scholarly journals ‘Real Angiosome’ Assessment from Peripheral Tissue Perfusion Using Tissue Oxygen Saturation Foot-mapping in Patients with Critical Limb Ischemia

2014 ◽  
Vol 47 (4) ◽  
pp. 433-441 ◽  
Author(s):  
Y. Kagaya ◽  
N. Ohura ◽  
H. Suga ◽  
H. Eto ◽  
A. Takushima ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Tissue Perfusion ◽  
Peripheral Tissue ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen

scholarly journals To Divide or Not to Divide? A Case Report Using Near-Infrared Spectroscopy to Assist With Decision Making on Timing of Division of Forehead Flaps

2021 ◽  
Vol 7 ◽  
pp. 2513826X2110511
Author(s):  
Spencer Yakaback ◽  
Carmen Webb ◽  
Claire Temple-Oberle
Keyword(s):  
Infrared Spectroscopy ◽  
Oxygen Saturation ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Free Flaps ◽  
Cost Effective ◽  
Tissue Perfusion ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Novel Device

Paramedian forehead flaps (PMFFs) are commonly performed procedures for the reconstruction of complex nasal defects and require multiple stages predicated on when the interpolated pedicle is no longer required to provide perfusion to the neo-nose. As the presence of the pedicle is disfiguring, the flap is therefore divided ideally as soon as safely possible, but that determination is challenging. Recently, a novel device that uses near-infrared spectroscopy (NIRS) to measure tissue oxygen saturation has been developed and may provide an accurate and cost-effective tool to assess tissue perfusion. Here we present the use of this technology in the management of 2 patients who underwent successful oncologic nasal reconstructions using PMFFs. Using the device as a clinical adjunct, we measured tissue oxygen saturation values in the flaps before and after pedicle division, which assisted us in deciding when to safely divide the flaps, as well as with post-division management, particularly when a low tissue oxygen saturation reading ultimately necessitated the use of nitroglycerine past to improve flap perfusion in one of our patients. Interestingly, the values we recorded corresponded well to previously published cut-off values for adequate tissue perfusion, which have to date only been reported for free flaps. To our knowledge, this is the first description of the use of NIRS in the division of PMFFs, which we overall found to be a useful and reliable adjunct to a clinical examination in assessing flap neovascularization.

scholarly journals Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

2020 ◽  
Author(s):  
Qing Feng ◽  
Meilin Ai ◽  
Li Huang ◽  
Qianyi Peng ◽  
Yuhang Ai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Mortality Rate ◽  
Oxygen Saturation ◽  
Peripheral Tissue ◽  
Tissue Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Tissue Oxygen ◽  
Cerebral Hemodynamic

Abstract Background Patients with septic shock are prone to have impaired cerebral autoregulation and to have an imbalance in cerebral oxygen metabolism. Transcranial doppler (TCD) and tissue oxygen saturation monitoring were performed to observe the changes in cerebral hemodynamic indices of the middle cerebral artery, and in cerebral and peripheral tissue oxygen saturation (StO 2 ) to identify risk factors for sepsis-associated delirium (SAD). Methods Patients with septic shock that were admitted to the Department of Critical Care Medicine of Xiangya Hospital of Central South University from May 2018 to March 2019 were prospectively enrolled, which were divided into an SAD group and a non-SAD group according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Both groups were compared with respect to patient characteristics, blood gas analysis indexes, organ function indicators, cerebral hemodynamic index, cerebrovascular automatic regulation function (transient hyperemia response rate, THRR index), the changes in regional cerebral oxygen saturation, and peripheral tissue oxygen saturation. Results The incidence of SAD was 39% (20/51). The overall 28-day mortality rate was 43% (22/51). Compared with the non-SAD group, patients in the SAD group required a longer mechanical ventilation time (5 days [95% confidence interval (CI) 2, 6] vs 1day [95% CI 1, 4], p=0.015) and ICU stay (9 days [95% CI 5, 20] vs 5 days [95% CI 3, 9], p=0.042) and has a higher 28-day mortality rate(65% vs 29%, p=0.011).Multivariate regression analysis showed that the THRR index (OR=5.770, 95% CI:1.222-27.255; p=0.027)and mean value of regional cerebral oxygen saturation (rSO 2 ) <55% (OR=3.864, 95% CI:1.026-14.550;p=0.046) were independent risk factors for SAD. Conclusions SAD has a high incidence in septic patients and is associated with poor prognosis. Our results provide a clinical basis for improving early detection and treatment of SAD.

scholarly journals Bedside Assessment of Tissue Oxygen Saturation Monitoring in Critically Ill Adults: An Integrative Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-19 ◽  
Author(s):  
Carol Diane Epstein ◽  
Karen Toby Haghenbeck
Keyword(s):  
Oxygen Saturation ◽  
Critically Ill ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Integrative Review ◽  
Tissue Oxygen Saturation ◽  
Future Research ◽  
Tissue Oxygen ◽  
Critically Ill Adults ◽  
Ill Adults

Objective. Tissue oxygen saturation (StO2) monitoring is a noninvasive technology with the purpose of alerting the clinician of peripheral hypoperfusion and the onset of tissue hypoxia. This integrative review examines the rigor and quality of studies focusing on StO2monitoring in adult critically ill patients.Background. Clinicians must rapidly assess adverse changes in tissue perfusion while minimizing potential complications associated with invasive monitoring. The noninvasive measurement of tissue oxygen saturation is based on near-infrared spectroscopy (NIRS), an optical method of illuminating chemical compounds which absorb, reflect, and scatter light directed at that compound.Methods. An integrative review was conducted to develop a context of greater understanding about complex topics. An Integrative review draws on multiple experimental and nonexperimental research methodologies.Results. Fourteen studies were graded at the C category. None reported the use of probability sampling or demonstrated a cause-and-effect relationship between StO2values and patient outcomes.Conclusions. Future research should be based on rigorous methods of sampling and design in order to enhance the internal and external validity of the findings.

scholarly journals Quantifying dermal microcirculatory changes of neuropathic and neuroischemic diabetic foot ulcers using spatial frequency domain imaging: a shade of things to come?

