigal
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - G Gruartmoner
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Prebiotic Effect of Lycopene and Dark Chocolate on Gut Microbiome with Systemic Changes in Liver Metabolism, Skeletal Muscles and Skin in Moderately Obese Persons. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4625279. [PMID: 31317029 PMCID: PMC6604498 DOI: 10.1155/2019/4625279] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/01/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022]
Abstract
Lycopene rich food and dark chocolate are among the best-documented products with a broad health benefit. This study explored the systemic effect of lycopene and dark chocolate (DC) on gut microbiota, blood, liver metabolism, skeletal muscle tissue oxygenation and skin. 30 volunteers were recruited for this trial, 15 women and 15 men with a mean age of 55 ± 5.7 years and with moderate obesity, 30 < BMI < 35 kg/m2. They were randomized and divided into five equal interventional groups: three received different formulations of lycopene, one of them with a 7 mg daily dose and two with 30 mg; another group was given 10 g of DC with 7 mg lycopene embedded into its matrix, and the last group received 10 g DC. The trial was double-blinded for the three lycopene groups and separately for the 2 DC groups; the trial lasted for 1 month. By the end of the trial there were dose-dependent changes in the gut microbiota profile in all three lycopene groups with an increase of relative abundance of, e.g., Bifidobacterium adolescentis and Bifidobacterium longum. This was also accompanied by dose-dependent changes in the blood, liver metabolism, skeletal muscle and skin parameters. Consumption of DC resulted in increased relative abundance of, e.g., Lactobacillus and a reduction of corneocyte exfoliation. This is the first study which reports the prebiotic potential of lycopene and DC.
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Zheng YY, Guo F, Lu B, Li Q. Comment on the article: "Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery". CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:121. [PMID: 30992029 PMCID: PMC6469045 DOI: 10.1186/s13054-019-2412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/27/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Ye Ying Zheng
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province, China.
| | - Fei Guo
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province, China
| | - Bin Lu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province, China
| | - Qiang Li
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan Province, China
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Huber W, Zanner R, Schneider G, Schmid R, Lahmer T. Assessment of Regional Perfusion and Organ Function: Less and Non-invasive Techniques. Front Med (Lausanne) 2019; 6:50. [PMID: 30968023 PMCID: PMC6438879 DOI: 10.3389/fmed.2019.00050] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 02/25/2019] [Indexed: 12/13/2022] Open
Abstract
Sufficient organ perfusion essentially depends on preserved macro- and micro-circulation. The last two decades brought substantial progress in the development of less and non-invasive monitoring of macro-hemodynamics. However, several recent studies suggest a frequent incoherence of macro- and micro-circulation. Therefore, this review reports on interactions of macro- and micro-circulation as well as on specific regional and micro-circulation. Regarding global micro-circulation the last two decades brought advances in a more systematic approach of clinical examination including capillary refill time, a graded assessment of mottling of the skin and accurate measurement of body surface temperatures. As a kind of link between macro- and microcirculation, a number of biochemical markers can easily be obtained. Among those are central-venous oxygen saturation (ScvO2), plasma lactate and the difference between central-venous and arterial CO2 (cv-a-pCO2-gap). These inexpensive markers have become part of clinical routine and guideline recommendations. While their potential to replace parameters of macro-circulation such as cardiac output (CO) is limited, they facilitate the interpretation of the adequacy of CO and other macro-circulatory markers. Furthermore, they give additional hints on micro-circulatory impairment. In addition, a number of more sophisticated technical approaches to quantify and visualize micro-circulation including video-microscopy, laser flowmetry, near-infrared spectroscopy (NIRS), and partial oxygen pressure measurement have been introduced within the last 20 years. These technologies have been extensively used for scientific purposes. Moreover, they have been successfully used for educational purposes and to visualize micro-circulatory disturbances during sepsis and other causes of shock. Despite several studies demonstrating the association of these techniques and parameters with outcome, their practical application still is limited. However, future improvements in automated and “online” diagnosis will help to make these technologies more applicable in clinical routine. This approach is promising with regard to several studies which demonstrated the potential to guide therapy in different types of shock. Finally several organs have specific patterns of circulation related to their special anatomy (liver) or their auto-regulatory capacities (brain, kidney). Therefore, this review also discusses specific issues of monitoring liver, brain, and kidney circulation and function.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Robert Zanner
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Gerhard Schneider
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Domizi R, Damiani E, Scorcella C, Carsetti A, Castagnani R, Vannicola S, Bolognini S, Gabbanelli V, Pantanetti S, Donati A. Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study. PLoS One 2019; 14:e0213085. [PMID: 30835764 PMCID: PMC6400441 DOI: 10.1371/journal.pone.0213085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 02/14/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previous studies described impaired microvascular perfusion and tissue oxygenation as reliable predictors of Multiple Organ Failure in major trauma. However, this relationship has been incompletely investigated. The objective of this analysis is to further evaluate the association between organ dysfunction and microcirculation after trauma. MATERIALS AND METHODS This is a retrospective subgroup analysis on 28 trauma patients enrolled for the Microcirculation DAIly MONitoring in critically ill patients study (NCT 02649088). Patients were divided in two groups according with their Sequential Organ Failure Assessment (SOFA) score at day 4. At admission and every 24 hours, the sublingual microcirculation was evaluated with Sidestream Darkfield Imaging (SDF) and peripheral tissue perfusion was assessed with Near Infrared Spectroscopy (NIRS) and Vascular Occlusion Test (VOT). Simultaneously, hemodynamic, clinical/laboratory parameters and main organ supports were collected. RESULTS Median SOFA score at Day 4 was 6.5. Accordingly, patients were divided in two groups: D4-SOFA ≤6.5 and D4-SOFA >6.5. The Length of Stay in Intensive Care was significantly higher in patients with D4-SOFA>6.5 compared to D4-SOFA≤6.5 (p = 0.013). Total Vessel Density of small vessels was significantly lower in patients with high D4-SOFA score at Day 1 (p = 0.002) and Day 2 (p = 0.006) after admission; the Perfused Vessel Density was lower in patients with high D4-SOFA score at Day 1 (p = 0.007) and Day 2 (p = 0.033). At Day 1, NIRS monitoring with VOT showed significantly faster tissue oxygen saturation downslope (p = 0.018) and slower upslope (p = 0.04) in patients with high D4-SOFA. DISCUSSION In our cohort of major traumas, sublingual microcirculation and peripheral microvascular reactivity were significantly more impaired early after trauma in those patients who developed more severe organ dysfunctions. Our data would support the hypothesis that restoration of macrocirculation can be dissociated from restoration of peripheral and tissue perfusion, and that microvascular alterations can be associated with organ failure.
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Affiliation(s)
- Roberta Domizi
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Elisa Damiani
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Claudia Scorcella
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Carsetti
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Castagnani
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Sara Vannicola
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Sandra Bolognini
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Vincenzo Gabbanelli
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Simona Pantanetti
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Abele Donati
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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Loggi S, Mininno N, Damiani E, Marini B, Adrario E, Scorcella C, Domizi R, Carsetti A, Pantanetti S, Pagliariccio G, Carbonari L, Donati A. Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study. BMC Anesthesiol 2019; 19:1. [PMID: 30611197 PMCID: PMC6320625 DOI: 10.1186/s12871-018-0673-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/26/2018] [Indexed: 12/19/2022] Open
Abstract
Background In vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patients undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia. Methods Prospective observational study. Patients undergoing elective open infrarenal abdominal aortic aneurysm repair received balanced (desflurane + remifentanil, n = 20) or total intravenous anaesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n = 20) according to the clinician’s decision. A goal-directed haemodynamic management was applied in all patients. Measurements were obtained before anaesthesia induction (baseline) and at end-surgery and included haemodynamics, arterial/venous blood gases, sublingual microvascular flow and density (incident dark field illumination imaging), peripheral muscle tissue oxygenation and microcirculatory reactivity (thenar near infrared spectroscopy with a vascular occlusion test). Results The two groups did not differ for baseline characteristics, mean aortic-clamping time and requirement of vasoactive agents during surgery. Changes in mean arterial pressure, systemic vascular resistance index, haemoglobin and blood lactate levels were similar between the two groups, while the cardiac index increased at end-surgery in patients undergoing balanced anaesthesia. The sublingual microcirculation was globally unaltered in the TIVA group at end-surgery, while patients undergoing balanced anaesthesia showed an increase in the total and perfused small vessel densities (from 16.6 ± 4.2 to 19.1 ± 5.4 mm/mm2, p < 0.05). Changes in microvascular density were negatively correlated with changes in the systemic vascular resistance index. The area of reactive hyperaemia during the VOT increased in the balanced anaesthesia group (from 14.8 ± 8.1 to 25.6 ± 14.8%*min, p < 0.05). At end-surgery, the tissue haemoglobin index in the TIVA group was lower than that in the balanced anaesthesia group. Conclusions In patients undergoing elective open abdominal aortic aneurysm repair with a goal-directed hemodynamic management, indices of sublingual or peripheral microvascular perfusion/oxygenation were globally preserved with both balanced anaesthesia and TIVA. Patients undergoing balanced anaesthesia showed microvascular recruitment at end-surgery. Trial registration NCT03510793, https://www.clinicaltrials.gov, date of registration April 27th 2018, retrospectively registered.
