Intraoperative hyperglycemic stress response and tissue perfusion in cardiac surgery

Background and aim of the study Approximately 30% of patients undergoing cardiac surgery have a history of diabetes and 60-80% of patients without diabetes have stress hyperglycemia. We examined patients undergoing cardiac surgery to determine the presence of stress hyperglycemia and its relationship to tissue perfusion. Methods Hemodynamic parameters, central venous oxygen saturation, lactate,oxygen delivery and consumption, oxygen extraction rate were analyzed at four intraoperative time points. Results The stress-induced hyperglycemic response during cardiac surgery was more severe in patients without diabetes. When focusing on the oxygen extraction rate in terms of tissue oxygenation, diabetic patients had 1.22 times higher and significant oxygen extraction rate than non-diabetic patients. Conclusions Although lactate values were slightly higher and central venous oxygen saturation were slightly lower in the diabetic group, considering the fact that oxygen extraction rate reflects the total outcome of small changes in all these parameters, we can emphasize the conclusion that diabetic patients undergoing cardiac surgery have greater tissue oxygen demand/supply imbalance compared to non-diabetic patients. In our study, this tissue oxygenation defect in diabetic patients was not found to be directly correlated with blood glucose levels. Perhaps, even if the disease is under control, the negative effects of diabetes on all systems have accumulated and led to such a result.

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Thenar Muscle Oxygen Saturation Levels: A Surrogate for Central Venous Oxygen Saturation?

Clinical Pediatrics ◽

10.1177/0009922819832094 ◽

2019 ◽

Vol 58 (5) ◽

pp. 528-533 ◽

Cited By ~ 1

Author(s):

Ravi S. Samraj ◽

Maria Kerrigan ◽

Maria Mejia ◽

Laura Wilson ◽

James C. Fudge ◽

...

Keyword(s):

Oxygen Saturation ◽

Tissue Oxygenation ◽

Central Venous Oxygen Saturation ◽

Oxygen Extraction ◽

Critically Ill Children ◽

Tissue Oxygen ◽

Central Venous ◽

Thenar Muscle ◽

Study Results ◽

Venous Oxygen Saturation

Purpose. Shock is associated with increased tissue oxygen extraction. Near-infrared spectroscopy–derived thenar muscle tissue oxygenation (StO2) levels can provide an estimate of the oxygen supply-demand balance at the tissue level. We hypothesized that thenar StO2 levels would correlate with central venous oxygen saturation (ScvO2) levels, the gold standard for global tissue oxygen extraction in the body. Methods. We prospectively enrolled 60 pediatric subjects admitted to pediatric intensive care unit or who underwent cardiac catheterization from September 2015 to March 2018. Thenar StO2 levels were measured using the InSpectra StO2 probe. Concurrent measurements of ScvO2 and peripheral tissue oxygenation (StO2) were achieved through simultaneous testing. For ScvO2, a central line placed in the superior vena cava was utilized for serum specimen collection, while the InSpectra probe recorded StO2 measurements from the thenar eminence of the patient’s right hand. Results. Sixty observations of thenar StO2 and ScvO2 levels were derived from 60 subjects. Mean thenar StO2 levels were 74.72 ± 11.18% and displayed significant correlation with paired ScvO2 measurements ( m = 72.17 ± 9.77%; ρ = 0.317, P = .018). Correlation was much more significant in subjects who were not on mechanical ventilatory support as opposed to those who were on it ( ρSORA = 0.496, PSORA = .003, vs ρVENT = 0.161, PVENT = .433). A thenar StO2 of 73% had a sensitivity of 80% and a specificity of 77.8% in predicting an ScvO2 of less than 65%. Conclusion. This is the first study to report correlation of thenar StO2 and ScvO2 levels in children. Our study results show a significant correlation between these levels. Thenar StO2 measurements may have a role in the bedside management of critically ill children in whom ScvO2 monitoring is not available.

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A Comparison of Mixed and Central Venous Oxygen Saturation in Patients during and after Cardiac Surgery

Journal of the Intensive Care Society ◽

10.1177/175114370901000207 ◽

2009 ◽

Vol 10 (2) ◽

pp. 99-101 ◽

Cited By ~ 2

Author(s):

Hicham Sekkat ◽

Schoeb Sohawon ◽

S Oaleed Noordally

Keyword(s):

Cardiac Surgery ◽

Oxygen Saturation ◽

Central Venous Oxygen Saturation ◽

Central Venous ◽

Venous Oxygen Saturation

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Tissue Oxygenation Monitoring as a Guide for Trauma Resuscitation

Critical Care Nurse ◽

10.4037/ccn2016206 ◽

2016 ◽

Vol 36 (3) ◽

pp. 12-70 ◽

Cited By ~ 2

Author(s):

Cathy Mitchell

Keyword(s):

Oxygen Saturation ◽

Tissue Oxygenation ◽

Central Venous Oxygen Saturation ◽

Multiple Organ ◽

Tissue Oxygen Saturation ◽

Multiple Organ Dysfunction ◽

Tissue Oxygen ◽

Trauma Resuscitation ◽

Central Venous ◽

Venous 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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