Tiba Mohamad H, Awad Abdelrahman B, Pennington Amanda, Fung Christopher M, Napolitano Lena M, Park Pauline K, Machado-Aranda David A, Gunnerson Kyle J, Romfh Padraic, Ward Kevin R
Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan.
Shock. 2021 Jul 1;56(1):92-97. doi: 10.1097/SHK.0000000000001696.
In this study, we examined the ability of resonance Raman spectroscopy to measure tissue hemoglobin oxygenation (R-StO2) noninvasively in critically ill patients and compared its performance with conventional central venous hemoglobin oxygen saturation (ScvO2).
Critically ill patients (n = 138) with an indwelling central venous or pulmonary artery catheter in place were consented and recruited. R-StO2 measurements were obtained by placing a sensor inside the mouth on the buccal mucosa. R-StO2 was measured continuously for 5 min. Blood samples were drawn from the distal port of the indwelling central venous catheter or proximal port of the pulmonary artery catheter at the end of the test period to measure ScvO2 using standard co-oximetry analyzer. A regression algorithm was used to calculate the R-StO2 based on the observed spectra.
Mean (SD) of pooled R-StO2 and ScvO2 were 64(7.6) % and 65(9.2) % respectively. A paired t test showed no significant difference between R-StO2 and ScvO2 with a mean(SD) difference of -1(7.5) % (95% CI: -2.2, 0.3%) with a Clarke Error Grid demonstrating 84.8% of the data residing within the accurate and acceptable grids. Area under the receiver operator curve for R-StO2's was 0.8(0.029) (95% CI: 0.7, 0.9 P < 0.0001) at different thresholds of ScvO2 (≤60%, ≤65%, and ≤70%). Clinical adjudication by five clinicians to assess the utility of R-StO2 and ScvO2 yielded Fleiss' Kappa agreement of 0.45 (P < 0.00001).
R-StO2 has the potential to predict ScvO2 with high precision and might serve as a faster, safer, and noninvasive surrogate to these measures.
在本研究中，我们检测了共振拉曼光谱法对危重症患者进行无创组织血红蛋白氧合（R-StO2）测量的能力，并将其性能与传统中心静脉血红蛋白氧饱和度（ScvO2）进行比较。
征得138例留置中心静脉或肺动脉导管的危重症患者同意并纳入研究。通过将传感器置于口腔内颊黏膜处获得R-StO2测量值。连续测量R-StO2 5分钟。在测试期结束时，从留置中心静脉导管的远端端口或肺动脉导管的近端端口采集血样，使用标准的共血氧定量分析仪测量ScvO2。基于观察到的光谱，采用回归算法计算R-StO2。
汇总的R-StO2和ScvO2的均值（标准差）分别为64（7.6）%和65（9.2）%。配对t检验显示R-StO2和ScvO2之间无显著差异，平均（标准差）差异为-1（7.5）%（95%可信区间：-2.2，0.3%），克拉克误差网格显示84.8%的数据位于准确和可接受的网格内。在ScvO2的不同阈值（≤60%、≤65%和≤70%）下，R-StO2的受试者工作特征曲线下面积为0.8（0.029）（95%可信区间：0.7，0.9；P<0.0001）。五位临床医生对R-StO2和ScvO2实用性的临床判定得出Fleiss' Kappa一致性为0.45（P<0.00001）。
R-StO2有潜力高精度预测ScvO2，可能成为这些测量方法的更快、更安全且无创的替代方法。