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Affiliation(s)
- Silvia Loggi
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Nicoletta Mininno
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Elisa Damiani
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Benedetto Marini
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Erica Adrario
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Claudia Scorcella
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Roberta Domizi
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Andrea Carsetti
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Simona Pantanetti
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy
| | - Gabriele Pagliariccio
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria "Ospedali Riuniti Umberto I - Lancisi - Salesi" of Ancona, Ancona, Italy
| | - Luciano Carbonari
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria "Ospedali Riuniti Umberto I - Lancisi - Salesi" of Ancona, Ancona, Italy
| | - Abele Donati
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Torrette di Ancona, Italy.
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Petyaev IM, Dovgalevsky PY, Klochkov VA, Chalyk NE, Pristensky DV, Chernyshova MP, Udumyan R, Kocharyan T, Kyle NH, Lozbiakova MV, Bashmakov YK. Effect of lycopene supplementation on cardiovascular parameters and markers of inflammation and oxidation in patients with coronary vascular disease. Food Sci Nutr 2018; 6:1770-1777. [PMID: 30258622 PMCID: PMC6145244 DOI: 10.1002/fsn3.734] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 01/23/2018] [Accepted: 06/08/2018] [Indexed: 02/06/2023] Open
Abstract
Oxidative stress and antioxidant deficiency play a pivotal role in initiation, development, and outcomes of cardiovascular disease. Pharmacokinetic parameters as well as the impact of highly bioavailable lycopene on cardiovascular variables, markers of inflammation and oxidation were investigated during a 30-day clinical trial in patients with coronary vascular disease. The patients were randomized into two major groups and were supplemented with a single 7 mg daily dose of lycopene ingested either in the form of lactolycopene (68 patients) or in the form of lycosome-formulated GA lycopene (74 patients). The endpoints included cardiovascular function parameters, serum lipids, and four markers of oxidative stress and inflammation. Ingestion of lycosome-formulated lycopene increased serum lycopene levels by 2.9- and 4.3-fold, respectively, after 2 and 4 weeks of the trial, whereas supplementation with lactolycopene upregulated serum lycopene by half-fold only after 4 weeks of ingestion. Lycosome formulation of lycopene resulted by the end of the trial in a threefold reduction in Chlamydia pneumoniae IgG and reduction to the same degree of the inflammatory oxidative damage marker. The decrease in oxidized LDL caused by lycosome-formulated lycopene was fivefold. Moreover, supplementation with lycosome-formulated lycopene was accompanied by a significant increase in tissue oxygenation and flow-mediated dilation by the end of the observational period. In contrast, lactolycopene did not cause any significant changes in the parameters studied. Therefore, enhanced bioavailability of lycopene promotes its antioxidant and anti-inflammatory functions and endorses a positive effect of lycopene on cardiovascular system.
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Affiliation(s)
| | | | | | | | | | | | - Ruzan Udumyan
- Orebro University Hospital and School of Health and Medical SciencesOrebro UniversityÖrebroSweden
| | - Taron Kocharyan
- Orebro University Hospital and School of Health and Medical SciencesOrebro UniversityÖrebroSweden
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Tafner PFDA, Chen FK, Rabello R, Corrêa TD, Chaves RCDF, Serpa A. Recent advances in bedside microcirculation assessment in critically ill patients. Rev Bras Ter Intensiva 2018; 29:238-247. [PMID: 28977264 PMCID: PMC5496759 DOI: 10.5935/0103-507x.20170033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/18/2016] [Indexed: 12/22/2022] Open
Abstract
Parameters related to macrocirculation, such as the mean arterial pressure, central venous pressure, cardiac output, mixed venous saturation and central oxygen saturation, are commonly used in the hemodynamic assessment of critically ill patients. However, several studies have shown that there is a dissociation between these parameters and the state of microcirculation in this group of patients. Techniques that allow direct viewing of the microcirculation are not completely disseminated, nor are they incorporated into the clinical management of patients in shock. The numerous techniques developed for microcirculation assessment include clinical assessment (e.g., peripheral perfusion index and temperature gradient), laser Doppler flowmetry, tissue oxygen assessment electrodes, videomicroscopy (orthogonal polarization spectral imaging, sidestream dark field imaging or incident dark field illumination) and near infrared spectroscopy. In the near future, the monitoring and optimization of tissue perfusion by direct viewing and microcirculation assessment may become a goal to be achieved in the hemodynamic resuscitation of critically ill patients.
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Affiliation(s)
| | | | - Roberto Rabello
- Unidade de Terapia Intensiva Adulto, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | - Thiago Domingos Corrêa
- Unidade de Terapia Intensiva Adulto, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | | | - Ary Serpa
- Unidade de Terapia Intensiva Adulto, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
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Ng NYY, Ang HHE, Tan JCL, Ho WH, Kuan WS, Chua MT. Evaluation for occult sepsis incorporating NIRS and emergency sonography. Am J Emerg Med 2018. [PMID: 29530355 DOI: 10.1016/j.ajem.2018.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE We aim to determine whether the combination of regional tissue oxygen saturation (StO2) measurement using near-infrared spectroscopy (NIRS), inferior vena cava (IVC) collapsibility and ejection fraction (EF) is able to detect occult sepsis. METHODS We included adult patients in the emergency department with at least one of the following: fever; any one component of the quick sepsis-related organ function assessment (SOFA) score; heart rate≥100 beats per minute; or white cell count <4.0×109/L or >12.0×109/L. StO2 parameters, IVC collapsibility and EF were assessed. Primary outcome was composite of admission to intensive care unit, hypotension requiring fluid resuscitation or vasopressor use, and antibiotic escalation. RESULTS We included 184 patients with mean age of 55.4years and slight male predominance (51.6%). Increase in temperature (adjusted odds ratio [aOR] 3.05; 95% confidence interval [CI] 1.16 to 8.02), higher white cell counts (aOR 1.10; 95% CI 1.03 to 1.19), increase in time taken to new StO2 baseline (aOR 1.03; 95% CI 1.01 to 1.06) and reduced EF (aOR 33.9; 95% CI 2.19 to 523.64) had higher odds of achieving the primary outcome. CONCLUSION Change in StO2 and time taken to reach new StO2 baseline, combined with EF could potentially predict sepsis among patients with infection.
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Affiliation(s)
- Natalie Yu Yi Ng
- Heidelberg University School of Medicine, Im Neuenheimer Feld 346, 69120 Heidelberg, Germany
| | - Hannah Hui En Ang
- Emergency Medicine Department, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore.
| | - Jacqueline Chieh Ling Tan
- Emergency Medicine Department, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore.
| | - Weng Hoe Ho
- Emergency Medicine Department, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore.
