Curve analysis of tissue oxygen desaturation after a venous occlusion test does not identify the central venous hemoglobin oxygen saturation

Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome during trauma resuscitation. Detecting subtle changes in perfusion is crucial to ensure adequate tissue oxygenation and perfusion. Traditional methods of detecting physiological changes include measurements of blood pressure, heart rate, urine output, serum levels of lactate, mixed venous oxygen saturation, and central venous oxygen saturation. Continuous noninvasive monitoring of tissue oxygen saturation in muscle has the potential to indicate severity of shock, detect occult hypoperfusion, guide resuscitation, and be predictive of the need for interventions to prevent multiple organ dysfunction syndrome. Tissue oxygen saturation is being used in emergency departments, trauma rooms, operating rooms, and emergency medical services. Tissue oxygen saturation technology is just as effective as mixed venous oxygen saturation, central venous oxygen saturation, serum lactate, and Stewart approach with strong ion gap, yet tissue oxygen saturation assessment is also a direct, noninvasive microcirculatory measurement of oxygen saturation.

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Oxygen exchange in the microcirculation of hamster retractor muscle

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1989.256.1.h247 ◽

1989 ◽

Vol 256 (1) ◽

pp. H247-H255 ◽

Cited By ~ 21

Author(s):

D. P. Swain ◽

R. N. Pittman

Keyword(s):

Blood Cell ◽

Oxygen Saturation ◽

Oxygen Tension ◽

Red Blood Cell ◽

Unit Length ◽

Retractor Muscle ◽

Tissue Oxygen ◽

Hemoglobin Oxygen Saturation ◽

First Order ◽

Weighted Values

We determined percent hemoglobin oxygen saturation (SO2) in arterioles and venules of the hamster retractor muscle at rest. We found that SO2 decreased from 69.9 +/- 1.4% (SE) in large input arterioles (first order, 1A, ID = 60 +/- 3 micron) to flow-weighted values of 56.7% in small arterioles (4A, ID = 20 +/- 1 micron), 51.3% in small venules (4V, ID = 28 +/- 1 micron), and to 50.6 +/- 1.0% in large venules (1V, ID = 147 +/- 13 micron). Thus approximately two-thirds of the net decline in SO2 for this tissue occurred by diffusion of oxygen from arterioles, whereas only about one-third occurred by diffusion from capillaries. Furthermore, no net shunting of oxygen from the arterioles to the venules was detected as evidenced by the absence of any significant change in venular SO2. By determining the SO2 at upstream and downstream ends of arterioles in four consecutive branching orders (1A-4A), we found that the decrease in SO2 per unit length (delta SO2/L) increased approximately 20-fold from 1A to 4A. This increase in delta SO2/L was directly proportional to estimated luminal minus tissue oxygen tension and inversely proportional to red blood cell flow.

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Nocturnal Oxygen Desaturation and Disordered Sleep as a Potential Factor in Executive Dysfunction in Sickle Cell Anemia

Journal of the International Neuropsychological Society ◽

10.1017/s1355617711001469 ◽

2011 ◽

Vol 18 (1) ◽

pp. 168-173 ◽

Cited By ~ 40

Author(s):

Matthew J. Hollocks ◽

Tessa B. Kok ◽

Fenella J. Kirkham ◽

Johanna Gavlak ◽

Baba P. Inusa ◽

...

Keyword(s):

Cognitive Impairment ◽

Oxygen Saturation ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Cognitive Assessment ◽

Executive Dysfunction ◽

Oxygen Desaturation ◽

Sleep Fragmentation ◽

Hemoglobin Oxygen Saturation ◽

Neuropsychological Measures

AbstractPrevious research has identified cognitive impairment in children with sickle cell anemia (SCA, Hemoglobin SS) compared with controls, partly accounted for by overt neuropathology after clinical stroke, “covert” (“silent”) infarction, and severity of anemia. However, cognitive deficits have also been identified in children with SCA with no history of stroke and a normal T2-weighted magnetic resonance imaging (MRI) scan. Our aim was to investigate whether nocturnal hemoglobin oxygen desaturation and sleep fragmentation could be associated with cognitive impairment in children with SCA. We assessed 10 children with SCA (9 with normal MRI) using neuropsychological measures of executive function. Cognitive assessment was immediately followed by overnight polysomnography to record nocturnal hemoglobin oxygen saturation and sleep arousals. Decreases in hemoglobin oxygen saturation and/or increased sleep arousals were associated with reduced performance on cognitive assessment. Nocturnal hemoglobin oxygen desaturation and sleep fragmentation may be a contributing factor to executive dysfunction in SCA. (JINS, 2012, 18, 168–173)

