Brain Tissue Oxygenation in Patients with Septic Shock: a Feasibility Study

AbstractBackground: Delirium is common in critically ill patients and its presence is associated with increased mortality and increased likelihood of poor cognitive function among survivors. However, the cause of delirium is unknown. The purpose of this study was to demonstrate the feasibility of using near-infrared spectroscopy (NIRS) to assess brain tissue oxygenation in patients with septic shock, who are at high risk of developing delirium. Methods: This prospective observational study was conducted in a 33-bed general medical surgical intensive care unit (ICU). Patients with severe sepsis or septic shock were eligible for recruitment. The FORESIGHT NIRS monitor was used to assess brain tissue oxygenation in the frontal lobes for the first 72 hours of ICU admission. Physiological data was also recorded. We used the Confusion Assessment Method-ICU to screen for delirium.Results: From March 1st 2014-September 30th 2014, 10 patients with septic shock were recruited. The NIRS monitor captured 81% of the available data. No adverse events were recorded. Brain tissue oxygenation demonstrated significant intra- and inter-individual variability in the way it correlated with physiological parameters, such as mean arterial pressure, heart rate, and peripheral oxygen saturation. Mean brain tissue oxygen levels were significantly lower in patients who were delirious for the majority of their ICU stay. Conclusion: It is feasible to record brain tissue oxygenation with NIRS in patients with septic shock. This study provides the infrastructure necessary for a larger prospective observational study to further examine the relationship between brain tissue oxygenation, physiological parameters, and acute neurological dysfunction.

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Assessing the relationship between brain tissue oxygenation and neurological dysfunction in critically ill patients: study protocol

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20162792 ◽

2016 ◽

Vol 3 (3) ◽

pp. 98 ◽

Cited By ~ 6

Author(s):

Michael D. Wood ◽

David Maslove ◽

John Muscedere ◽

Stephen H. Scott ◽

Andrew Day ◽

...

Keyword(s):

Critical Illness ◽

Brain Tissue ◽

Tissue Oxygenation ◽

Cerebral Oxygenation ◽

Surrogate Marker ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Brain Tissue Oxygenation

Background: Acute and chronic neurological complications amongst survivors of critical illness is common, however, the underlying etiology of this neurological dysfunction is unknown. This is the first study to use near-infrared spectroscopy to non-invasively measure brain tissue oxygenation, as a surrogate marker of cerebral perfusion, and correlate these values with subsequent neurological dysfunction. We will test the hypothesis that poor cerebral oxygenation during the first 24 hours of critical illness is correlated with acute and chronic neurological complications.Methods: This single-centre prospective observational study will be performed in a 33-bed medical/surgical intensive care unit (ICU). Adult patients are eligible for enrolment if they are admitted to the ICU within 24 hours, require mechanical ventilation, and/or vasopressor support. For 24 hours, cerebral oxygenation levels will be measured with the FORESIGHT oximeter; vital signs and tissue oxygenation will be captured with data monitoring software. Participants will be screened daily for delirium with the confusion assessment method-ICU. Long-term neurological function will be assessed with the Repeatable Battery for the Assessment of Neuropsychological Status and the kinesiological instrument for normal and altered reaching movements (KINARM) robot.Conclusions: This study will provide novel information regarding the determinants of cerebral oxygenation during the acute phase (i.e. 24 hours) of critical illness, and its potential relationship with subsequent neurological complications. Should a relationship exist between cerebral oxygenation and neurological complications, future studies will be aimed at using brain tissue oxygenation as a therapeutic target to prevent acute and chronic neurological dysfunction. Clinical Trial Registration: This trial is registered on clinicaltrials.gov (Identifier: NCT02344043), retrospectively registered January 8, 2015.

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Association of Microcirculation, Macrocirculation, and Severity of Illness in Septic Shock: A Prospective Observational Study to Identify Microcirculatory Targets Potentially Suitable for Guidance of Hemodynamic Therapy

Journal of Intensive Care Medicine ◽

10.1177/0885066616671689 ◽

2016 ◽

Vol 33 (4) ◽

pp. 256-266 ◽

Cited By ~ 4

Author(s):

Timo Sturm ◽

Julia Leiblein ◽

Verena Schneider-Lindner ◽

Thomas Kirschning ◽

Manfred Thiel

Keyword(s):

Septic Shock ◽

Observational Study ◽

Oxygen Saturation ◽

Fluid Balance ◽

Prospective Observational Study ◽

Lactate Concentration ◽

Severity Of Illness ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Hemodynamic Therapy

