Skip to main content
SpringerLink
Log in

Prognostische Relevanz der Gewebesauerstoffsättigung bei Patienten in der Frühphase eines Multiorgandysfunktionssyndroms

Prognostic relevance of tissue oxygen saturation in patients in the early stage of multiple organ dysfunction syndrome

  • Originalien
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Patienten weisen im Schockzustand eine zu geringe periphere Durchblutung auf, um eine ausreichende Sauerstoffversorgung lebenswichtiger Organe, wie Herz und Gehirn, sicherzustellen. Die frühzeitige Erkennung einer verminderten Gewebesauerstoffsättigung (StO2) im Bereich der Mikrozirkulation könnte die Chance zum schnellstmöglichen Therapieeingriff bieten und auf diese Weise die Prognose von Patienten in der Frühphase eines Multiorgandysfunktionssyndroms (MODS) verbessern.

Material und Methoden

Im Rahmen einer monozentrischen prospektiven randomisierten Phase-II-Studie wurde bei 60 Patienten in der Frühphase eines Multiorgandysfunktions-Syndroms (MODS) (APACHE[„Acute Physiology and Chronic Health Evaluation“]-II-Score ≥20) die StO2 mittels des InSpectraTM-StO2-Systems aufgezeichnet und anschließend mit bekannten Hypoxieindikatoren (pulsoxymetrische Sauerstoffsättigung [SpO2], arterielle Sauerstoffsättigung [SaO2], zentralvenöse Sauerstoffsättigung [ScvO2], pH-Wert, Serumlaktatspiegel) verglichen. Klinische Endpunkte der Studie waren neben der 28-Tage- und 6‑Monats-Letalität auch die Notwendigkeit zur Beatmung und Nierenersatztherapie während des Klinikaufenthalts.

Ergebnisse

Studienteilnehmer mit einer StO2 <75 % weisen im Vergleich zu Patienten mit einer StO2 ≥75 % eine erhöhte 28-Tage- und 6‑Monats-Letalität auf. Hinsichtlich der Notwendigkeit zur Beatmung oder Nierenersatztherapie ergibt sich keine prognostische Aussagekraft. Des Weiteren kann eine Korrelation der StO2 mit bekannten Hypoxieindikatoren, wie SpO2, ScvO2 und dem Serumlaktatspiegel bestätigt werden. Ebenso zeigen Patienten mit einer reduzierten StO2 tendenziell eine höhere Krankheitsschwere gemessen am APACHE-II-Score.

Schlussfolgerung

Die StO2 zeigt prognostische Relevanz bei Patienten in der Frühphase eines MODS. Die rasche und nichtinvasive Erhebung dieses Parameters könnte somit bei der Risikostratifizierung dieser Patienten von Nutzen sein.

Abstract

Background

Patients in circulatory shock exhibit insufficient peripheral perfusion to ensure adequate oxygenation of vital organs such as the heart and brain. Early detection of reduced tissue oxygen saturation (StO2) could be used for rapid therapeutic intervention and thus improve the prognosis of patients in the early stage of multiple organ dysfunction syndrome (MODS).

Materials and methods

A total of 60 patients in the early stage of MODS (APACHE [Acute Physiology and Chronic Health Evaluation] II score ≥20) were investigated in a monocentric, prospective, randomized phase II study. StO2 was measured using the InSpectraTM StO2 system and compared with known indicators of hypoxia (peripheral oxygen saturation [SpO2], arterial oxygen saturation [SaO2], central venous oxygen saturation [ScvO2], pH, serum lactate). Clinical endpoints of the study were 28-day and 6‑month mortality as well as the need for invasive mechanical ventilation and renal replacement therapy during the hospital stay, respectively.

Results

An increased 28-day and 6‑month mortality is found for patients with StO2 <75% in contrast to patients with StO2 ≥75%. Correlations of StO2 with SpO2, ScvO2, and serum lactate are confirmed. Patients with reduced StO2 tend to show a higher disease severity as measured by APACHE II score.