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McManus CJ, Collison J, Cooper CE. Performance comparison of the MOXY and PortaMon near-infrared spectroscopy muscle oximeters at rest and during exercise. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-14. [PMID: 29368457 DOI: 10.1117/1.jbo.23.1.015007] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/04/2018] [Indexed: 05/23/2023]
Abstract
The purpose of the study was to compare muscle oxygenation as measured by two portable, wireless near-infrared spectroscopy (NIRS) devices under resting and dynamic conditions. A recently developed low-cost NIRS device (MOXY) was compared against an established PortaMon system that makes use of the spatially resolved spectroscopy algorithm. The influence of increasing external pressure on tissue oxygen saturation index (TSI) indicated that both devices are stable between 2 and 20 mmHg. However, above this pressure, MOXY reports declining TSI values. Analysis of adipose tissue thickness (ATT) and TSI shows a significant, nonlinear difference between devices at rest. The devices report similar TSI (%) values at a low ATT (<7 mm) (PortaMon minus MOXY difference is +1.1±2.8%) with the major subsequent change between the devices occurring between 7 and 10 mm; at ATT values >10 mm the difference remains constant (-14.7±2.8%). The most likely explanation for this difference is the small source-detector separation (2.5 cm) in the MOXY resulting in lower tissue penetration into muscle in subjects with higher ATT. Interday test-retest reliability of resting TSI was evaluated on five separate occasions, with the PortaMon reporting a lower coefficient of variation (1.8% to 2.5% versus 5.7% to 6.2%). In studies on male subjects with low ATT, decreases in the TSI were strongly correlated during isometric exercise, arterial occlusion, and incremental arm crank exercise. However, the MOXY reports a greater dynamic range, particularly during ischemia induced by isometric contraction or occlusion (Δ74.3% versus Δ43.7%; hyperemia MAX-occlusion MIN). This study shows that in this subject group both MOXY and PortaMon produce physiologically credible TSI measures during rest and exercise. However, the absolute values obtained during exercise are generally not comparable between devices unless corrected by physiological calibration following an arterial occlusion.
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Affiliation(s)
- Chris J McManus
- University of Essex, School of Sport, Rehabilitation and Exercise Sciences, Colchester, United Kingdom
| | - Jay Collison
- University of Essex, School of Sport, Rehabilitation and Exercise Sciences, Colchester, United Kingdom
| | - Chris E Cooper
- University of Essex, School of Sport, Rehabilitation and Exercise Sciences, Colchester, United Kingdom
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Abstract
Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds). Here, we explore approaches to TDM that address the above gaps.
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Affiliation(s)
- Chris Markham
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA
| | - Sara Small
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Peter Hovmand
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Allan Doctor
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA.
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Donati A, Damiani E, Zuccari S, Domizi R, Scorcella C, Girardis M, Giulietti A, Vignini A, Adrario E, Romano R, Mazzanti L, Pelaia P, Singer M. Effects of short-term hyperoxia on erythropoietin levels and microcirculation in critically Ill patients: a prospective observational pilot study. BMC Anesthesiol 2017; 17:49. [PMID: 28335733 PMCID: PMC5364633 DOI: 10.1186/s12871-017-0342-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/16/2017] [Indexed: 01/24/2023] Open
Abstract
Background The normobaric oxygen paradox states that a short exposure to normobaric hyperoxia followed by rapid return to normoxia creates a condition of ‘relative hypoxia’ which stimulates erythropoietin (EPO) production. Alterations in glutathione and reactive oxygen species (ROS) may be involved in this process. We tested the effects of short-term hyperoxia on EPO levels and the microcirculation in critically ill patients. Methods In this prospective, observational study, 20 hemodynamically stable, mechanically ventilated patients with inspired oxygen concentration (FiO2) ≤0.5 and PaO2/FiO2 ≥ 200 mmHg underwent a 2-hour exposure to hyperoxia (FiO2 1.0). A further 20 patients acted as controls. Serum EPO was measured at baseline, 24 h and 48 h. Serum glutathione (antioxidant) and ROS levels were assessed at baseline (t0), after 2 h of hyperoxia (t1) and 2 h after returning to their baseline FiO2 (t2). The microvascular response to hyperoxia was assessed using sublingual sidestream dark field videomicroscopy and thenar near-infrared spectroscopy with a vascular occlusion test. Results EPO increased within 48 h in patients exposed to hyperoxia from 16.1 [7.4–20.2] to 22.9 [14.1–37.2] IU/L (p = 0.022). Serum ROS transiently increased at t1, and glutathione increased at t2. Early reductions in microvascular density and perfusion were seen during hyperoxia (perfused small vessel density: 85% [95% confidence interval 79–90] of baseline). The response after 2 h of hyperoxia exposure was heterogeneous. Microvascular perfusion/density normalized upon returning to baseline FiO2. Conclusions A two-hour exposure to hyperoxia in critically ill patients was associated with a slight increase in EPO levels within 48 h. Adequately controlled studies are needed to confirm the effect of short-term hyperoxia on erythropoiesis. Trial registration ClinicalTrials.gov (www.clinicaltrials.gov), NCT02481843, registered 15th June 2015, retrospectively registered
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Affiliation(s)
- Abele Donati
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy.
| | - Elisa Damiani
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy
| | - Samuele Zuccari
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy
| | - Roberta Domizi
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy
| | - Claudia Scorcella
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy
| | - Massimo Girardis
- Department of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100, Modena, Italy
| | - Alessia Giulietti
- Department of Clinical Sciences, Section of Biochemistry, Università Politecnica delle Marche, via Tronto 10, 60126, Torrette di Ancona, Italy
| | - Arianna Vignini
- Department of Clinical Sciences, Section of Biochemistry, Università Politecnica delle Marche, via Tronto 10, 60126, Torrette di Ancona, Italy
| | - Erica Adrario
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy
| | - Rocco Romano
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy
| | - Laura Mazzanti
- Department of Clinical Sciences, Section of Biochemistry, Università Politecnica delle Marche, via Tronto 10, 60126, Torrette di Ancona, Italy
| | - Paolo Pelaia
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10, 6126, Torrette di Ancona, Italy
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, Gower Street, London, WC1E 6BT, UK
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Microcirculatory monitoring in septic patients: Where do we stand? Med Intensiva 2017; 41:44-52. [PMID: 28104277 DOI: 10.1016/j.medin.2016.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/09/2016] [Accepted: 11/13/2016] [Indexed: 11/23/2022]
Abstract
Microcirculatory alterations play a pivotal role in sepsis-related morbidity and mortality. However, since the microcirculation has been a "black box", current hemodynamic management of septic patients is still guided by macrocirculatory parameters. In the last decades, the development of several technologies has shed some light on microcirculatory evaluation and monitoring, and the possibility of incorporating microcirculatory variables to clinical practice no longer seems to be beyond reach. The present review provides a brief summary of the current technologies for microcirculatory evaluation, and attempts to explore the potential role and benefits of their integration to the resuscitation process in critically ill septic patients.
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Charlton M, Sims M, Coats T, Thompson JP. The microcirculation and its measurement in sepsis. J Intensive Care Soc 2016; 18:221-227. [PMID: 29118834 DOI: 10.1177/1751143716678638] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The microcirculation describes the smallest elements of the cardiovascular conducting system and is pivotal in the maintenance of homeostasis. Microcirculatory dysfunction is present early in the pathophysiology of sepsis, with the extent of microcirculatory derangement relating to disease severity and prognosis in ICU patients. However, at present microcirculatory function is not routinely monitored at the bedside. This article describes the pathophysiology of microcirculatory derangements in sepsis, methods of its measurement and evidence to support their clinical use.
