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Intensive Care Medicine

, Volume 38, Issue 6, pp 976–983 | Cite as

Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock

  • H. Ait-OufellaEmail author
  • J. Joffre
  • P. Y. Boelle
  • A. Galbois
  • S. Bourcier
  • J. L. Baudel
  • D. Margetis
  • M. Alves
  • G. Offenstadt
  • B. Guidet
  • E. Maury
Original

Abstract

Purpose

Thenar eminence tissue oxygen saturation (StO2) was developed to assess organ perfusion. However, mottling, a strong predictor of mortality in septic shock, develops preferentially around the knee. We aimed to evaluate the prognostic value of StO2 measured around the knee in septic shock patients and compare it to thenar StO2.

Methods

This was a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included. Parameters were recorded when vasopressors were started (H0) and every 6 h during 24 h. Their predictive value was assessed on 14-day mortality.

Results

Fifty-two patients were included. SOFA score was 11 (9–15) and SAPS II was 56 (40–72). At 6 h after ICU admission (H6), mean arterial pressure, cardiac index, and central venous pressure were not different between non-survivors and survivors; but non-survivors had higher arterial lactate level (8.8 ± 5.0 vs. 2.2 ± 1.5 mmol/l, P < 0.001), lower urinary output (0.22 ± 0.45 vs. 0.70 ± 0.50 ml/kg/h, P < 0.001) and ScvO2 (62 ± 20 vs. 72 ± 9 %, P = 0.03). At H6, StO2 was lower in non-survivors; this difference was not significant for thenar StO2 (70 ± 15 vs. 77 ± 12 %, P = 0.10) but was very pronounced for knee StO2 (39 ± 23 vs. 71 ± 12 %, P < 0.001). At H6, a low knee StO2 was associated with a higher mottling score (P < 0.01), a higher lactate level (P < 0.002, R 2 = 0.2), and a lower urinary output (P = 0.02, R 2 = 0.12).

Conclusion

After initial septic shock resuscitation, StO2 measured around the knee is a strong predictive factor of 14-day mortality.

Keywords

Near-infrared spectroscopy Shock Microcirculation Prognosis Mottling Intensive care medicine 

Notes

Conflicts of interest

The authors had no conflict of interest.

Supplementary material

134_2012_2555_MOESM1_ESM.ppt (148 kb)
Supplementary material 1. Analysis of hemodynamic parameters at H6 reflecting macro- and microcirculation and identification of five significant risk factors of 14-day death in univariable analysis, namely urinary output, arterial lactate level, ScvO2, knee StO2, and mottling score. Cardiac index was measured using transthoracic echocardiography (PPT 148 kb)