Conclusion

StO2 shows prognostic relevance in patients at the early stage of MODS. Thus, the rapid and noninvasive assessment of StO2 could be useful in risk stratification of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Briegel J (2012) Systemic Inflammatory Response Syndrome (SIRS), Sepsis und Multiorganversagen. In: Rossaint R (Hrsg) Die Anästhesiologie, 3. Aufl. Springer, Berlin Heidelberg, S 1578–1592

    Chapter  Google Scholar 

  2. Bauer M, Kortgen A (2013) Schock und Multiorganversagen. In: Wilhelm W (Hrsg) Praxis der Intensivmedizin, 2. Aufl. Springer, Berlin Heidelberg, S 473–482

    Chapter  Google Scholar 

  3. Müller-Werdan U, Buerke M, Nuding S, Prondzinsky R, Loppnow H, Ebelt H et al (2011) Schock. In: Erdmann E (Hrsg) Klinische Kardiologie: Krankheiten des Herzens, des Kreislaufs und der herznahen Gefäße, 8. Aufl. Springer, Berlin Heidelberg, S 181–246

    Chapter  Google Scholar 

  4. Nuding S, Ebelt H, Hoke RS, Krummenerl A, Wienke A, Müller-Werdan U et al (2011) Reducing elevated heart rate in patients with multiple organ dysfunction syndrome by the I (f) (funny channel current) inhibitor ivabradine : MODI(f)Y trial. Clin Res Cardiol 100(10):915–923

    Article  CAS  Google Scholar 

  5. Schuster HP, Müller-Werdan U (2005) Definition und Diagnose von Sepsis und Multiorganversagen. In: Werdan K (Hrsg) Sepsis und MODS, 5. Aufl. Springer, Berlin Heidelberg

    Google Scholar 

  6. Crookes BA, Cohn SM, Bloch S, Amortegui J, Manning R, Li P et al (2005) Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma 58(4):806–816

    Article  Google Scholar 

  7. Cohn SM, Nathens AB, Moore FA, Rhee P, Puyana JC, Moore EE et al (2007) Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma 62(1):44–55

    Article  Google Scholar 

  8. Carlile C, Wade CE, Baraniuk MS, Holcomb JB, Moore LJ (2015) Evaluation of StO2 tissue perfusion monitoring as a tool to predict the need for lifesaving interventions in trauma patients. Am J Surg 210(6):1070–1075

    Article  Google Scholar 

  9. Vorwerk C, Coats TJ (2012) The prognostic value of tissue oxygen saturation in emergency department patients with severe sepsis or septic shock. Emerg Med J 29(9):699–703

    Article  Google Scholar 

  10. Lichtenstern C, Koch C, Rohrig R, Rosengarten B, Henrich M, Weigand MA (2012) Near-infrared spectroscopy in sepsis therapy : predictor of a low central venous oxygen saturation. Anaesthesist 61(10):883–891

    Article  CAS  Google Scholar 

  11. Ducrocq N, Kimmoun A, Levy B (2013) Lactate or ScvO2 as an endpoint in resuscitation of shock states? Minerva Anestesiol 79(9):1049–1058

    CAS  PubMed  Google Scholar 

  12. Cerny V, Turek Z, Parizkova P (2009) In situ assessment of the liver microcirculation in mechanically ventilated rats using sidestream dark-field imaging. Physiol Res 58(1):49–55

    CAS  PubMed  Google Scholar 

  13. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patiens with sepsis. Am J Respir Crit Care Med 166(1):98–104

    Article  Google Scholar 

  14. Creteur J (2008) Muscle StO2 in critically ill patients. Curr Opin Crit Care 14(3):361–366

    Article  Google Scholar 

  15. Skarda DE, Mulier KE, Myers DE, Taylor JH, Beilman GJ (2007) Dynamic near-infrared spectroscopy measurements in patients with severe sepsis. Shock 27(4):348–353

    Article  CAS  Google Scholar 

  16. Doerschug KC, Delsing AS, Schmidt GA, Haynes WG (2007) Impairments in microvascular reactivity are related to organ failure in human sepsis. Am J Physiol Heart Circ Physiol 293(2):H1065–H1071

    Article  CAS  Google Scholar 

  17. Moore FA, Cohn SM, Nathens AB, Rhee P, Puyana JC, Moore EE (2007) Tissue oxygen saturation predicts the development of organ failure during traumatic shock resuscitation. Inflamm Res 56(2):217–218