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Affiliation(s)
- Matthew Charlton
- Anaesthetics and Critical Care, Diagnostic Development Unit, University of Leicester, Leicester, UK
| | - Mark Sims
- Astrobiology and Space Instrumentation, Diagnostic Development Unit, University of Leicester, Leicester, UK
| | - Tim Coats
- Emergency Medicine, Diagnostic Development Unit, University of Leicester, Leicester, UK
| | - Jonathan P Thompson
- Anaesthetics and Critical Care, Diagnostic Development Unit, University of Leicester, Leicester, UK
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Podbregar M, Gavric AU, Podbregar E, Mozina H, Stefanovic S. Red blood cell transfusion and skeletal muscle tissue oxygenation in anaemic haematologic outpatients. Radiol Oncol 2016; 50:449-455. [PMID: 27904454 PMCID: PMC5120575 DOI: 10.1515/raon-2015-0046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/06/2015] [Indexed: 12/15/2022] Open
Abstract
Background Stored red blood cells (RBCs) accumulate biochemical and biophysical changes, known as storage lesion. The aim of this study was to re-challenge current data that anaemia in chronically anaemic haematology patients is not associated with low skeletal muscle tissue oxygen (StO2), and that RBC storage age does not influence the tissue response after ischaemic provocation, using near-infrared spectroscopy. Patients and methods Twenty-four chronic anaemic haematology patients were included. Thenar skeletal muscle StO2 was measured at rest (basal StO2), with vascular occlusion testing (upslope StO2, maximum StO2) before and after transfusion. Results Basal StO2 was low (53% ± 7%). Average RBC storage time was 10.5 ± 3.9 days. Effects of RBC transfusions were as follows: basal StO2 and upslope StO2 did not change significantly; maximum StO2 increased compared to baseline (64 ± 14% vs. 59 ± 10%, p = 0.049). Change of basal StO2, upslope StO2 and maximum StO2 was negatively related to age of RBCs. The decrease of maximum StO2 was predicted (sensitivity 70%, specificity 100%), after receiving RBCs ≥ 10days old. Discussion Resting skeletal muscle StO2 in chronic anaemic patients is low. RBC storage time affects skeletal muscle StO2 in the resting period and after ischaemic provocation.
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Affiliation(s)
- Matej Podbregar
- Clinical Department for Anaesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Eva Podbregar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Hugon Mozina
- Emergency Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
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28
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Donati A, Damiani E, Domizi R, Scorcella C, Carsetti A, Tondi S, Monaldi V, Adrario E, Romano R, Pelaia P, Singer M. Near-infrared spectroscopy for assessing tissue oxygenation and microvascular reactivity in critically ill patients: a prospective observational study. Crit Care 2016; 20:311. [PMID: 27716370 PMCID: PMC5045573 DOI: 10.1186/s13054-016-1500-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/19/2016] [Indexed: 11/15/2022] Open
Abstract
Background Impaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of this study was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). Methods Prospective observational study in critically ill adults admitted to a 12-bed intensive care unit (ICU) of a University Hospital. NIRS with a VOT (using a 40 % tissue oxygen saturation (StO2) target) was applied daily until discharge from the ICU or death. A group of healthy volunteers were evaluated in a single session. During occlusion, StO2 downslope was measured separately for the first (downslope 1) and last part (downslope 2) of the desaturation curve. The difference between downslope 2 and 1 was calculated (delta-downslope). The upslope and area of the hyperaemic phase (receive operating characteristic (ROC) area under the curve (AUC) of StO2) were calculated, reflecting microvascular reactivity. Outcomes were ICU and 90-day mortality. Results Patients (n = 89) had altered downslopes and upslopes compared to healthy volunteers (n = 27). Mean delta-downslope was higher in ICU non-survivors (2.8 (0.4, 3.8) %/minute versus 0.4 (−0.8, 1.8) in survivors, p = 0.004) and discriminated 90-day mortality (ROC AUC 0.72 (95 % confidence interval 0.59, 0.84)). ICU non-survivors had lower mean upslope (141 (75, 193) %/minute versus 185 (143, 217) in survivors, p = 0.016) and AUC StO2 (7.9 (4.3, 12.6) versus 14.5 (11.2, 21.3), p = 0.001). Upslope and AUC StO2 on admission were significant although weak predictors of 90-day mortality (ROC AUC = 0.68 (0.54, 0.82) and 0.70 (0.58, 0.82), respectively). AUC StO2 ≤ 6.65 (1st quartile) on admission was independently associated with higher 90-day mortality (hazard ratio 7.964 (95 % CI 2.211, 28.686)). The lowest upslope in the ICU was independently associated with survival after ICU discharge (odds ratio 0.970 (95 % CI 0.945, 0.996)). Conclusions In critically ill patients, NIRS with a VOT enables identification of alterations in tissue oxygen extraction capacity and microvascular reactivity that can predict mortality. Trial registration NCT02649088, www.clinicaltrials.gov, date of registration 23rd December 2015, retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1500-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abele Donati
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
| | - Elisa Damiani
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Domizi
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Claudia Scorcella
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Carsetti
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Tondi
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Valentina Monaldi
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Erica Adrario
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Rocco Romano
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Pelaia
- Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
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Kim TK, Nam K, Cho YJ, Min JJ, Hong YJ, Park KU, Hong DM, Jeon Y. Microvascular reactivity and endothelial glycocalyx degradation when administering hydroxyethyl starch or crystalloid during off-pump coronary artery bypass graft surgery: a randomised trial. Anaesthesia 2016; 72:204-213. [DOI: 10.1111/anae.13642] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 01/30/2023]
Affiliation(s)
- T. K. Kim
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - K. Nam
- Cheoncheon Public Health Subcentre; Jangsu Health Centre and County Hospital; Jangsu Jeollabuk-do Korea
| | - Y. J. Cho
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - J. J. Min
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - Y. J. Hong
- Department of Laboratory Medicine; Seoul National University Bundang Hospital; Seongnam Gyeongi-do Korea
| | - K. U. Park
- Department of Laboratory Medicine; Seoul National University Bundang Hospital; Seongnam Gyeongi-do Korea
| | - D. M. Hong
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - Y. Jeon
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
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Willingham TB, Southern WM, McCully KK. Measuring reactive hyperemia in the lower limb using near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:091302. [PMID: 27050534 DOI: 10.1117/1.jbo.21.9.091302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/14/2016] [Indexed: 05/24/2023]
Abstract
Near-infrared spectroscopy (NIRS) has been used to measure reactive hyperemia following a vascular occlusion. However, the procedures and methods of analysis used have varied. The purpose of the present study is to identify reproducible methods for measuring reactive hyperemia using HbO2 NIRS signals in the calf and foot. Healthy participants (10 male, 10 female) aged 19 to 28 years performed one of two tests: reproducibility trials or elevation protocol (30 and 60 cm limb elevation above the heart). The time to 50% reperfusion (T1/2) and the second (R2q) quartile rates of reperfusion were found to be the most reproducible parameters (coefficient of variation= 7.12 to 14.1%). The time to 95% reperfusion (T95) was 12.7% more reproducible on average than the previously reported parameter of time to peak hyperemia. Measures of reperfusion time and rate slowed with increasing limb elevation. Correlations were identified between the calf and foot in the measurements of R2q (R2 = 0.713, p = 0.021), T1/2 (R2 = 0.673, p = 0.033), and T95 (R2 = 0.792, p = 0.006). Half and 95% recovery times and second and third quartile rates expressed good reproducibility and sensitivity to change with reduced perfusion pressure. NIRS measures of reactive hyperemia have the potential to evaluate microvascular perfusion in clinical populations.
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Vranken NP, Ganushchak YM, Willigers HM, Maessen JG, Weerwind PW. Vascular Occlusion Test to Dynamically Assess Microcirculation During Normothermic Pulsatile Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 30:979-84. [DOI: 10.1053/j.jvca.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Indexed: 11/11/2022]
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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.
