Abstract
Tissue oximetry, already a practical reality in some centers, holds considerable promise for clinical use. It has the capacity to monitor the oxygen delivery system and estimate perfusion of tissues; and we suspect it can add considerably to prevention of surgical complications and treatment of surgical infections. Present instruments are relatively difficult to use, but their potential is not being utilized largely because of misconceptions about the transport of oxygen in tissue and the significance of peripheral perfusion. Oximetry measures perfusion, whereas currently popular indices such as urine output are indirect indicators and are often misleading.
The basic concepts of tissue oxygenation, the relevance of partial pressure of oxygen in tissue, the connection with perfusion, various technologies for measuring tissue oxygenation, and the currently available methods are discussed.
Résumé
L'oxymétrie tissulaire déjà employée dans quelques centres est porteuse de promesses considérables sur le plan de la clinique. La méthode possède la capacité de monitorer la distribution de l'oxygène et d'apprécier la perfusion des tissus. Pour les auteurs de l'article, elle est susceptible également de constituer un appoint considérable pour prévenir l'apparition des complications chirurgicales et pour traiter les infections chirurgicales. Les instruments actuels sont d'un emploi relativement difficile, mais leur potentiel n'a pas été assez utilisé en raison de conceptions inexactes concernant le transport de l'oxygène dans les tissus et l'importance de la perfusion périphérique. L'oxymétrie permet de mesurer directement la perfusion périphérique alors que les indices couramment utilisés, tel que le débit urinaire, ne sont que des indications indirectes conduisant souvent à des erreurs.
Fort de ces faits, les auteurs de l'article passent en revue les concepts de base de l'oxygénation tissulaire, la valeur de la pression partielle de l'oxygène tissulaire, la connexion avec la perfusion, les différentes techniques de mesure de l'oxygénation tissulaire et les méthodes actuellement disponibles.
Resumen
La oximetría tisular, la cual ya es una realidad práctica en algunos centros médicos, aparece como promisoria para el uso clínico. Posee la capacidad de monitoría del sistema de provisión tisular de oxígeno y de estimar la perfusión de los tejidos; se espera que pueda contribuir en forma considerable a la prevención de las complicaciones quirúrgicas y al tratamiento de las infecciones en cirugía. Los instrumentos actuales son de difícil uso, pero su potencial no ha sido utilizado en razón, principalmente, de las concepciones erróneas que existen sobre el transporte del oxígeno en los tejidos y el significado de la perfusión periférica. La oximetría mide la perfusión tisular, mientras algunos índices de uso común, tal como el volumen urinario, son sólo indicadores indirectos y con frecuencia engañosos.
En este trabajo se discuten los conceptos básicos de oxigenación, la pertinencia de la presión parcial de oxígeno en los tejidos, la relación con la perfusión, las diversas tecnologías para medir oxigenación tisular, y los métodos actualmente disponibles.
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Hunt, T.K., Rabkin, J., Jensen, J.A. et al. Tissue oximetry: An interim report. World J. Surg. 11, 126–132 (1987). https://doi.org/10.1007/BF01656394
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DOI: https://doi.org/10.1007/BF01656394