    Google Scholar 

  18. 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(9):1549–1556

    Article  Google Scholar 

  19. Mulier KE, Skarda DE, Taylor JH, Myers DE, McGraw MK, Gallea BL et al (2008) Near-infrared spectroscopy in patients with severe sepsis: correlation with invasive hemodynamic measurements. Surg Infect 9(5):515–519

    Article  Google Scholar 

  20. Payen D, Luengo C, Heyer L, Resche-Rigon M, Kerever S, Damoisel C et al (2009) Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome? Crit Care 13(5):6

    Article  Google Scholar 

  21. Shapiro NI, Arnold R, Sherwin R, O’Connor J, Najarro G, Singh S et al (2011) The association of near-infrared spectroscopy-derived tissue oxygenation measurements with sepsis syndromes, organ dysfunction and mortality in emergency department patients with sepsis. Crit Care 15(5):R223

    Article  Google Scholar 

  22. Norzan NA, Wahab MA (2012) Non invasive method of assesing hypoperfusion in paediatric cases in emergency department – our experience using StO2. Crit Care Shock 15(3):83–84

    Google Scholar 

  23. Crawford J, Otero R, Goyal N, Sankey S, Rivers E (2007) Near infrared spectroscopy to assess systemic perfusion in the critically ill. Crit Care Med 35(12):A254, Abstract 913

    Google Scholar 

  24. Leone M, Blidi S, Antonini F, Meyssignac B, Bordon S, Garcin F et al (2009) Oxygen tissue saturation is lower in nonsurvivors than in survivors after early resuscitation of septic shock. Anesthesiology 111(2):366–371

    Article  CAS  Google Scholar 

  25. Li T, Duan M, Li K, Yu G, Ruan Z (2015) Bedside monitoring of patients with shock using a portable spatially-resolved near-infrared spectroscopy. Biomed Opt Express 6(9):3431–3436

    Article  CAS  Google Scholar 

  26. Crawford J, Otero R, Rivers EP, Goldsmith D (2008) Near-infrared spectroscopy as a potential surrogate for mixed venous oxygen saturation for evaluation of patients with hemodynamic derangements. Crit Care 12(2):27–28, Abstract P69

    Google Scholar 

  27. Mesquida J, Masip J, Gili G, Artigas A, Baigorri F (2009) Thenar oxygen saturation measured by near infrared spectroscopy as a noninvasive predictor of low central venous oxygen saturation in septic patients. Intensive Care Med 35(6):1106–1109

    Article  Google Scholar 

  28. Napoli AM, Machan JT, Forcada A, Corl K, Gardiner F (2010) Tissue oxygenation does not predict central venous oxygenation in emergency department patients with severe sepsis and septic shock. Acad Emerg Med 17(4):349–352

    Article  Google Scholar 

  29. Permpikul C, Cheranakhorn C (2014) The temporal changes of tissue oxygen saturation (StO2) and central venous oxygen saturation (ScvO2) during sepsis/septic shock resuscitation. J Med Assoc Thai 97(Suppl 3):168–175

    Google Scholar 

  30. Leichtle SW, Kaoutzanis C, Brandt M‑M, Welch KB, Purtill M‑A (2013) Tissue oxygen saturation for the risk stratification of septic patients. J Crit Care 28(6):1111.e1–1111.e5

    Article  Google Scholar 

  31. Ebelt H, Werdan K (2012) Septischer Kreislaufschock und septische Kardiomyopathie. Med Klin Intensivmed Notfmed 107(1):24–28

    Article  CAS  Google Scholar 

  32. Müller-Werdan U, Prondzinsky R, Werdan K (2016) Effect of inflammatory mediators on cardiovascular function. Curr Opin Crit Care 22(5):453–463

    Article  Google Scholar 

  33. Boekstegers P, Weidenhöfer S, Kapsner T, Werdan K (1994) Skeletal muscle partial pressure of oxygen in patients with sepsis. Crit Care Med 22(4):640–650

    Article  CAS  Google Scholar 

  34. Lima A, van Genderen ME, Klijn E, Bakker J, van Bommel J (2012) Peripheral vasoconstriction influences thenar oxygen saturation as measured by near-infrared spectroscopy. Intensive Care Med 38(4):606–611

    Article  CAS  Google Scholar 

  35. Nicks BA, Campons KM, Bozeman WP (2015) Association of low non-invasive near-infrared spectroscopic measurements during initial trauma resuscitation with future development of multiple organ dysfunction. World J Emerg Med 6(2):105–110

