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Use of non-invasive NIRS during a vascular occlusion test to assess dynamic tissue O2 saturation response

Intensive Care Medicine volume 34, Article number: 1600 (2008) Cite this article

Abstract

Introduction

We assessed tissue O2 saturation (StO2) and total hemoglobin (HbT) changes during a vascular occlusion test (VOT) as markers of O2 consumption and cardiovascular reserve.

Methods

Using the non-invasive InSpectra® near infrared spectrometer, we studied the effect of VOT to StO2 < 40% then release on thenar eminence StO2 and HbT in 15 normal volunteers (controls) and 10 trauma patients. We repeated the VOT four times in controls and twice in patients, with controls exercising during the last VOT, and correlated StO2 with HbT changes by linear regression analysis.

Results

StO2 started to decrease 3–28 s post-occlusion (latency) in controls and then decreased in a linear fashion (−0.18 ± 0.04% O2/s, mean ± SD), while post-occlusion StO2 recovery was rapid (5.20 ± 1.19% O2/s). Exercise decreased latency (0–5 s) and increased desaturation rate (−0.18 and −0.69% O2/s, P < 0.005) without altering recovery. Trauma patients showed similar StO2 desaturation rates, but slower recovery (5.20 ± 1.19 vs. 2.88 ± 1.71%/s, P < 0.0001). Repeated VOT gave similar recovery results within study groups. The hyperemic response was variable in both groups and, if present, was associated with an increased HbT. HbT pre- and post-VOT were significantly different within each subject. Although HbT slope of recovery correlated significantly with StO2 recovery in trauma patients (rho 0.76), it was not in controls.

Conclusions

One VOT defines StO2 deoxygenation and recovery. That StO2 and HbT recovery co-vary only in trauma patients suggests that pre-existing vasoconstriction was unmasked by the ischemic challenge consistent with increased sympathetic tone.

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Acknowledgment

This research was supported in part by NHLBI grants HL67181 and HL76157.

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Affiliations

  1. Department of Critical Care Medicine, Cardiopulmonary Research Laboratory, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Hernando Gómez, Hyung Kook Kim, Sven Zenker, Juan Carlos Puyana & Michael R. Pinsky

  2. Department of Surgery, Cardiopulmonary Research Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, USA

    Andrés Torres, Patricio Polanco & Juan Carlos Puyana

Authors
  1. Hernando Gómez
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  2. Andrés Torres
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  3. Patricio Polanco
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  4. Hyung Kook Kim
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  5. Sven Zenker
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  6. Juan Carlos Puyana
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  7. Michael R. Pinsky
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Correspondence to Michael R. Pinsky.

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This article is discussed in the editorial available at doi:10.1007/s00134-008-1146-0.

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Table E1 Comparison of deoxygenation and recovery slopes between initial measurement and 6 months after in healthy volunteers (DOC 33 kb)

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Gómez, H., Torres, A., Polanco, P. et al. Use of non-invasive NIRS during a vascular occlusion test to assess dynamic tissue O2 saturation response. Intensive Care Med 34, 1600 (2008). https://doi.org/10.1007/s00134-008-1145-1

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Keywords

  • Cardiovascular reserve
  • Human study
  • Microcirculation
  • Tissue oxygen saturation