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Ruan Z, Li R, Dong W, Cui Z, Yang H, Ren R. Laser speckle contrast imaging to monitor microcirculation: An effective method to predict outcome in patients with sepsis and septic shock. Front Bioeng Biotechnol 2023; 10:1067739. [PMID: 36743655 PMCID: PMC9890168 DOI: 10.3389/fbioe.2022.1067739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Background: This study examines the microcirculation of patients with sepsis and septic shock using Laser Speckle Contrast Imaging (LSCI) technology, to enhance monitoring and predict outcomes of sepsis and septic shock. Methods: From 01 July 2021, to 31 January 2022, 44 patients diagnosed with septic shock and sepsis were included in the study, their clinical data were collected, and LSCI was used to monitor the mean peripheral blood flow perfusion index (PI). Results: The average peripheral blood flow PI of septic shock patients was significantly lower than that of septic patients, with a cutoff value of 26.25. The average peripheral blood flow PI negatively correlated with acute physiology and chronic health evaluation (APACHE) Ⅱ score (p = .01 < .05), sequential organ failure assessment (SOFA) score (p < .01), and lactic acid levels (p = .01 < .05). We report average peripheral blood flow no correlation with age, mean arterial pressure, body temperature, oxygen saturation, heart rate, and body mass index. There was no correlation with procalcitonin, C-reactive protein (CRP), red blood cell distribution width, or platelet distribution width (p > .05). PI significantly correlated with the group sepsis and septic shock (p < .001, r = -.865). And PI significantly correlated with the outcome or mortality (p = .007 < .05, r = -.398). The ROC curve was calculated for PI and the sensitivity was 81.3%, and the specificity was 75% when PI cutoff value chooses 20.88. Conclusion: LSCI technology successfully detected the fingertip microcirculation of patients with septic shock. LSCI can reliably differentiate patients with sepsis vs patients with septic shock. Additionally, the average peripheral blood PI negatively correlated with APACHE Ⅱ, SOFA score, and lactate acid levels, providing useful and supplementary information for the diagnosis and monitoring of septic shock. Trial registration: Chictr2100046761. Registered on May 28, 2021. Clinical Trial Registration: clinicaltrials.gov, identifier Chictr2100046761.
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Affiliation(s)
- Zhengshang Ruan
- Department of Infectious Diseases, Xinhua Children’s Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Li
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Wenwen Dong
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhilei Cui
- Department of Respiratory Medicine, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Zhilei Cui, ; Hui Yang, ; Rongrong Ren,
| | - Hui Yang
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China,*Correspondence: Zhilei Cui, ; Hui Yang, ; Rongrong Ren,
| | - Rongrong Ren
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China,*Correspondence: Zhilei Cui, ; Hui Yang, ; Rongrong Ren,
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Sircan-Kucuksayan A, Eray O, Buyukaksu M, Gumus B, Dursun O, Canpolat M. Investigating spectroscopic measurement of sublingual veins and tissue to estimate central venous oxygen saturation. Technol Health Care 2021; 30:541-549. [PMID: 34397435 DOI: 10.3233/thc-202793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Venous oxygen saturation reflects venous oxygenation status and can be used to assess treatment and prognosis in critically ill patients. A novel method that can measure central venous oxygen saturation (ScvO2) non-invasively may be beneficial and has the potential to change the management routine of critically ill patients. OBJECTIVE The study aims to evaluate the potential of sublingual venous oxygen saturation (SsvO2) to be used in the estimation of ScvO2. METHODS We have developed two different approaches to calculate SsvO2. In the first one, near-infrared spectroscopy (NIRS) measurements were performed directly on the sublingual veins. In the second approach, NIRS spectra were acquired from the sublingual tissue apart from the sublingual veins, and arterial oxygen saturation was measured using a pulse oximeter on the fingertip. RESULTS Twenty-six healthy subjects were included in the study. In the first and second approaches, average SsvO2 values were 75.0% ± 1.8 and 75.8% ± 2.1, respectively. The results of the two different approaches were close to each other and similar to ScvO2 of healthy persons (> 70%). CONCLUSION Oxygen saturation of sublingual veins has the potential to be used in intensive care units, non-invasively and in real-time, to estimate ScvO2.
