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Prognosis value of dynamic variation of tissue oxygen saturation during severe cardiogenic shock
Critical Carevolume 15, Article number: P37 (2011)
To evaluate the prognosis value of dynamic thenar O2 saturation (StO2) response using a vascular occlusion test (VOT) during cardiogenic shock.
A retrospective clinical observational analysis was performed on adult patients treated for severe cardiogenic shock in a surgical ICU. The non-invasive InSpectra near-infrared spectrometer was used to assess the effect of VOT on thenar eminence StO2. The VOT manoeuvre was repeated within the first 24 hours of admission. StO2 VOT-induced changes were compared between surviving and nonsurviving patients between the first 8 hours and the next 16 hours.
Ten patients suffering from cardiogenic shock (age 59.8 ± 13.8 years; APACHE score 21.3 ± 5.9) were treated with inotropes (n = 7) and/or circulatory mechanical assistance (four IABP, three ELS, one LVAD) and vasopressors (n = 9). Mortality in the ICU was 50%. Hemodynamic and metabolic parameters were not different between survivors and nonsurvivors (Table 1). The post-VOT StO2 recovery slope tended to be faster within the first 8 hours in survivors than in nonsurvivors (2.8 ± 1.1 vs. 1.7 ± 0.4%/s, P = 0.09) and improved significantly in the H8 to H24 period (4.5 ± 1.2 vs. 2 ± 1.1%/s, P = 0.007). The post-VOT StO2 recovery slope increased significantly within the first 24 hours in all survivors (Figure 1).
Our results suggest that, in patients treated for cardiogenic shock, rapid improvement in the post-VOT StO2 recovery slope is associated with a better prognosis.