    Article  Google Scholar 

  36. Iyegha UP, Conway T, Pokorney K, Mulier KE, Nelson TR, Beilman GJ (2014) Low StO2 measurements in surgical intensive care unit patients is associated with poor outcomes. J Trauma Acute Care Surg 76(3):809–816

    Article  CAS  Google Scholar 

  37. Colin G, Nardi O, Polito A, Aboab J, Maxime V, Clair B et al (2012) Masseter tissue oxygen saturation predicts normal central venous oxygen saturation during early goal-directed therapy and predicts mortality in patients with severe sepsis. Crit Care Med 40(2):435–440

    Article  CAS  Google Scholar 

  38. Sagraves SG, Newell MA, Bard MR, Watkins FR, Corcoran KJ, McMullen PD et al (2009) Tissue oxygenation monitoring in the field: a new EMS vital sign. J Trauma 67(3):441–444

    Article  CAS  Google Scholar 

  39. Goulet H, Andre S, Sahakian GD, Freund Y, Khelifi G, Claessens YE et al (2014) Accuracy of oxygen tissue saturation values in assessing severity in patients with sepsis admitted to emergency departments. Eur J Emerg Med 21(4):266–271

    Article  Google Scholar 

  40. Furmaga W, Cohn S, Prihoda TJ, Muir MT, Mikhailov V, McCarthy J et al (2015) Novel markers predict death and organ failure following hemorrhagic shock. Clin Chim Acta 440:87–92

    Article  CAS  Google Scholar 

  41. Poeze M (2006) Tissue-oxygenation assessment using near-infrared spectroscopy during severe sepsis: confounding effects of tissue edema on StO2 values. Intensive Care Med 32(5):788–789

    Article  CAS  Google Scholar 

  42. Saha C, Jones MP (2016) Type I and Type II error rates in the last observation carried forward method under informative dropout. J Appl Stat 43(2):336–350

    Article  Google Scholar 

  43. Schwertz H, Müller-Werdan U, Prondzinsky R, Werdan K, Buerke M (2004) Katecholamine im kardiogenen Schock: hilfreich, nutzlos oder gefährlich? Dtsch Med Wochenschr 129(37):1925–1930

    Article  CAS  Google Scholar 

  44. Werdan K, Ruß M, Buerke M, Engelmann L, Ferrari M, Friedrich I et al (2011) Deutsch-österreichische S3-Leitlinie „Infarktbedingter kardiogener Schock – Diagnose, Monitoring und Therapie“. Kardiologe 3(5):166–224

    Google Scholar 

  45. Riessen R, Tschritter O, Janssens U, Haap M (2016) Katecholamine: Pro und Kontra. Med Klin Intensivmed Notfallmed 111(1):37–46

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle, Deutschland

    D. Huster, F. Härtel, S. Nuding, J. Schroeder, Y. Zhang, K. Werdan &  H. Ebelt

  2. Katholisches Krankenhaus „St. Johann Nepomuk“, Haarbergstr. 72, 99097, Erfurt, Deutschland

    H. Ebelt

Authors
  1. D. Huster
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Härtel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Nuding
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Schroeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Werdan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Ebelt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Ebelt.

Ethics declarations

Interessenkonflikt

D. Huster, F. Härtel, J. Schroeder, Y. Zhang, K. Werdan und H. Ebelt geben an, dass kein Interessenkonflikt besteht. S. Nuding hat während der Durchführung der Studie eine Förderung durch das Wilhelm-Roux-Programm der Martin-Luther-Universität erhalten (Roux-Programm: FKZ 21/19).

Das Prüfprotokoll der MODIfY-Studie wurde von der zuständigen Ethikkommission der medizinischen Fakultät der Martin-Luther-Universität Halle-Wittenberg genehmigt.

Additional information

Redaktion

M. Buerke, Siegen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huster, D., Härtel, F., Nuding, S. et al. Prognostische Relevanz der Gewebesauerstoffsättigung bei Patienten in der Frühphase eines Multiorgandysfunktionssyndroms. Med Klin Intensivmed Notfmed 114, 146–153 (2019). https://doi.org/10.1007/s00063-018-0438-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-018-0438-6

Schlüsselwörter

Keywords

Search

Navigation