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Differences Between Central Venous and Cerebral Tissue Oxygen Saturation in Anaesthetised Patients With Diabetes Mellitus

Scientific Reports ◽

10.1038/s41598-019-56221-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Roberta Sudy ◽

Ferenc Petak ◽

Almos Schranc ◽

Szilvia Agocs ◽

Ivett Blaskovics ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Tissue Oxygen Saturation ◽

Anaesthesia Induction ◽

Tissue Oxygen ◽

Cerebral Tissue ◽

Central Venous ◽

Patients With Diabetes ◽

And Control

AbstractThe brain has high oxygen extraction, thus the regional cerebral tissue oxygen saturation (rSO2) is lower than the central venous oxygen saturation (ScvO2). We hypothesised that diabetes widens the physiological saturation gap between ScvO2 and rSO2 (gSO2), and the width of this gap may vary during various phases of cardiac surgery. Cardiac surgery patients with (n = 48) and without (n = 91) type 2 diabetes mellitus (T2DM) underwent either off-pump coronary artery bypass (OPCAB) or other cardiac surgery necessitating cardiopulmonary bypass (CPB) were enrolled. rSO2 was measured by near-infrared spectroscopy (NIRS) and ScvO2 was determined simultaneously from central venous blood. rSO2 was registered before and after anaesthesia induction and at different stages of the surgery. ScvO2 did not differ between the T2DM and control patients at any stage of surgery, whereas rSO2 was lower in T2DM patients, compared to the control group before anaesthesia induction (60.4 ± 8.1%[SD] vs. 67.2 ± 7.9%, p<0.05), and this difference was maintained throughout the surgery. After anaesthesia induction, the gSO2 was higher in diabetic patients undergoing CPB (20.2 ± 10.4% vs. 12.4 ± 8.6%, p < 0.05) and OPCAB grafting surgeries (17.0 ± 7.5% vs. 9.5 ± 7.8%, p < 0.05). While gSO2 increased at the beginning of CPB in T2DM and control patients, no significant intraoperative changes were observed during the OPCAB surgery. The wide gap between ScvO2 and rSO2 and their uncoupled relationship in patients with diabetes indicate that disturbances in the cortical oxygen saturation cannot be predicted from the global clinical parameter, the ScvO2. Thus, our findings advocate the monitoring value of NIRS in T2DM.

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Studies on Platelet Aggregation before and after Carotid Endarterectomy (Part2) : Relationship between Coagulo-fibrinolytic Activities and Platelet Aggregation following Venous Occlusion Test

Japanese Journal of Neurosurgery ◽

10.7887/jcns.4.351 ◽

1995 ◽

Vol 4 (4) ◽

pp. 351-358

Author(s):

Noboru Asano ◽

Shin Ueda

Keyword(s):

Platelet Aggregation ◽

Carotid Endarterectomy ◽

Venous Occlusion ◽

Occlusion Test ◽

Before And After ◽

Venous Occlusion Test

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Decreased fibrinolytic stimulation by a short-term venous occlusion test in patients with cerebrovascular disease

Thrombosis Research ◽

10.1016/0049-3848(95)00124-a ◽

1995 ◽

Vol 79 (4) ◽

pp. 363-368 ◽

Cited By ~ 5

Author(s):

Bernhard Kempter ◽

Alexander Peinemann ◽

Oliver Biniasch ◽

Roman L. Haberl

Keyword(s):

Cerebrovascular Disease ◽

Venous Occlusion ◽

Short Term ◽

Occlusion Test ◽

Venous Occlusion Test

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Study of the venous occlusion test in smokers

Fibrinolysis and Proteolysis ◽

10.1016/0268-9499(90)90192-m ◽

1990 ◽

Vol 4 ◽

pp. 65

Author(s):

J.C. Gris ◽

J.F. Schved ◽

P. Martinez ◽

A. Arnaud ◽

N. Sanchez ◽

...