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Affiliation(s)
| | - Oktay Eray
- Department of Emergency Medicine, Faculty of Medicine, Akdeniz University, Turkey
| | - Murat Buyukaksu
- Department of Biophysics, Faculty of Medicine, Alanya Alaaddin Keykubat University, Turkey
| | - Birce Gumus
- Department of Biophysics, Faculty of Medicine, Akdeniz University, Turkey
| | - Oguz Dursun
- Department of Pediatrics, Faculty of Medicine, Akdeniz University, Turkey
| | - Murat Canpolat
- Department of Biophysics, Faculty of Medicine, Akdeniz University, Turkey
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Tran NN, Tran M, Lopez J, Ogbaa M, Votava-Smith JK, Brady KM. Near-Infrared Spectroscopy: Clinical Use in High-Risk Neonates. Neonatal Netw 2021; 40:73-79. [PMID: 33731373 DOI: 10.1891/0730-0832/11-t-678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
Abstract
In this review, we describe the near-infrared spectroscopy (NIRS) technology and its clinical use in high-risk neonates in critical care settings. We searched databases (e.g., PubMed, Google Scholar, EBSCOhost) to find studies describing the use of NIRS on critically ill and high-risk neonates. Near-infrared spectroscopy provides continuous noninvasive monitoring of venous oxygen saturation. It uses technology similar to pulse oximetry to measure the oxygen saturation of hemoglobin in a tissue bed to describe the relative delivery and extraction of oxygen. Near-infrared spectroscopy can be a valuable bedside tool to provide clinicians indirect evidence of perfusion. It may prompt early interventions that promote oxygen delivery, which can improve high-risk neonatal outcomes.
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Altun D, Doğan A, Arnaz A, Yüksek A, Yalçinbaş YK, Türköz R, Sarioğlu T. Noninvasive monitoring of central venous oxygen saturation by jugular transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery. Turk J Med Sci 2020; 50:1280-1287. [PMID: 32490634 PMCID: PMC7491293 DOI: 10.3906/sag-1911-135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background and aim In patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation (ScvO2) is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show ScvO2 indirectly. In this study, we aimed to determine the correlation between ScvO2 with NIRSijv in pediatric patients undergoing congenital cardiac surgery. Materials and methods Fifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NIRS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NIRS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NIRS (NIRSc) and ScvO2, were recorded at certain times until postoperative 24th hour. Results Data were collected at 8 different time points. There was a significant correlation between ScvO2 and NIRSijv in all measurement time points (r = 0.91), (P = 0.001). The mean bias between ScvO2 and NIRSijv was 2.92% and the limits of agreement were from 11% to –5.2%. There was a moderate correlation between ScvO2 and NIRSc (r = 0.45), (P = 0.001). The mean bias between ScvO2 and NIRSc was 2.7% and the limits of agreement were from +26% to –20%. Conclusion In this study, we found a strong correlation between ScvO2 and NIRS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery.