Purpose: Clinically unapparent microcirculatory impairment is common and has a negative impact on septic shock, but specific therapy is not established so far. This prospective observational study aimed at identifying candidate parameters for microcirculatory-guided hemodynamic therapy. : NCT01530932. Materials and Methods: Microcirculatory flow and postcapillary venous oxygen saturation were detected during vaso-occlusive testing (VOT) on days 1 (T0), 2 (T24), and 4 (T72) in 20 patients with septic shock at a surgical intensive care unit using a laser Doppler spectrophotometry system (O2C). Results: Reperfusional maximal venous capillary oxygen saturation (SvcO2max) showed negative correlations with Simplified Acute Physiology Score II (SAPSII)/Sequential Organ Failure Assessment (SOFA) score, norepinephrine dosage, and lactate concentration and showed positive correlations with cardiac index (CI). At T24 and T72, SvcO2max was also inversely linked to fluid balance. With respect to any predictive value, SvcO2max and CI determined on day 1 (T0) were negatively correlated with SAPS II/SOFA on day 4 (T72). Moreover, SvcO2max measured on day 1 or day 2 was negatively correlated with cumulated fluid balance on day 4 ( r= −.472, P < .05 and r = −.829, P < .001). By contrast, CI neither on day 1 nor on day 2 was correlated with cumulated fluid balance on day 4 ( r = −.343, P = .17 and r = −.365, P = .15). Conclusion: In patients with septic shock, microcirculatory reserve as assessed by SvcO2max following VOT was impaired and negatively correlated with severity of illness and fluid balance. In contrast to CI, SvcO2max determined on day 1 or day 2 was significantly negatively correlated with cumulative fluid balance on day 4. Therefore, early microcirculatory measurement of SvcO2max might be superior to CI in guidance of sepsis therapy to avoid fluid overload. This has to be addressed in future clinical studies.

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Low brain tissue oxygenation contributes to the development of delirium in critically ill patients: A prospective observational study

Journal of Critical Care ◽

10.1016/j.jcrc.2017.06.009 ◽

2017 ◽

Vol 41 ◽

pp. 289-295 ◽

Cited By ~ 11

Author(s):

Michael D. Wood ◽

David M. Maslove ◽

John G. Muscedere ◽

Andrew G. Day ◽

J. Gordon Boyd

Keyword(s):

Observational Study ◽

Brain Tissue ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Tissue Oxygenation ◽

Brain Tissue Oxygenation

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Exercise is feasible in patients receiving vasoactive medication in a cardiac surgical intensive care unit: A prospective observational study

Australian Critical Care ◽

10.1016/j.aucc.2020.02.004 ◽

2020 ◽

Vol 33 (3) ◽

pp. 244-249 ◽

Cited By ~ 1

Author(s):

Jemima Boyd ◽

Jennifer Paratz ◽

Oystein Tronstad ◽

Lawrence Caruana ◽

James Walsh

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Prospective Observational Study ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Vasoactive Medication

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The Dose-Dependent Effect of RSR13, a Synthetic Allosteric Modifier of Hemoglobin, on Physiological Parameters and Brain Tissue Oxygenation in Rats

Oxygen Transport to Tissue XXIV - Advances in Experimental Medicine and Biology ◽

10.1007/978-1-4615-0075-9_27 ◽

2003 ◽

pp. 287-296 ◽

Cited By ~ 12

Author(s):

Oleg Y. Grinberg ◽

Minoru Miyake ◽

Huagang Hou ◽

Robert P. Steffen ◽

Harold M. Swartz

Keyword(s):

Brain Tissue ◽

Tissue Oxygenation ◽

Physiological Parameters ◽

Brain Tissue Oxygenation ◽

Dependent Effect ◽

Dose Dependent ◽

Dose Dependent Effect

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Faculty Opinions recommendation of Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2082971.2577054 ◽

2010 ◽

Author(s):

Jonathan Rhodes

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Brain Tissue ◽

Cerebral Perfusion Pressure ◽

Cerebral Perfusion ◽

Tissue Oxygenation ◽

Perfusion Pressure ◽

Brain Tissue Oxygenation ◽

Pressure Reactivity ◽

Cerebrovascular Pressure Reactivity

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Faculty Opinions recommendation of Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2082971.1671069 ◽

2010 ◽

Author(s):

Nicolas Bruder

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Brain Tissue ◽

Cerebral Perfusion Pressure ◽

Cerebral Perfusion ◽

Tissue Oxygenation ◽

Perfusion Pressure ◽

Brain Tissue Oxygenation ◽

Pressure Reactivity ◽

Cerebrovascular Pressure Reactivity

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Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0502 ◽

2020 ◽

Vol 33 (5) ◽

pp. 653-659

Author(s):

Jia Song ◽

Yun Cui ◽

Chunxia Wang ◽

Jiaying Dou ◽

Huijie Miao ◽

...

Keyword(s):

Septic Shock ◽

Thyroid Hormone ◽

Observational Study ◽

Hospital Mortality ◽

Predictive Value ◽

Prospective Observational Study ◽

Threshold Value ◽

Nonthyroidal Illness ◽

Hormone Levels ◽

Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

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