References

  1. 1.
    Vincent JL, De Backer D (2005) Microvascular dysfunction as a cause of organ dysfunction in severe sepsis. Crit Care 9(Suppl 4):S9–S12PubMedCrossRefGoogle Scholar
  2. 2.
    Ince C (2005) The microcirculation is the motor of sepsis. Crit Care 9(Suppl 4):S13–S19PubMedCrossRefGoogle Scholar
  3. 3.
    De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104PubMedCrossRefGoogle Scholar
  4. 4.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36:296–327PubMedCrossRefGoogle Scholar
  5. 5.
    Ait-Oufella H, Maury E, Lehoux S, Guidet B, Offenstadt G (2010) The endothelium: physiological functions and role in microcirculatory failure during severe sepsis. Intensive Care Med 36:1286–1298PubMedCrossRefGoogle Scholar
  6. 6.
    Boerma EC (2009) The microcirculation as a clinical concept: work in progress. Curr Opin Crit Care 15:261–265PubMedCrossRefGoogle Scholar
  7. 7.
    De Backer D, Ospina-Tascon G, Salgado D, Favory R, Creteur J, Vincent JL (2010) Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med 36:1813–1825PubMedCrossRefGoogle Scholar
  8. 8.
    Leone M, Blidi S, Antonini F, Meyssignac B, Bordon S, Garcin F, Charvet A, Blasco V, Albanese J, Martin C (2009) Oxygen tissue saturation is lower in nonsurvivors than in survivors after early resuscitation of septic shock. Anesthesiology 111:366–371PubMedCrossRefGoogle Scholar
  9. 9.
    Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, Joffre J, Margetis D, Guidet B, Maury E, Offenstadt G (2011) Mottling score predicts survival in septic shock. Intensive Care Med 37:801–807PubMedCrossRefGoogle Scholar
  10. 10.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256PubMedCrossRefGoogle Scholar
  11. 11.
    Moller S, Henriksen JH (2008) Cardiovascular complications of cirrhosis. Gut 57:268–278PubMedCrossRefGoogle Scholar
  12. 12.
    Thomson SJ, Cowan ML, Forton DM, Clark SJ, Musa S, Grounds M, Rahman TM (2010) A study of muscle tissue oxygenation and peripheral microcirculatory dysfunction in cirrhosis using near infrared spectroscopy. Liver Int 30:463–471PubMedCrossRefGoogle Scholar
  13. 13.
    Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 25:686–696PubMedCrossRefGoogle Scholar
  14. 14.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  15. 15.
    Koch T, Geiger S, Ragaller MJ (2001) Monitoring of organ dysfunction in sepsis/systemic inflammatory response syndrome: novel strategies. J Am Soc Nephrol 12(Suppl 17):S53–S59PubMedGoogle Scholar
  16. 16.
    Myers D, McGraw M, George M, Mulier K, Beilman G (2009) Tissue hemoglobin index: a non-invasive optical measure of total tissue hemoglobin. Crit Care 13(Suppl 5):S2PubMedCrossRefGoogle Scholar
  17. 17.
    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845PubMedCrossRefGoogle Scholar
  18. 18.
    Drazenovic R, Samsel RW, Wylam ME, Doerschuk CM, Schumacker PT (1992) Regulation of perfused capillary density in canine intestinal mucosa during endotoxemia. J Appl Physiol 72:259–265PubMedCrossRefGoogle Scholar
  19. 19.
    Dubin A, Edul VS, Pozo MO, Murias G, Canullan CM, Martins EF, Ferrara G, Canales HS, Laporte M, Estenssoro E, Ince C (2008) Persistent villi hypoperfusion explains intramucosal acidosis in sheep endotoxemia. Crit Care Med 36:535–542PubMedCrossRefGoogle Scholar
  20. 20.
    De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G, Dobbe I, Ince C (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101PubMedCrossRefGoogle Scholar
  21. 21.
    Weil MH (2000) Tissue PCO2 as universal marker of tissue hypoxia. Minerva Anestesiol 66:343–347PubMedGoogle Scholar
  22. 22.
    Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL (2007) The prognostic value of muscle StO2 in septic patients. Intensive Care Med 33:1549–1556PubMedCrossRefGoogle Scholar
  23. 23.
    Payen D, Luengo C, Heyer L, Resche-Rigon M, Kerever S, Damoisel C, Losser MR (2009) Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome? Crit Care 13(Suppl 5):S6PubMedCrossRefGoogle Scholar
  24. 24.
    Bartels SA, Bezemer R, de Vries FJ, Milstein DM, Lima A, Cherpanath TG, van den Meiracker AH, van Bommel J, Heger M, Karemaker JM, Ince C (2011) Multi-site and multi-depth near-infrared spectroscopy in a model of simulated (central) hypovolemia: lower body negative pressure. Intensive Care Med 37:671–677PubMedCrossRefGoogle Scholar
  25. 25.
    Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32:1825–1831PubMedCrossRefGoogle Scholar
  26. 26.
    Oppert M, Engel C, Brunkhorst FM, Bogatsch H, Reinhart K, Frei U, Eckardt KU, Loeffler M, John S (2008) Acute renal failure in patients with severe sepsis and septic shock—a significant independent risk factor for mortality: results from the German Prevalence Study. Nephrol Dial Transplant 23:904–909PubMedCrossRefGoogle Scholar
  27. 27.
    Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, Bellamy SL, Christie JD (2009) Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 37:1670–1677PubMedCrossRefGoogle Scholar
  28. 28.
    Davis SL, Fadel PJ, Cui J, Thomas GD, Crandall CG (2006) Skin blood flow influences near-infrared spectroscopy-derived measurements of tissue oxygenation during heat stress. J Appl Physiol 100:221–224PubMedCrossRefGoogle Scholar
  29. 29.
    Lima A, van Bommel J, Sikorska K, van Genderen M, Klijn E, Lesaffre E, Ince C, Bakker J (2011) The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients. Crit Care Med 39:1649–1654PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • H. Ait-Oufella
    • 1
    • 2
    • 3
    Email author
  • J. Joffre
    • 1
  • P. Y. Boelle
    • 3
    • 4
    • 5
  • A. Galbois
    • 1
  • S. Bourcier
    • 1
  • J. L. Baudel
    • 1
  • D. Margetis
    • 1
  • M. Alves
    • 1
  • G. Offenstadt
    • 1
    • 3
    • 5
  • B. Guidet
    • 1
    • 3
    • 5
  • E. Maury
    • 1
    • 3
    • 5
  1. 1.Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de ParisParis Cedex 12France
  2. 2.Inserm U970, Paris Research Cardiovascular CenterParisFrance
  3. 3.Université Pierre et Marie Curie-Paris 6ParisFrance
  4. 4.Service de santé publique, Hôpital Saint-Antoine, AP-HPParisFrance
  5. 5.Inserm U707ParisFrance

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