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

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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.

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The authors had no conflict of interest.

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Authors and Affiliations

  1. Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France

    H. Ait-Oufella, J. Joffre, A. Galbois, S. Bourcier, J. L. Baudel, D. Margetis, M. Alves, G. Offenstadt, B. Guidet & E. Maury

  2. Inserm U970, Paris Research Cardiovascular Center, Paris, France

    H. Ait-Oufella

  3. Université Pierre et Marie Curie-Paris 6, Paris, France

    H. Ait-Oufella, P. Y. Boelle, G. Offenstadt, B. Guidet & E. Maury

  4. Service de santé publique, Hôpital Saint-Antoine, AP-HP, Paris, 75012, France

    P. Y. Boelle

  5. Inserm U707, Paris, 75012, France

    P. Y. Boelle, G. Offenstadt, B. Guidet & E. Maury

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  1. H. Ait-Oufella
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  2. J. Joffre
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  3. P. Y. Boelle
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  6. J. L. Baudel
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  7. D. Margetis
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  8. M. Alves
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  9. G. Offenstadt
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  10. B. Guidet
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Correspondence to H. Ait-Oufella.

Electronic supplementary material

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134_2012_2555_MOESM1_ESM.ppt

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)

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Ait-Oufella, H., Joffre, J., Boelle, P.Y. et al. Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock. Intensive Care Med 38, 976–983 (2012). https://doi.org/10.1007/s00134-012-2555-7

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  • DOI: https://doi.org/10.1007/s00134-012-2555-7

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