Volume 18 Supplement 1

34th International Symposium on Intensive Care and Emergency Medicine

Open Access

Tissue oxygenation in patients with severe sepsis

  • A Oei1,
  • M Kok2,
  • A Karakus3 and
  • H Endeman4
Critical Care201418(Suppl 1):P240

https://doi.org/10.1186/cc13430

Published: 17 March 2014

Introduction

The aim of this study was to determine the correlation between regional tissue oxygenation (SrO2) measured by near-infrared spectroscopy (NIRS), central venous oxygen saturation (SvO2) and levels of serum lactate (SL) in patients with severe sepsis.

Methods

An observational pilot study was performed in an ICU of a medium-sized teaching hospital. Adult patients admitted with severe sepsis were included and three NIRS electrodes were attached: on the left side of the forehead (LF), the right side of the forehead (RF) and the right forearm (RA). SL and SvO2 measured in a jugular or subclavian central venous line sample were determined every 4 hours. Descriptive statistics were calculated. Pearson correlation coefficients (PCC) were calculated between SrO2, SvO2 and SL. Normal values for SrO2 were defined as the median ± 1 interquartile range in patients with SL <1.7 mmol/l. Differences between groups were calculated by Pearson chi-square tests. P < 0.05 was considered statistically significant.

Results

Twenty-five patients (12 men) were included. Mean age was 68 years, mean APACHE score 31. The most frequent reasons for ICU admission were abdominal sepsis (n = 11) and pneumosepsis (n = 7). Statistically significant correlations were found between SvO2 and SrO2: PCC SrO2 LF, 0.46; PCC SrO2 RF, 0.50; PCC SrO2 RA, 0.21. Low, although statistically significant, correlations were found between SrO2 and SL: PCC SrO2 LF, -0.16; PCC SrO2 RF, -0.15; and PCC SrO2 RA, -0.20. Calculated normal values for SrO2 LF were 60 to 80%, for SrO2 RF were 60 to 76% and for SrO2 RA were 64 to 84%. An out-of-range SrO2 had a high positive predictive value (PPV) for an increased SL. The PPV for out-of-range SrO2 LF was 85% versus 58% for normal SrO2 LF (OR 4.27; 95% CI 2.09 to 8.72), the PPV for out-of-range SrO2 RF was 77% versus 60% for normal SrO2 RF (OR 2.32; 95% CI 1.25 to 4.31) and the PPV for out-of-range SrO2 RA 75% versus 60% for normal SrO2 RA (OR 1.94; 95% CI 0.95 to 4.00).

Conclusion

This pilot study shows a statistically significant correlation between SvO2 and SrO2 in patients with severe sepsis. An out-of-range SrO2 LF or RF had a high predictive value for increased serum lactate. We therefore conclude that NIRS could have a role in goal-directed therapy of patients with severe sepsis.

Authors’ Affiliations

(1)
Academic Medical Center
(2)
University Medical Center
(3)
Diakonessenhuis
(4)
Onze Lieve Vrouwen Gasthuis

Copyright

© Oei et al.; BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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