Peripheral Muscle Near-Infrared Spectroscopy Variables are Altered Early in Septic Shock. Issue 1 (July 2018)

• Record Type: Journal Article
• Authors: Orbegozo, Diego; Su, Fuhong; Xie, Keliang; Rahmania, Lokmane; Taccone, Fabio Silvio; De Backer, Daniel; Vincent, Jean-Louis; Creteur, Jacques
• Is Part Of: Shock. Volume 50:Issue 1(2018)
• Publication Date: 2018-07
• Subjects: CO2 gap -- microcirculation -- microdialysis -- near-infrared spectroscopy -- noninvasive monitoring -- oxygen consumption -- perfusion -- sepsis -- vascular reactivity; Shock -- Periodicals; Shock -- Periodicals; Choc (Pathologie) -- Périodiques; Shock; Periodicals; 616.0475
• DOI: 10.1097/SHK.0000000000000991
• Languages: English
• ISSNs: 1073-2322

Abstract

ABSTRACT: Background: Noninvasive evaluation of muscle perfusion using near-infrared spectroscopy (NIRS) coupled with a vascular occlusion test (VOT) may provide an early and simple marker of altered perfusion and microcirculatory function in sepsis. Objective: The aim of the study was to compare the time-course of NIRS-derived variables with systemic measures of perfusion in an experimental model of peritonitis. Methods: Peritonitis was induced in eight anesthetized, mechanically ventilated, adult sheep (24–34 kg), by injecting autologous feces into the peritoneal cavity. Animals were followed until death or for a maximum of 30 h. Muscle tissue oxygen saturation (StO2 ) was determined using NIRS on the right posterior leg and arterial VOTs were performed by intermittent intra-aortic balloon inflation. Microdialysis was used to measure muscle lactate and pyruvate levels. Results: Muscle StO2 was significantly lower than baseline values from 8 h after sepsis induction, but with considerable intersubject variability. The NIRS VOT ascending (Asc) slope decreased to values <120%/min in most animals from 12 h after sepsis induction. Muscle lactate/pyruvate ratios were higher than baseline from 16 h after sepsis induction. Mixed venous oxygen saturation (SvO2 ) decreased to <70% and blood lactate levels increased to >2 mmol/L in most of the animals only 24 and 28 h after sepsis induction, respectively. Muscle NIRS StO2 correlated strongly with femoral venous oxygen saturation ( r = 0.820) and moderately with SvO2 ( r = 0.436). Conclusions: The muscle NIRS Asc slope after a VOT is altered earlier than global markers of tissue hypoperfusion during sepsis. This simple noninvasive test can detect early changes in peripheral perfusion in sepsis. Abstract : Supplemental Digital Content is available in the text