2020 ◽  
Vol 8 (2) ◽  
pp. e001815
Author(s):  
Grant A Murphy ◽  
Rajinder P Singh-Moon ◽  
Amaan Mazhar ◽  
David J Cuccia ◽  
Vincent L Rowe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Spatial Frequency ◽  
Oxygen Saturation ◽  
Diabetic Foot ◽  
Clinical Course ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Spatial Frequency Domain Imaging ◽  
Patients With Diabetes ◽  
Spatial Frequency Domain

IntroductionThe use of non-invasive vascular and perfusion diagnostics are an important part of assessing lower extremity ulceration and amputation risk in patients with diabetes mellitus. Methods for detecting impaired microvascular vasodilatory function in patients with diabetes may have the potential to identify sites at risk of ulceration prior to clinically identifiable signs. Spatial frequency domain imaging (SFDI) uses patterned near-infrared and visible light spectroscopy to determine tissue oxygen saturation and hemoglobin distribution within the superficial and deep dermis, showing distinct microcirculatory and oxygenation changes that occur prior to neuropathic and neuroischemic ulceration.Research designs and methods35 patients with diabetes mellitus and a history of diabetic foot ulceration were recruited for monthly imaging with SFDI. Two patients who ulcerated during the year-long longitudinal study were selected for presentation of their clinical course alongside the dermal microcirculation biomarkers from SFDI.ResultsPatient 1 developed a neuropathic ulcer portended by a focal increase in tissue oxygen saturation and decrease in superficial papillary hemoglobin concentration 3 months prior. Patient 2 developed bilateral neuroischemic ulcers showing decreased tissue oxygen saturation and increased superficial papillary and deep dermal reticular hemoglobin concentrations.ConclusionsWounds of different etiology show unique dermal microcirculatory changes prior to gross ulceration. Before predictive models can be developed from SFDI, biomarker data must be correlated with the clinical course of patients who ulcerate while being followed longitudinally.Trial registration numberNCT03341559.

Evaluation of Tissue Perfusion by Wound Blush and 2D Color-Coded Digital Subtraction Angiography During Endovascular Intervention and Its Impact on Limb Salvage in Critical Limb Ischemia

2021 ◽  
pp. 152660282110659
Author(s):  
Hassan Lotfy ◽  
Ahmed Abou El-Nadar ◽  
Wael Shaalan ◽  
Ali El Emam ◽  
Akram Ibrahim ◽  
...  
Keyword(s):  
Wound Healing ◽  
Digital Subtraction Angiography ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Tissue Perfusion ◽  
Technical Failure ◽  
Digital Subtraction ◽  
Reliable Technique ◽  
Significant Difference

Purpose: Critical limb ischemia (CLI) is an entity with high mortality if not properly treated. The primary aim of CLI revascularization is to enhance wound healing, which greatly depends on microvascular circulation. The available tools for assessment of revascularization success are deficient in the evaluation of local microvascular tissue perfusion, that wound blush (WB) reflects. A reliable technique that assesses capillary flow to foot lesions is needed. This study aims to assess WB angiographically at sites of interest in the foot after revascularization and its impact on limb salvage in CLI. Materials and Methods: 198 CLI patients (Rutherford category 5/6) with infrainguinal atherosclerotic lesions amenable for endovascular revascularization (EVR) were included. Limbs were directly or indirectly revascularized by EVR. Direct revascularization meant that successful revascularization of the area of interest according to the angiosome concept was achieved. A completion angiographic run was taken to assess WB. Patients were divided into 2 groups; positive and negative WB groups. In the event of a disagreement between the observational investigators, the digital subtraction angiography (DSA) series was analyzed for hemodynamic changes with a computerized 2D color-coded DSA (Syngo iFlow). Results: 176 limbs had successful revascularization in 157 patients. The successful revascularization rate was 88.9% (176/198), with technical failure encountered in 22 limbs. 121 patients had positive WB and 55 patients had negative WB. Direct revascularization of target areas was obtained in 98 limbs (55.7%). There was a significant difference in the rate of achieving direct flow to the lesion between the positive WB and negative WB groups (36.4% vs 19.3%, p≤0.001). We noticed a nonsignificant difference between patients who had direct revascularization of the foot lesion(s) and those who had indirect revascularization as regards limb salvage. Patients were followed up for 25.2 ± 12.7 months. By the end of the first year, limb salvage rate was significantly higher in patients who had positive WB (98% vs 63%, p<0.001, after 2 years (97% vs 58%, p<0.001) and after 3 years (94% vs 51.5%, p<0.001). Conclusions: WB is an important predictor and a prognostic factor for wound healing in CLI patients with soft tissue lesions.

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