Department of Intensive Care Adults, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.
Crit Care Med. 2011 Jul;39(7):1649-54. doi: 10.1097/CCM.0b013e3182186675.
We conducted this observational study to investigate tissue oxygen saturation during a vascular occlusion test in relationship with the condition of peripheral circulation and outcome in critically ill patients.
Prospective observational study.
Multidisciplinary intensive care unit in a university hospital.
Seventy-three critically ill adult patients admitted to the intensive care unit.
None.
Patients were followed every 24 hrs until day 3 after intensive care admission. Near-infrared spectroscopy was used to measure thenar tissue oxygen saturation, tissue oxygen saturation deoxygenation rate, and tissue oxygen saturation recovery rate after the vascular occlusion test. Measurements included heart rate, mean arterial pressure, forearm-to-fingertip skin-temperature gradient, and physical examination of peripheral perfusion with capillary refill time. Patients were stratified according to the condition of peripheral circulation (abnormal: forearm-to-fingertip skin-temperature gradient ≥4 and capillary refill time >4.5 secs). The outcome was defined based on the daily Sequential Organ Failure Assessment score and blood lactate levels. Upon intensive care unit admission, 35 (47.9%) patients had abnormal peripheral perfusion (forearm-to-fingertip skin-temperature gradient >4 or capillary refill time >4.5 secs). With the exception of the tissue oxygen saturation deoxygenation rate, tissue oxygen saturation baseline and tissue oxygen saturation recovery rate were statistically lower in patients who exhibited abnormal peripheral perfusion than in those with normal peripheral perfusion: 72 ± 9 vs. 81 ± 9; p = .001 and 1.9 ± 0.7 vs. 3.2 ± 0.9; p = .001, respectively. When a mixed-model analysis was performed over time for estimate (s) calculation, adjusted to the condition of disease, we did not find a significant clinical effect between vascular occlusion test-derived tissue oxygen saturation measurements (as response variables) and mean systemic hemodynamic variables (as independent variables): tissue oxygen saturation vs. heart rate: s (95% confidence interval) = 0.007 (-0.08; 0.09); tissue oxygen saturation vs. mean arterial pressure: s (95% confidence interval) = -0.02 (-0.12; 0.08); tissue oxygen saturation deoxygenation rate vs. heart rate: s (95% confidence interval) = 0.002 (-0.0004; 0.006); tissue oxygen saturation deoxygenation rate vs. mean arterial pressure: s (95% confidence interval) - 0.0007 (-0.003; 0.004); tissue oxygen saturation recovery rate vs. heart rate: s (95% confidence interval) = -0.009 (-0.02; -0.0015); tissue oxygen saturation recovery rate vs. mean arterial pressure: s (95% confidence interval) = 0.01 (0.002; 0.018). However, there was a strong association between tissue oxygen saturation baseline and tissue oxygen saturation recovery rate with abnormal peripheral perfusion: tissue oxygen saturation vs. abnormal peripheral perfusion: s (95% confidence interval) = -10.1 (-13.9; -6.2); tissue oxygen saturation recovery rate vs. abnormal peripheral perfusion: s (95% confidence interval) =-10.1 (-13.9; -6.2); tissue oxygen saturation recovery rate vs. abnormal peripheral perfusion: s (95% confidence interval) = -1.1 (-1.4; -0.81). Poor outcome was more closely related to abnormalities in peripheral perfusion than to tissue oxygen saturation-derived parameters.
We found that the condition of peripheral circulation in critically ill patients strongly influences tissue oxygen saturation resting values and the tissue oxygen saturation reoxygenation rate but not the tissue oxygen saturation deoxygenation rate. In addition, changes in near-infrared spectroscopy-derived variables were independent of condition of disease and were not accompanied by any major differences in systemic hemodynamic variables.
我们进行这项观察性研究，旨在探讨在血管阻塞试验期间组织氧饱和度与危重患者外周循环状况和结局之间的关系。
前瞻性观察性研究。
大学医院多学科重症监护病房。
73 名入住重症监护病房的成年危重患者。
无。
患者在入住重症监护病房后的第 3 天内每 24 小时进行一次随访。使用近红外光谱法测量鱼际组织氧饱和度、组织氧饱和度去氧率和血管阻塞试验后组织氧饱和度再氧合率。测量包括心率、平均动脉压、前臂到指尖皮肤温度梯度以及外周灌注毛细血管再充盈时间的体格检查。根据外周循环状况（异常：前臂到指尖皮肤温度梯度>4 和毛细血管再充盈时间>4.5 秒）对患者进行分层。根据每日序贯器官衰竭评估评分和血乳酸水平定义结局。入住重症监护病房时，35 名（47.9%）患者存在异常外周灌注（前臂到指尖皮肤温度梯度>4 或毛细血管再充盈时间>4.5 秒）。除组织氧饱和度去氧率外，异常外周灌注患者的组织氧饱和度基线和组织氧饱和度再氧合率均显著低于正常外周灌注患者：72±9 比 81±9（p=0.001）和 1.9±0.7 比 3.2±0.9（p=0.001）。进行时间估计（s）计算的混合模型分析时，我们未发现血管阻塞试验衍生的组织氧饱和度测量（作为反应变量）与平均全身血流动力学变量（作为独立变量）之间存在显著的临床效应：组织氧饱和度与心率：s（95%置信区间）=0.007（-0.08；0.09）；组织氧饱和度与平均动脉压：s（95%置信区间）=-0.02（-0.12；0.08）；组织氧饱和度去氧率与心率：s（95%置信区间）=0.002（-0.0004；0.006）；组织氧饱和度去氧率与平均动脉压：s（95%置信区间）=-0.0007（-0.003；0.004）；组织氧饱和度再氧合率与心率：s（95%置信区间）=-0.009（-0.02；-0.0015）；组织氧饱和度再氧合率与平均动脉压：s（95%置信区间）=0.01（0.002；0.018）。然而，组织氧饱和度基线和组织氧饱和度再氧合率与异常外周灌注之间存在强烈关联：组织氧饱和度与异常外周灌注：s（95%置信区间）=-10.1（-13.9；-6.2）；组织氧饱和度再氧合率与异常外周灌注：s（95%置信区间）=-10.1（-13.9；-6.2）。不良结局与外周灌注异常的相关性大于与组织氧饱和度衍生参数的相关性。
我们发现，危重患者的外周循环状况强烈影响组织氧饱和度静息值和组织氧饱和度再氧合率，但不影响组织氧饱和度去氧率。此外，近红外光谱衍生变量的变化与疾病状况无关，且不伴有全身血流动力学变量的任何显著差异。
