Imai Ryota, Abe Takafumi, Iwata Kentaro, Yamaguchi Seigo, Kitai Takeshi, Tsubaki Atsuhiro
Department of Rehabilitation, Uonuma Kikan Hospital, Minamiuonuma, Japan.
Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan.
Intensive Care Med Exp. 2025 Feb 3;13(1):13. doi: 10.1186/s40635-025-00722-2.
Vital signs help determine the safety of early mobilization in critically ill patients in intensive care units. However, none of these variables directly assess cerebral circulation. Therefore, we aimed to investigate the relationship of regional cerebral oxygen saturation (rSO) and vital signs with in-hospital death in critically ill patients.
This prospective study included critically ill patients admitted to the Uonuma Kikan Hospital Emergency Center who received physical therapy between June 2020 and December 2022. We continuously measured rSO during the initial mobilization using a wearable brain near-infrared spectroscopy device. With in-hospital death as the primary endpoint, the association between rSO and in-hospital death was assessed in Analysis 1 to determine the rSO cut-off value that predicts in-hospital death. In Analysis 2, patients were categorised into survival and non-survival groups to examine the temporal changes in vital signs and rSO associated with postural changes during mobilization.
Of the 132 eligible patients, 98 were included in Analysis 1, and 70 were included in Analysis 2. Analysis 1 demonstrated that lower premobilization rSO was independently associated with in-hospital death (odds ratio 0.835, 95% confidence interval 0.724-0.961, p = 0.012). Receiver operating characteristic curve analysis identified an optimal rSO cut-off value of 57% for predicting in-hospital death (area under the curve 0.818, sensitivity 73%, specificity 83%). Analysis 2 showed that rSO changes during mobilization were unrelated to changes in vital signs, suggesting rSO as an independent prognostic marker.
The results suggest that rSO measured during initial mobilization is associated with in-hospital death in critically ill patients.
生命体征有助于确定重症监护病房中危重症患者早期活动的安全性。然而，这些变量均无法直接评估脑循环。因此，我们旨在研究危重症患者局部脑氧饱和度（rSO）和生命体征与院内死亡之间的关系。
这项前瞻性研究纳入了2020年6月至2022年12月期间在小野间纪念医院急诊中心接受物理治疗的危重症患者。我们在初次活动期间使用可穿戴式脑近红外光谱设备持续测量rSO。以院内死亡作为主要终点，在分析1中评估rSO与院内死亡之间的关联，以确定预测院内死亡的rSO临界值。在分析2中，将患者分为存活组和非存活组，以检查活动期间与体位变化相关的生命体征和rSO的时间变化。
在132例符合条件的患者中，98例纳入分析1，70例纳入分析2。分析1表明，活动前较低的rSO与院内死亡独立相关（比值比0.835，95%置信区间0.724-0.961，p = 0.012）。受试者工作特征曲线分析确定预测院内死亡的最佳rSO临界值为57%（曲线下面积0.818，敏感性73%，特异性83%）。分析2表明，活动期间rSO的变化与生命体征的变化无关，提示rSO为独立的预后标志物。
结果表明，初次活动期间测量的rSO与危重症患者的院内死亡相关。