Keyword(s):

Venous Occlusion ◽

Occlusion Test ◽

Venous Occlusion Test

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Characterization of tissue oxygen saturation and the vascular occlusion test: influence of measurement sites, probe sizes and deflation thresholds

Critical Care ◽

10.1186/cc8001 ◽

2009 ◽

Vol 13 (Suppl 5) ◽

pp. S3 ◽

Cited By ~ 56

Author(s):

Hernando Gómez ◽

Jaume Mesquida ◽

Peter Simon ◽

Hyung Kim ◽

Juan C Puyana ◽

...

Keyword(s):

Oxygen Saturation ◽

Vascular Occlusion ◽

Tissue Oxygen Saturation ◽

Tissue Oxygen ◽

Vascular Occlusion Test ◽

Occlusion Test

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Activation of platelets in the venous occlusion test

Thrombosis Research ◽

10.1016/0049-3848(84)90314-1 ◽

1984 ◽

Vol 35 (1) ◽

pp. 77-80

Author(s):

Torbjörn Nilsson

Keyword(s):

Venous Occlusion ◽

Occlusion Test ◽

Venous Occlusion Test

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Use of a Low-Molecular Weight Heparin (Enoxaparin) or of a Phenformin-like Substance (Moroxydine Chloride) in Primary Early Recurrent Aborters with an Impaired Fibrinolytic Capacity

Thrombosis and Haemostasis ◽

10.1055/s-0038-1653781 ◽

1995 ◽

Vol 73 (03) ◽

pp. 362-367 ◽

Cited By ~ 38

Author(s):

Jean-Christophe Gris ◽

Sylvie Neveu ◽

Marie-Laure Tailland ◽

Christophe Courtieu ◽

Pierre Marès ◽

...

Keyword(s):

Molecular Weight ◽

Low Molecular Weight Heparin ◽

Venous Occlusion ◽

Clot Lysis ◽

Primary Study ◽

Low Molecular Weight ◽

Occlusion Test ◽

Number Of Patients ◽

Fibrinolytic Capacity ◽

Venous Occlusion Test

SummaryAn impaired fibrinolytic capacity, defined as an insufficient venous occlusion-induced shortening of the plasma euglobulin clot lysis time, is a common feature in women suffering from primary early recurrent unexplained miscarriages (1,2). We investigated the therapeutic effect of a low-molecular-weight heparin and of a phenformin-like substance.In a prospective, randomized trial, 30 consecutive patients initially received either enoxaparin, 20 mg per day during one month, or moroxydine chloride, 1200 mg per day during one month. In case of fibrinolytic status normalization, they were treated during 6 months by the beneficial treatment which was planned to be continued during eventual pregnancies. Patients with hypofibrinolysis persistence received the alternative treatment during another month and a new evaluation was performed. No treatment was given when a persistent abnormal response to the venous occlusion test was evidenced. In case of positive response, the treatment was continued during 6 months. The primary study end-points consisted of any of the following: effect of the treatments on the fibrinolytic response; number of patients becoming pregnant during the 6 months following the last venous occlusion test; number of full-term pregnancies.Concerning the effects on the fibrinolytic system, 20 out of 29 women responded to the first or second-line enoxaparin treatment whereas only 1 woman out of 19 responded to moroxydine chloride (p=0.00002). Concerning the effects on fertility, responders to LMWH were more likely to initiate a new pregnancy than non-responders (16/20 vs 2/10, p=0.002). In patients conceiving, LMWH responders were more likely to obtain live births than nonresponders (13/16 vs. 0/2, p=0.02). The 9 women who had not responded to both treatments and the one who had responded to moroxydine chloride are still childless. Thirteen of the 20 previously childless women who had responded to enoxaparin had a successful pregnancy whilst taking the low-molecular weight heparin (p=0.0009).The low-molecular weight heparin enoxaparin was associated with successful pregnancies in patients with recurrent unexplained miscarriages associated with an impaired fibrinolytic capacity.

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