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Affiliation(s)
- Dilek Altun
- Department of Anesthesiology and Reanimation, Vocational School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ahmet Arnaz
- Department of Cardiovascular Surgery, Faculty of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Adnan Yüksek
- Department of Anesthesiology and Reanimation, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | | | - Riza Türköz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Tayyar Sarioğlu
- Department of Pediatric Cardiovascular Surgery, Faculty of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
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Vincent JL, Michard F, Saugel B. Intensive care medicine in 2050: towards critical care without central lines. Intensive Care Med 2018; 44:922-924. [PMID: 29777262 DOI: 10.1007/s00134-018-5205-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/05/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
| | | | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mitchell C. Tissue Oxygenation Monitoring as a Guide for Trauma Resuscitation. Crit Care Nurse 2018; 36:12-70. [PMID: 27252098 DOI: 10.4037/ccn2016206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome during trauma resuscitation. Detecting subtle changes in perfusion is crucial to ensure adequate tissue oxygenation and perfusion. Traditional methods of detecting physiological changes include measurements of blood pressure, heart rate, urine output, serum levels of lactate, mixed venous oxygen saturation, and central venous oxygen saturation. Continuous noninvasive monitoring of tissue oxygen saturation in muscle has the potential to indicate severity of shock, detect occult hypoperfusion, guide resuscitation, and be predictive of the need for interventions to prevent multiple organ dysfunction syndrome. Tissue oxygen saturation is being used in emergency departments, trauma rooms, operating rooms, and emergency medical services. Tissue oxygen saturation technology is just as effective as mixed venous oxygen saturation, central venous oxygen saturation, serum lactate, and Stewart approach with strong ion gap, yet tissue oxygen saturation assessment is also a direct, noninvasive microcirculatory measurement of oxygen saturation.
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Affiliation(s)
- Cathy Mitchell
- Cathy Mitchell works in the interventional radiology department at Sacred Heart Medical Center, Spokane, Washington.
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Duadi H, Nitzan M, Fixler D. Simulation of oxygen saturation measurement in a single blood vein. OPTICS LETTERS 2016; 41:4312-5. [PMID: 27628385 DOI: 10.1364/ol.41.004312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The value of oxygen saturation in venous blood, SvO2, has important clinical significance since it is related to the tissue oxygen utilization, which is related to the blood flow to the tissue and to its metabolism rate. However, existing pulse oximetry techniques are not suitable for blood in veins. In the current study we examine the feasibility of difference oximetry to assess SvO2 by using two near-infrared wavelengths and collecting the backscattered light from two photodetectors located at different distances from the light source.
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The Role of Regional Oxygen Saturation Using Near-Infrared Spectroscopy and Blood Lactate Levels as Early Predictors of Outcome After Pediatric Cardiac Surgery. Can J Cardiol 2015; 32:970-7. [PMID: 26868838 DOI: 10.1016/j.cjca.2015.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the association between regional oxygen saturation (rSO2) desaturation score (calculated by multiplying the rSO2 < 50% by time in seconds the preoperative baseline value) measured with near-infrared spectroscopy and the peak of lactate with postoperative major morbidities in pediatric patients who undergo cardiac surgery. METHODS We retrospectively analyzed the postoperative course of 152 patients between January 2012 and December 2013, for whom we continuously monitored cerebral rSO2 using near-infrared spectroscopy and serial arterial blood lactate levels for at least 48 hours. RESULTS The median age at surgery was 128 days (interquartile range [IQR], 17-537 days). Thirty-nine patients had a single ventricle physiology (26%) and 135 patients (89%) required the use of cardiopulmonary bypass (median time of 130 minutes; IQR, 93-172 minutes). Median postoperative peak lactate level was 3 mmol/L (IQR, 2-5.3 mmol/L); 52 patients (34%) had a postoperative lactate level > 4.6 mmol/L. The median postoperative rSO2 desaturation score was 157 (IQR, 0-2050); 62 patients (41%) had an rSO2 desaturation score > 345. Fifty-seven patients (37%) had postoperative major morbidities. Using a multivariable regression model only rSO2 desaturation score > 345 was independently associated with major morbidities after surgery (odds ratio, 27.26; 95% confidence interval, 10.18-73.00). The proportion of patients with an rSO2 desaturation score > 345 within 240 minutes after surgery was higher than the rate of those who showed a peak of lactate > 4.6 mmol/L (84% vs 59%; P = 0.05). CONCLUSIONS The postoperative rSO2 desaturation score has a stronger association with major postoperative morbidities than lactate and it also provides an earlier warning sign of hemodynamic or metabolic compromise.
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