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Biedrzycka A, Kowalik M, Pawlaczyk R, Jagielak D, Świetlik D, Szymanowicz W, Lango R. Aortic cross-clamping phase of cardiopulmonary bypass is related to decreased microvascular reactivity after short-term ischaemia of the thenar muscle both under intravenous and volatile anaesthesia: a randomized trial. Interact Cardiovasc Thorac Surg 2016; 23:770-778. [PMID: 27401083 DOI: 10.1093/icvts/ivw232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 05/06/2016] [Accepted: 05/26/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to assess, by near-infrared spectroscopy with an INVOS oximeter during the vascular occlusion test (VOT), the influence of cardiopulmonary bypass (CPB) on tissue saturation in the thenar muscle. The secondary aim was to compare the effects of propofol and sevoflurane anaesthesia on tissue saturation. METHODS This was a prospective, randomized, open-label study. Sixty cardiac surgery patients received either propofol or sevoflurane anaesthesia. Three-minute VOT was performed at the following time points: 30 min after anaesthesia induction, directly after sternotomy, 20 and 40 min after aortic cross-clamping, 20 min after aortic cross-clamp removal and 45 min after weaning of cardiopulmonary bypass. Group and time effects on tissue saturation were analysed with RM-ANOVA and the post hoc Tukey test. RESULTS In both groups at baseline, the lowest and the highest tissue saturation and the rate of saturation recovery during the reperfusion phase of the vascular occlusion test were lower during aortic cross-clamping in comparison to the values before CPB. Lower nadir tissue saturation during ischaemia was observed under propofol in comparison to sevoflurane anaesthesia (P = 0.018). CONCLUSIONS This study demonstrated that the aortic cross-clamping phase of CPB cardiac surgery is associated with lower values of tissue saturation and a decreased rate of saturation recovery under both propofol and sevoflurane anaesthesia. Aortic cross-clamp release is followed by accelerated tissue desaturation during VOT. Propofol anaesthesia for CPB cardiac surgery results in greater reduction of nadir tissue saturation during the ischaemic phase of VOT in comparison to that of sevoflurane. TRIAL REGISTRATION NUMBER NCT02593448.
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Affiliation(s)
- Aleksandra Biedrzycka
- Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Kowalik
- Department of Cardiac Anaesthesia, Medical University of Gdansk, Gdańsk, Poland
| | - Rafał Pawlaczyk
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Dariusz Świetlik
- Intrafaculty College of Medical Informatics and Biostatistics, Medical University of Gdansk, Gdańsk, Poland
| | - Wiktor Szymanowicz
- Department of Cardiac Anaesthesia, Medical University of Gdansk, Gdańsk, Poland
| | - Romuald Lango
- Department of Cardiac Anaesthesia, Medical University of Gdansk, Gdańsk, Poland
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Green MS, Sehgal S, Tariq R. Near-Infrared Spectroscopy: The New Must Have Tool in the Intensive Care Unit? Semin Cardiothorac Vasc Anesth 2016; 20:213-24. [PMID: 27206637 DOI: 10.1177/1089253216644346] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Standard hemodynamic monitoring such as blood pressure and pulse oximetry may only provide a crude estimation of organ perfusion in the critical care setting. Near-infrared spectroscopy (NIRS) is based on the same principle as a pulse oximeter and allows continuous noninvasive monitoring of hemoglobin oxygenation and deoxygenation and thus tissue saturation "StO2" This review aims to provide an overview of NIRS technology principles and discuss its current clinical use in the critical care setting. The study selection was performed using the PubMed database to find studies that investigated the use of NIRS in both the critical care setting and in the intensive care unit. Currently, NIRS in the critical care setting is predominantly being used for infants and neonates. A number of studies in the past decade have shown promising results for the use of NIRS in surgical/trauma intensive care units during shock management as a prognostic tool and in guiding resuscitation. It is evident that over the past 2 decades, NIRS has gone from being a laboratory fascination to an actively employed clinical tool. Even though the benefit of routine use of this technology to achieve better outcomes is still questionable, the fact that NIRS is a low-cost, noninvasive monitoring modality improves the attractiveness of the technology. However, more research may be warranted before recommending its routine use in the critical care setting.
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Affiliation(s)
- Michael Stuart Green
- Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA
| | - Sankalp Sehgal
- Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA
| | - Rayhan Tariq
- Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA
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Salcedo MC, Tart K, Hall K. A systematic review of human and veterinary applications of noninvasive tissue oxygen monitoring. J Vet Emerg Crit Care (San Antonio) 2016; 26:323-32. [PMID: 27062438 DOI: 10.1111/vec.12465] [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: 03/27/2014] [Revised: 08/27/2014] [Accepted: 09/15/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe the methodology for and utilization of tissue oxygen monitoring by near infrared spectroscopy, and to review the current literature on the use of this monitoring modality in human and veterinary settings. DATA SOURCES Scientific reviews and original research found using the PubMed and CAB Abstract search engines with the following keywords: "tissue oxygen monitoring," "near-infrared tissue spectroscopy," and "tissue oxygen saturation (StO2 )." HUMAN DATA SYNTHESIS Tissue oxygen monitors have been evaluated in a wide variety of human clinical applications including trauma and triage, surgery, sepsis, and septic shock, and early goal-directed therapy. StO2 more rapidly identifies occult shock in human patients compared to traditional methods, which can lead to earlier intervention in these patients. VETERINARY DATA SYNTHESIS Veterinary studies involving tissue oxygen monitoring are limited, but the technology may have utility for identification of hemorrhagic shock earlier than changes in base excess, blood lactate concentration, or other traditional perfusion parameters. CONCLUSION Tissue oxygen monitoring is most commonly performed utilizing a noninvasive, portable monitor, which provides real-time, continuous, repeatable StO2 measurements. A decline in StO2 is an early indicator of shock in both human and veterinary patients. Low StO2 values in human patients are associated with increased morbidity, mortality, and length of hospitalization, as well as the development of multiple organ system dysfunction and surgical site infections.
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Affiliation(s)
- Mallory C Salcedo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
| | - Kelly Tart
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
| | - Kelly Hall
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
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Claverias L, Marí M, Marín-Corral J, Magret M, Trefler S, Bodí M, García-España A, Yébenes JC, Pascual S, Gea J, Rodríguez A. The prognostic value of muscle regional oxygen saturation index in severe community-acquired pneumonia: a prospective observational study. J Intensive Care 2016; 4:7. [PMID: 26788325 PMCID: PMC4717666 DOI: 10.1186/s40560-016-0129-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/13/2016] [Indexed: 01/08/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) mortality exceeds 20 % in critical care patients despite appropriate antibiotic therapy. Regional tissue oxygen saturation index (rSO2) measured with near-infrared spectroscopy (NIRS) might facilitate early detection for patients at risk of serious complications. Our objectives were to determine the relationship between early determination of rSO2 and mortality and to compare discrimination power for mortality of rSO2 and other resuscitation variables in critically ill CAP patients. Methods This is a prospective observational study. Patients with CAP were enrolled within 6 h to intensive care admission. Demographics and clinical variables were recorded. rSO2 was determined using NIRS in brachioradialis muscle. All variables were determined at baseline and 24 h after admission. Results Forty patients were enrolled. Fourteen patients (35 %) had a baseline rSO2 < 60 % and 7 of them died (50 %). Only 1 of 26 (3.8 %) patients with rSO2 ≥ 60 % died (p = 0.007). The area under ROC curve (AUROC) showed consistent mortality discrimination at baseline (0.84, p = 0.03) and at 24 h (0.86, p = 0.006) for rSO2 values. Cox regression analysis showed that “low” rSO2 at ICU admission (hazard ratio (HR) = 8.99; 95 % confidence interval (CI) 1.05–76.8; p = 0.045) and “low” rSO2 at 24 h (HR = 13.18; 95 % CI 1.52–113.6; p = 0.019) were variables independently associated with mortality. In contrast, other variables such as Acute Physiology and Chronic Health Evaluation (APACHE II) score (HR = 1.09; 95 % CI 0.99–1.19; p = 0.052) were not associated with mortality. Conclusions Our findings suggest that forearm skeletal muscle rSO2 differs in patients with severe CAP according to outcome and might be an early prognosis tool.
