Prognostic Value of Tissue Oxygen Monitoring and Regional Cerebral Oxygen Saturation Monitoring and Their Correlation in Neurological Patients with Sepsis

2020 ◽  
Vol 32 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Badri P. Das ◽  
Megha Sharma ◽  
Sonia Bansal ◽  
Mariamma Philip ◽  
Ganne S. Umamaheswara Rao
Keyword(s):  
Oxygen Saturation ◽  
Prognostic Value ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Tissue Oxygen ◽  
Neurological Patients ◽  
Oxygen Monitoring

scholarly journals Relationship Between Cerebral Hemodynamics, Tissue Oxygen Saturation, and Delirium in Patients With Septic Shock: A Pilot Observational Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Qing Feng ◽  
Meilin Ai ◽  
Li Huang ◽  
Qianyi Peng ◽  
Yuhang Ai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Oxygen Saturation ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen Saturation ◽  
Automatic Regulation ◽  
Tissue Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Tissue Oxygen ◽  
Cerebral Hemodynamic

Background: Septic shock patients have tendencies toward impairment in cerebral autoregulation and imbalanced cerebral oxygen metabolism. Tissue Oxygen Saturation (StO2) and Transcranial Doppler (TCD) monitoring were undertaken to observe the variations of cerebral hemodynamic indices and cerebral/peripheral StO2 to find risk factors that increase the sepsis-associated delirium (SAD).Materials and Methods: The research cohort was chosen from septic shock patients received in the Department of Critical Care Medicine, Xiangya Hospital, Central South University between May 2018 and March 2019. These patients were separated into two groups, SAD and non-SAD as assessed by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Comparisons were made between the two groups in terms of peripheral StO2, fluctuations in regional cerebral oxygen saturation (rSO2), cerebral vascular automatic regulation function [Transient Hyperemic Response Ratio (THRR) index], cerebral hemodynamic index, organ function indicators, blood gas analysis indices, and patient characteristics.Results: About 39% of the patients (20/51) suffered from SAD. Nearly 43% of the patients died within 28 days of admission (22/51). Individuals in the SAD cohort needed a longer period of mechanical ventilation [5 (95% CI 2, 6) vs. 1 days (95% CI 1, 4), p = 0.015] and more time in ICU [9 (95% CI 5, 20) vs. 5 days (95% CI 3, 9), p = 0.042]; they also experienced more deaths over the 28-day period (65 vs. 29%, p = 0.011). The multivariate regression analysis indicated that independent variables associated with SAD were THRR index [odds ratio (OR) = 5.770, 95% CI: 1.222–27.255; p = 0.027] and the mean value for rSO2 was < 55% (OR = 3.864, 95% CI: 1.026–14.550; p = 0.046).Conclusion: Independent risk factors for SAD were mean cerebral oxygen saturation below 55% and cerebrovascular dysregulation (THRR < 1.09).

Abstract 65: Evaluating the Role of Continuously Monitoring Regional Cerebral Oxygen Saturation in Predicting the Return of Spontaneous Circulation in Cardiac Arrest Patients: Does the Use of an Electrocardiogram Alone Provide Adequate Information During Cardiopulmonary Resuscitation?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hitoshi Kano ◽  
Tomoyo Saito ◽  
Toshihisa Matsui ◽  
Akio Endo ◽  
Masaki Nagama ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Oxygen Saturation ◽  
Near Infrared ◽  
Tissue Oxygenation ◽  
Oxygenation Index ◽  
Cerebral Oxygen Saturation ◽  
Infrared Light ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Brain Tissue Oxygenation

During CPR as it is currently administered, treatments are selected from an algorithm derived by monitoring with ECG alone. One of the reasons for this is that no other devices are presently thought to be effective in helping to make treatment determinations. Monitoring of regional cerebral oxygen saturation with near infrared light is non-invasive and provides information on brain tissue oxygenation and hemodynamics. The results of our study suggest that measurements derived from continuously monitoring regional cerebral oxygen saturation during CPR can be considered an effective method of predicting the ROSC in cardiac arrest patients. Methods: In 95 patients with out-of-hospital cardiac arrest, the tissue oxygenation index (TOI) was continuously monitored (NIRO-200NX, Hamamatsu Photonics). We investigated the following parameters with respect to whether or not ROSC was achieved: TOI value at the contact of patients (initial TOI); TOI value just before ROSC (pre-ROSC TOI); and the maximum TOI during CPR (maximum TOI). Results: All the patients monitored received treatment with shocks or drugs and the initial TOI was 35.3±7.3%. For 74 patients who did not achieve ROSC, the maximum TOI was 41.0±7.4%, whereas for 21 patients who did achieve ROSC, the pre-ROSC TOI was 51.3±3.6% and the maximum TOI was 64.3±11.4%. ROSC was not achieved in the patients with maximum TOI below 45%. Conclusion: The pre-ROSC TOI was significantly higher than the maximum TOI in the patients who did not achieve ROSC which suggests the possibility of predicting ROSC by monitoring the increase in TOI. In cases where the TOI remains low, there is a possibility that ROSC should not be expected. In such cases, it may be desirable to attempt to improve the quality of CPR to increase the TOI before delivering shocks or administering drugs.

Abstract 276: The Effects of Peep and Blood Pressure on Cerebral Tissue Oxygen Saturation During Hemorrhage in Swine

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jeff R Gould ◽  
Joshua W Lampe ◽  
Lyra Clark ◽  
George Beck ◽  
Brian C Harvey ◽  
...  
Keyword(s):  
Regression Model ◽  
Oxygen Saturation ◽  
Cerebral Oxygenation ◽  
Cerebral Oxygen Saturation ◽  
Right Atrial ◽  
Tissue Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Tissue Oxygen ◽  
Cerebral Tissue ◽  
Cerebral Tissue Oxygen Saturation

Introduction: Positive end-expiratory pressure (PEEP) is used to increase oxygen delivery by preventing end-expiratory alveolar collapse. However, the associated increased intrathoracic pressure can lead to an increase in right atrial pressure, and a decrease in venous return and cardiac output. Near infrared spectroscopy (NIRS) can be used as a non-invasive tool to continuously monitor cerebral tissue oxygen saturation. In this pilot study, we examined the effects of PEEP on cerebral oxygen saturation during a controlled hemorrhage. Methods: Four female, domestic swine (~30 kg), were bled to 3 target levels of mean arterial pressure (MAP; 55, 45, and 35 mm Hg). At each MAP target, 3 levels of PEEP were applied using a mechanical ventilator (5, 10, and 15 cm H 2 O) for ~10 minutes each. Following the reinfusion of shed blood and a recovery period, these interventions were repeated. Measurements included invasive aortic pressure and cerebral oxygen saturation using a commercially available tissue oximeter. A total of 61 epochs were entered into the following regression model: cerebral oxygen saturation = MAP + PEEP + animal number. Each epoch contained data from the last ~2 minutes of each MAP target and PEEP level. Results: The regression model yielded a coefficient of 0.30 for MAP ( P < 0.001) and -0.08 for PEEP ( P = 0.09) and overall, explained 94% of the variance in cerebral oxygenation (adjusted R 2 = 0.94, P < 0.001). While MAP was a stronger predictor in the model, higher PEEP levels appear to result in lower levels of cerebral oxygenation (see figure). Conclusions: Cerebral tissue oxygen saturation declines with lower mean arterial pressures and increased levels of PEEP. NIRS to measure cerebral oxygen saturation may be a useful clinical tool to ensure adequate cerebral oxygenation in patients with hypotension related to hemorrhage, particularly in those patients that require greater than physiologic PEEP to maintain central oxygenation.

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