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).

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.

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.

Prognostic implications of tissue oxygen saturation in human septic shock

2012 ◽  
Vol 38 (4) ◽  
pp. 592-597 ◽  
Author(s):  
J. Mesquida ◽  
C. Espinal ◽  
G. Gruartmoner ◽  
J. Masip ◽  
C. Sabatier ◽  
...  
Keyword(s):  
Septic Shock ◽  
Oxygen Saturation ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Human Septic Shock ◽  
Prognostic Implications

Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock

2012 ◽  
Vol 38 (6) ◽  
pp. 976-983 ◽  
Author(s):  
H. Ait-Oufella ◽  
J. Joffre ◽  
P. Y. Boelle ◽  
A. Galbois ◽  
S. Bourcier ◽  
...  
Keyword(s):  
Septic Shock ◽  
Oxygen Saturation ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen

scholarly journals Oxygen Tissue Saturation Is Lower in Nonsurvivors than in Survivors after Early Resuscitation of Septic Shock

2009 ◽  
Vol 111 (2) ◽  
pp. 366-371 ◽  
Author(s):  
Marc Leone ◽  
Sami Blidi ◽  
François Antonini ◽  
Bertrand Meyssignac ◽  
Sébastien Bordon ◽  
...  
Keyword(s):  
Septic Shock ◽  
Oxygen Saturation ◽  
Tissue Oxygenation ◽  
Microvascular Dysfunction ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Hemodynamic Variables ◽  
Central Venous Saturation

Background Growing evidence suggests that the microvascular dysfunction is the key element of the pathogenesis of septic shock. This study's purpose was to explore whether the outcome of septic shock patients after early resuscitation using early goal-directed therapy is related to their muscle tissue oxygenation. Methods Tissue oxygen saturation (Sto2) was monitored in septic shock patients using a tissue spectrometer (InSpectra Model 325; Hutchinson Technology, Hutchinson, MN). For the purpose of this retrospective study, the Sto2 values were collected at the first measurement done after the macrohemodynamic variables (mean arterial pressure, urine output, central venous saturation in oxygen) were optimized. Results After the hemodynamic variables were corrected, no difference was observed between the nonsurvivors and survivors, with the exception of pulse oximetry saturation (94% [92-97%] vs. 97% [94-99%], P = 0.04). The Sto2 values were significantly lower in the nonsurvivors than in the survivors (73% [68-82%] vs. 84% [81-90%], P = 0.02). No correlations were found between the Sto2 and Spo2 (P = 0.7). Conclusions In septic shock patients, tissue oxygen saturation below 78% is associated with increased mortality at day 28. Further investigations are required to determine whether the correction of an impaired level of tissue oxygen saturation may improve the outcome of these patients.

Sign in / Sign up

Export Citation Format

Share Document