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Affiliation(s)
- Laura Claverias
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
| | - Michael Marí
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain
| | - Judith Marín-Corral
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain
| | - Mónica Magret
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain
| | - Sandra Trefler
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
| | - María Bodí
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
| | | | | | - Sergi Pascual
- CIBER de enfermedades respiratorias (CIBERES), ISC III, Bunyola Palma de Mallorca, Spain ; Parc de Salut Mar, IMIM, Pneumology Department, CEXS, UPF, Barcelona, Spain
| | - Joaquim Gea
- CIBER de enfermedades respiratorias (CIBERES), ISC III, Bunyola Palma de Mallorca, Spain ; Parc de Salut Mar, IMIM, Pneumology Department, CEXS, UPF, Barcelona, Spain
| | - Alejandro Rodríguez
- Joan XXIII University Hospital, Critical Care Department, IISPV/URV, Carrer Dr. Mallafre Guasch 4, 43007, Tarragona, Spain ; Research Unit, Joan XXIII University Hospital, IISPV/URV, Tarragona, Spain
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Kim TK, Cho YJ, Min JJ, Murkin JM, Bahk JH, Hong DM, Jeon Y. Microvascular reactivity and clinical outcomes in cardiac surgery. Crit Care 2015; 19:316. [PMID: 26337035 PMCID: PMC4560090 DOI: 10.1186/s13054-015-1025-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 08/12/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Microvascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes. The objectives of the present study were to investigate microvascular reactivity in cardiac surgery patients and to assess any association with clinical outcomes. Methods We retrospectively analyzed a prospectively collected registry. In total, 254 consecutive adult patients undergoing cardiac and thoracic aortic surgeries from January 2013 through May 2014 were analyzed. We performed a vascular occlusion test (VOT) by using near-infrared spectroscopy to measure microvascular reactivity. VOT was performed three times per patient: prior to the induction of anesthesia, at the end of surgery, and on postoperative day 1. The primary endpoint was a composite of major adverse complications, including death, myocardial infarction, acute kidney injury, acute respiratory distress syndrome, and persistent cardiogenic shock. Results VOT recovery slope decreased during the surgery. VOT recovery slope on postoperative day 1 was significantly lower in patients with composite complications than those without (3.1 ± 1.6 versus 4.0 ± 1.5 %/s, P = 0.001), although conventional hemodynamic values, such as cardiac output and blood pressure, did not differ between the groups. On multivariable regression and linear analyses, low VOT recovery slope on postoperative day 1 was associated with increases of composite complications (odds ratio 0.742; 95 % confidence interval (CI) 0.584 to 0.943; P = 0.015) and hospital length of stay (regression coefficient (B) −1.276; 95 % CI −2.440 to −0.112; P = 0.032). Conclusion Microvascular reactivity largely recovered on postoperative day 1 in the patients without composite complications, but this restoration was attenuated in patients with composite complications. Trial registration ClinicalTrials.gov NCT01713192. Registered 22 October 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1025-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea.
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea.
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, 81, Irwon-Ro, Gangnam-Gu, 06351, Seoul, Korea.
| | - John M Murkin
- Department of Anesthesiology and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, 4, 1465 Richmond St, N6G 2M1, London, ON, Canada.
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea.
| | - Deok Man Hong
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea.
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea.
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Damiani E, Adrario E, Luchetti MM, Scorcella C, Carsetti A, Mininno N, Pierantozzi S, Principi T, Strovegli D, Bencivenga R, Gabrielli A, Romano R, Pelaia P, Ince C, Donati A. Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis. PLoS One 2015; 10:e0122655. [PMID: 25932999 PMCID: PMC4416810 DOI: 10.1371/journal.pone.0122655] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/10/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Free hemoglobin (fHb) may induce vasoconstriction by scavenging nitric oxide. It may increase in older blood units due to storage lesions. This study evaluated whether old red blood cell transfusion increases plasma fHb in sepsis and how the microvascular response may be affected. METHODS This is a secondary analysis of a randomized study. Twenty adult septic patients received either fresh or old (<10 or >15 days storage, respectively) RBC transfusions. fHb was measured in RBC units and in the plasma before and 1 hour after transfusion. Simultaneously, the sublingual microcirculation was assessed with sidestream-dark field imaging. The perfused boundary region was calculated as an index of glycocalyx damage. Tissue oxygen saturation (StO2) and Hb index (THI) were measured with near-infrared spectroscopy and a vascular occlusion test was performed. RESULTS Similar fHb levels were found in the supernatant of fresh and old RBC units. Despite this, plasma fHb increased in the old RBC group after transfusion (from 0.125 [0.098-0.219] mg/mL to 0.238 [0.163-0.369] mg/mL, p = 0.006). The sublingual microcirculation was unaltered in both groups, while THI increased. The change in plasma fHb was inversely correlated with the changes in total vessel density (r = -0.57 [95% confidence interval -0.82, -0.16], p = 0.008), De Backer score (r = -0.63 [95% confidence interval -0.84, -0.25], p = 0.003) and THI (r = -0.72 [95% confidence interval -0.88, -0.39], p = 0.0003). CONCLUSIONS Old RBC transfusion was associated with an increase in plasma fHb in septic patients. Increasing plasma fHb levels were associated with decreased microvascular density. TRIAL REGISTRATION ClinicalTrials.gov NCT01584999.
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Affiliation(s)
- Elisa Damiani
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Erica Adrario
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti”, Torrette di Ancona, Italy
| | - Michele Maria Luchetti
- Department of Clinical and Molecular Sciences, Clinica Medica, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Claudia Scorcella
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Andrea Carsetti
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Nicoletta Mininno
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Silvia Pierantozzi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Tiziana Principi
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti”, Torrette di Ancona, Italy
| | - Daniele Strovegli
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti”, Torrette di Ancona, Italy
| | - Rosella Bencivenga
- Immunohematology and Transfusional Medicine, AOU Ospedali Riuniti, Torrette di Ancona, Italy
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Clinica Medica, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Rocco Romano
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
| | - Paolo Pelaia
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti”, Torrette di Ancona, Italy
| | - Can Ince
- Department of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Abele Donati
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Torrette di Ancona, Italy
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria “Ospedali Riuniti”, Torrette di Ancona, Italy
- Department of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
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Mesquida J. Evaluating tissue oxygenation at the bedside: global, regional, or both? J Clin Monit Comput 2015; 29:431-3. [PMID: 25855405 DOI: 10.1007/s10877-015-9690-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 01/20/2023]
Abstract
Early recognition of tissue hypoperfusion, and monitoring tissue response to resuscitation interventions, are key points in the management of critically ill patients. In the present issue of J Clin Monit Comput, Dr. Koch and coworkers present the results of a study evaluating regional and global markers of tissue perfusion in a population of septic shock patients. We propose an integrative approach to tissue perfusion assessment, where combining both, global and regional variables, might account for a better understanding of tissue oxygenation status, and might prove useful for septic shock patients' management.
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Affiliation(s)
- Jaume Mesquida
- Critical Care Center, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Universitat Autònoma de Barcelona,, Parc Tauli, 1, 08208, Sabadell, Spain,
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Conrad M, Perez P, Thivilier C, Levy B. Early prediction of norepinephrine dependency and refractory septic shock with a multimodal approach of vascular failure. J Crit Care 2015; 30:739-43. [PMID: 25900257 DOI: 10.1016/j.jcrc.2015.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study is to improve our ability to detect catecholamine dependency and refractory septic shock. METHODS Fifty-one patients with septic shock were studied within the first 4 hours of norepinephrine administration. Patients were divided into 2 groups according to their evolution in the intensive care unit, namely, group A, shock reversal, and group B, no shock reversal. Reversal of shock was defined as the maintenance of a systolic blood pressure greater than or equal to 90 mm Hg without vasopressor support for 24 hours or more. Vascular reactivity was tested using incremental doses of phenylephrine. Muscle tissue oxygen saturation and its changes during a vascular occlusion test were measured. RESULTS Group B patients had a higher Sequential Organ Failure Assessment (SOFA) score and lactate level and more frequently received norepinephrine and renal replacement. Overall mortality was 100% in group B (16/16) and 20% (7/35) in group A. Phenylephrine increased mean arterial pressure in a dose-dependent manner more significantly in group A patients than in group B (P = .0004). Basal tissue oxygen saturation and the recovery slope after vascular occlusion test were lower in group B. In multivariate analysis, 4 parameters remained independently associated with mortality: the increase in mean arterial pressure at phenylephrine 6 μg/kg per minute, the recovery slope, SOFA score, and norepinephrine doses at H0. CONCLUSIONS The intensity of septic shock-induced vascular hyporesponsiveness to vasopressor is tightly linked to septic shock severity and evolution and may potentially be identified early with simple to obtain parameters such as near-infrared spectroscopy value, SOFA score, or norepinephrine dose.
