The prognostic value of tissue oxygen saturation in emergency department patients with severe sepsis or septic shock. Issue 9 (21st September 2011)

• Record Type: Journal Article
• Authors: Vorwerk, Christiane; Coats, Timothy J
• Is Part Of: Emergency medicine journal. Volume 29:Issue 9(2012)
• Page Start: 699
• Page End: 703
• Publication Date: 2011-09-21
• Subjects: Emergency department -- environmental medicine -- ethics -- forensic legal medicine -- haematology -- hyperbaric medicine -- infection -- mortality -- non-invasive -- paediatric injury -- prehospital care -- research -- resuscitation -- sepsis -- septic shock -- statistics -- tissue oxygen saturation -- trauma; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2011-200160
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Objectives: To determine the derangement of muscle tissue oxygen saturation (StO2 ) in the early phase of emergency department (ED) sepsis management and its relationship to 30-day mortality in patients with severe sepsis or septic shock. Methods: A prospective cohort study conducted in the ED of a university hospital. Patients were included if they had a clinical diagnosis of severe sepsis or septic shock. Thenar muscle tissue StO2 on arrival in the ED and its change with usual ED sepsis management was measured using near-infrared spectroscopy. A follow-up measurement was obtained after 24 h of treatment. All patients were followed for 30 days. Results: 49 patients were included, of which 24 (49%) died. There was no difference in mean StO2 on arrival in the ED between survivors and non-survivors (72% vs 72%; p=0.97). Following ED treatment the mean StO2 of survivors improved significantly to 78% (p<0.05) while StO2 remained persistently low in non-survivors (p=0.94). Persistently low StO2 (<75%) despite initial resuscitative treatment was associated with a twofold increase in mortality (RR of death 2.1%; 95% CI 1.2% to 3.5%). Conclusion: Patients with severe sepsis/septic shock have abnormal muscle tissue StO2 upon arrival in the ED. Inability to normalise StO2 with ED sepsis management is associated with a poor outcome. The role of StO2 as an early prognostic and potential therapeutic biomarker in severe sepsis or septic shock warrants further exploration.