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Affiliation(s)
- Marie Conrad
- Service de Réanimation Médicale Brabois, CHU Nancy Brabois, Institut du Coeur et des Vaisseaux, 54500 Vandoeuvre les Nancy, France
| | - Pierre Perez
- Service de Réanimation Médicale Brabois, CHU Nancy Brabois, Institut du Coeur et des Vaisseaux, 54500 Vandoeuvre les Nancy, France
| | - Carine Thivilier
- Service de Réanimation Médicale Brabois, CHU Nancy Brabois, Institut du Coeur et des Vaisseaux, 54500 Vandoeuvre les Nancy, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, CHU Nancy Brabois, Institut du Coeur et des Vaisseaux, 54500 Vandoeuvre les Nancy, France; INSERM U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, 54511 Vandoeuvre les Nancy, France; Université de Lorraine, 54000, Nancy, France.
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Kim TK, Cho YJ, Min JJ, Murkin JM, Bahk JH, Hong DM, Jeon Y. Tissue microcirculation measured by vascular occlusion test during anesthesia induction. J Clin Monit Comput 2015; 30:41-50. [PMID: 25750016 DOI: 10.1007/s10877-015-9679-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/27/2015] [Indexed: 11/27/2022]
Abstract
Tissue microcirculation measured by vascular occlusion test is impaired during septic shock. However, it has not been investigated extensively during anesthesia induction. The aim of the study is to evaluate tissue microcirculation during anesthesia induction. We hypothesized that during anesthesia induction, tissue microcirculation measured by vascular occlusion test might be enhanced with peripheral vasodilation during anesthesia induction. We conducted a prospective observational study of 50 adult patients undergoing cardiac surgery. During anesthesia induction, we measured and analyzed tissue oxygen saturation, vascular occlusion test, cerebral oximetry, forearm-minus-fingertip skin temperature gradients and hemodynamic data in order to evaluate microcirculation as related to alterations in peripheral vasodilation as reflected by increased Tforearm-finger thermal gradients. During anesthesia induction, recovery slope during vascular occlusion test and cerebral oxygen saturation increased from 4.0 (1.5) to 4.7 (1.3) % s(-1) (p = 0.02) and 64.0 (10.2) to 74.2 (9.2) % (p < 0.001), respectively. Forearm-minus-fingertip skin temperature gradients decreased from 1.9 (2.9) to -1.4 (2.2) °C (p < 0.001). There was an inverse correlation between changes in the skin temperature gradients and changes in cerebral oximetry (r = 0.33; p = 0.02). During anesthesia induction, blood pressure and forearm-minus-fingertip skin temperature gradients decrease while cerebral oximetry and vascular occlusion test recovery slope increase. These findings suggest that anesthesia induction increases tissue microcirculation with peripheral vasodilation.
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Affiliation(s)
- Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea
| | - John M Murkin
- Department of Anesthesiology and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea
| | - Deok Man Hong
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea.
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Engbers S, Boysen SR, Engbers J, Chalhoub S. A comparison of tissue oxygen saturation measurements by 2 different near-infrared spectroscopy monitors in 21 healthy dogs. J Vet Emerg Crit Care (San Antonio) 2014; 24:536-44. [DOI: 10.1111/vec.12229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 07/28/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Engbers
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta Canada
| | - Søren R. Boysen
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta Canada
| | - Jordan Engbers
- Faculty of Medicine; Clinical Research Unit; Calgary Alberta Canada
| | - Serge Chalhoub
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta Canada
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Lee JH, Park YH, Kim HS, Kim JT. Comparison of two devices using near-infrared spectroscopy for the measurement of tissue oxygenation during a vascular occlusion test in healthy volunteers (INVOS® vs. InSpectra™). J Clin Monit Comput 2014; 29:271-8. [DOI: 10.1007/s10877-014-9595-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/28/2014] [Indexed: 11/24/2022]
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Gupta NK, Dantu V, Dantu R. Effective CPR Procedure With Real Time Evaluation and Feedback Using Smartphones. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2014; 2:2800111. [PMID: 27170885 PMCID: PMC4861545 DOI: 10.1109/jtehm.2014.2327612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/28/2014] [Indexed: 11/21/2022]
Abstract
Timely cardio pulmonary resuscitation (CPR) can mean the difference between life and death. A trained person may not be available at emergency sites to give CPR. Normally, a 9-1-1 operator gives verbal instructions over the phone to a person giving CPR. In this paper, we discuss the use of smartphones to assist in administering CPR more efficiently and accurately. The two important CPR parameters are the frequency and depth of compressions. In this paper, we used smartphones to calculate these factors and to give real-time guidance to improve CPR. In addition, we used an application to measure oxygen saturation in blood. If blood oxygen saturation falls below an acceptable threshold, the person giving CPR can be asked to do mouth-to-mouth breathing. The 9-1-1 operator receives this information real time and can further guide the person giving CPR. Our experiments show accuracy >90% for compression frequency, depth, and oxygen saturation.
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Affiliation(s)
| | | | - Ram Dantu
- University of North TexasDentonTX76203USA
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Gruartmoner G, Mesquida J, Baigorri F. Saturación tisular de oxígeno en el paciente crítico. Med Intensiva 2014; 38:240-8. [DOI: 10.1016/j.medin.2013.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/06/2013] [Accepted: 07/12/2013] [Indexed: 01/01/2023]
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Regional oxygen saturation index (rSO2) in brachioradialis and deltoid muscle. Correlation and prognosis in patients with respiratory sepsis. Med Intensiva 2014; 39:68-75. [PMID: 24561087 DOI: 10.1016/j.medin.2013.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 11/12/2013] [Accepted: 12/09/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare oxygen saturation index (rSO2) obtained simultaneously in two different brachial muscles. DESIGN Prospective and observational study. SETTING Intensive care unit. PATIENTS Critically ill patients with community-acquired pneumonia. INTERVENTIONS Two probes of NIRS device (INVOS 5100) were simultaneously placed on the brachioradialis (BR) and deltoid (D) muscles. VARIABLES rSO2 measurements were recorded at baseline (ICU admission) and at 24h. Demographic and clinical variables were registered. Pearson's correlation coefficient was used to assess the association between continuous variables. The consistency of the correlation was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plot. The predictive value of the rSO2 for mortality was calculated by ROC curve. RESULTS Nineteen patients were included with an ICU mortality of 21.1%. The rSO2 values at baseline and at 24h were significantly higher in D than in BR muscle. Values obtained simultaneously in both limbs showed a strong correlation and adequate consistency: BR (r=0.95; p<0.001; ICC=0.94; 95% CI: 0.90-0.96; p<0.001), D (r=0.88; p=0.01; ICC=0.88; 95% CI: 0.80-0.90; p>0.001) but a wide limit of agreement. Non-survivors had rSO2 values significantly lower than survivors at all times of the study. No patient with rSO2 >60% in BR died, and only 17.6% died with an rSO2 value >60% in D. Both muscles showed consistent discriminatory power for mortality. CONCLUSION Both BR and D muscles were appropriate for measuring rSO2.
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Donati A, Damiani E, Luchetti M, Domizi R, Scorcella C, Carsetti A, Gabbanelli V, Carletti P, Bencivenga R, Vink H, Adrario E, Piagnerelli M, Gabrielli A, Pelaia P, Ince C. Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in patients with sepsis: a pilot study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R33. [PMID: 24528648 PMCID: PMC4057400 DOI: 10.1186/cc13730] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/28/2014] [Indexed: 12/14/2022]
Abstract
Introduction Microvascular alterations impair tissue oxygenation during sepsis. A red blood cell (RBC) transfusion increases oxygen (O2) delivery but rarely improves tissue O2 uptake in patients with sepsis. Possible causes include RBC alterations due to prolonged storage or residual leukocyte-derived inflammatory mediators. The aim of this study was to compare the effects of two types of transfused RBCs on microcirculation in patients with sepsis. Methods In a prospective randomized trial, 20 patients with sepsis were divided into two separate groups and received either non-leukodepleted (n = 10) or leukodepleted (n = 10) RBC transfusions. Microvascular density and perfusion were assessed with sidestream dark field (SDF) imaging sublingually, before and 1 hour after transfusions. Thenar tissue O2 saturation (StO2) and tissue hemoglobin index (THI) were determined with near-infrared spectroscopy, and a vascular occlusion test was performed. The microcirculatory perfused boundary region was assessed in SDF images as an index of glycocalyx damage, and glycocalyx compounds (syndecan-1, hyaluronan, and heparan sulfate) were measured in the serum. Results No differences were observed in microvascular parameters at baseline and after transfusion between the groups, except for the proportion of perfused vessels (PPV) and blood flow velocity, which were higher after transfusion in the leukodepleted group. Microvascular flow index in small vessels (MFI) and blood flow velocity exhibited different responses to transfusion between the two groups (P = 0.03 and P = 0.04, respectively), with a positive effect of leukodepleted RBCs. When within-group changes were examined, microcirculatory improvement was observed only in patients who received leukodepleted RBC transfusion as suggested by the increase in De Backer score (P = 0.02), perfused vessel density (P = 0.04), PPV (P = 0.01), and MFI (P = 0.04). Blood flow velocity decreased in the non-leukodepleted group (P = 0.03). THI and StO2 upslope increased in both groups. StO2 and StO2 downslope increased in patients who received non-leukodepleted RBC transfusions. Syndecan-1 increased after the transfusion of non-leukodepleted RBCs (P = 0.03). Conclusions This study does not show a clear superiority of leukodepleted over non-leukodepleted RBC transfusions on microvascular perfusion in patients with sepsis, although it suggests a more favorable effect of leukodepleted RBCs on microcirculatory convective flow. Further studies are needed to confirm these findings. Trial registration ClinicalTrials.gov, NCT01584999
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Wiramus S, Textoris J, Bardin R, Vigne C, Kelway C, Martin C, Leone M. Isoproterenol infusion and microcirculation in septic shock. HEART, LUNG AND VESSELS 2014; 6:274-9. [PMID: 25436209 PMCID: PMC4246846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Our study primarily aimed at investigating the effect of isoproterenol infusion on tissue oxygen saturation in patients with septic shock. The secondary aim was to assess the relation between cardiac index, central venous oxygen saturation and tissue oxygen saturation. METHODS This retrospective study was conducted from December 2010 to March 2012. We included 14 consecutive patients with septic shock treated with isoproterenol. All patients were monitored by cardiac index and tissue oxygen saturation. From medical charts, routine hemodynamic data were extracted one hour before and six hours after the onset of isoproterenol infusion. RESULTS From baseline to H6, tissue oxygen saturation levels rise from 78 [72-82]% to 85 [78-88]% (p = 0.03). Isoproterenol infusion was associated with an increase of central venous oxygen saturation (from 67 [65-74]% to 84 [77-86]%, p = 0.02) and cardiac index (from 2.9 [2.7-3.1] L/min/m² to 3.9 [3.0-4.4] L/min/m², p = 0.006). Tissue oxygen saturation was correlated neither to cardiac index (p = 0.14, R(2) = 0.08) nor to central venous oxygen saturation (p = 0.19, R(2) = 0.10). CONCLUSIONS Use of isoproterenol was associated with an increase of tissue oxygen saturation. This increase was not correlated to cardiac index, suggesting a decoupling between macrocirculation and microcirculation.
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'Real angiosome' assessment from peripheral tissue perfusion using tissue oxygen saturation foot-mapping in patients with critical limb ischemia. Eur J Vasc Endovasc Surg 2013; 47:433-41. [PMID: 24412085 DOI: 10.1016/j.ejvs.2013.11.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/25/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The "tissue oxygen saturation (StO2) foot-mapping" method was developed using a non-invasive near-infrared tissue oximeter monitor to classify the foot regions as ischemic and non-ischemic areas. The purpose of this study was to evaluate StO2 foot-mapping as a reliable method to detect ischemic areas in the feet of patients with critical limb ischemia (CLI), and to compare the results with assessments from the angiosome model. METHODS The foot areas of 20 CLI patients and 20 healthy controls were classified into four regions: (1) 0 ≤ StO2 < 30%, (2) 30 ≤ StO2 < 50%, (3) 50 ≤ StO2 < 70%, and (4) 70 ≤ StO2 ≤ 100% to perform StO2 foot-mapping. Each area occupancy rate was compared between the two groups, and the threshold StO2 value for detecting ischemia was set. Next, the locations of ulcers (in 16 patients) were compared to the predicted ischemic regions by the StO2 foot-mapping and by the angiosome model and angiography. RESULTS In regions (1) and (2) (StO2 < 50%), the area occupancy rate was significantly higher in the CLI group and almost zero in the control group, so that the threshold StO2 value for detecting ischemia was set at 50%. The locations of ulcers were compatible with StO2 foot-mapping in 87.5% of the cases (14/16), while they were compatible with the assessment from the angiosome model in 68.8% of the cases (11/16). CONCLUSIONS This study suggests that StO2 foot-mapping can successfully and non-invasively detect ischemic areas in the peripheral tissue of the foot, and also more appropriately than the assessment provided by the angiosome model. StO2 foot-mapping can be used to evaluate the real angiosome: the real distribution of the peripheral tissue perfusion in the CLI patient's foot, which is determined by the peripheral microvascular blood flow, rather than the main arterial blood flow.
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Masip J, Mesquida J, Luengo C, Gili G, Gomà G, Ferrer R, Teboul JL, Payen D, Artigas A. Near-infrared spectroscopy StO2 monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock. Ann Intensive Care 2013; 3:30. [PMID: 24007807 PMCID: PMC3847092 DOI: 10.1186/2110-5820-3-30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/22/2013] [Indexed: 12/19/2022] Open
Abstract
Background Sepsis is a leading cause of death despite appropriate management. There is increasing evidence that microcirculatory alterations might persist independently from macrohemodynamic improvement and are related to clinical evolution. Future efforts need to be directed towards microperfusion monitoring and treatment. This study explored the utility of thenar muscle oxygen saturation (StO2) and its changes during a transient vascular occlusion test (VOT) to measure the microcirculatory response to drotrecogin alfa (activated) (DrotAA) in septic patients. Methods A prospective, observational study was performed in three general intensive care units at three university hospitals. We studied 58 patients with recent onset of severe sepsis or septic shock and at least two organ dysfunctions. Thirty-two patients were treated with DrotAA and 26 were not treated because of formal contraindication. StO2 was monitored using near-infrared spectroscopy (NIRS), and VOT was performed to obtain deoxygenation (DeOx) and reoxygenation (ReOx) slopes. Measurements were obtained before DrotAA was started and were repeated daily for a 96-hour period. Results Patients’ characteristics, outcome, severity, and baseline values of StO2, DeOx, and ReOx did not differ between groups. Treated patients significantly improved DeOx and ReOx values over time, whereas control patients did not. In treated patients, ReOx improvements were correlated to norepinephrine dose reductions. Early clinical response (SOFA improvement after 48 hours of treatment) was not associated to changes in VOT-derived slopes. In the treated group, the relative improvement of DeOx within 48 hours was able to predict mortality (AUC 0.91, p < 0.01). Conclusions In patients with severe sepsis or septic shock, DrotAA infusion was associated with improvement in regional tissue oxygenation. The degree of DeOx amelioration after 2 days in treated patients predicted mortality with high sensitivity and specificity. Thus, StO2 derived variables might be useful to evaluate the microcirculatory response to treatment of septic shock.
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Affiliation(s)
- Jordi Masip
- Critical Care Department, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Consorci Sanitari Universitari Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí s/n, Sabadell (Barcelona) CP 08208, Spain.
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