Cusack Rachael, Rodríguez Alejandro, Cantan Ben, Miskolci Orsolya, Connolly Elizabeth, Zilahi Gabor, Coakley John Davis, Martin-Loeches Ignacio
Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James' Hospital, D08 NHY1 Dublin, Ireland.
School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland.
J Clin Med. 2025 Jul 14;14(14):4982. doi: 10.3390/jcm14144982.
: In septic shock, microcirculatory dysfunction contributes to organ failure and mortality. While sidestream dark-field (SDF) imaging is the reference method for assessing microvascular perfusion, its complexity limits routine use. This study evaluates near-infrared spectroscopy (NIRS) with vascular occlusion testing (VOT) as a potential bedside tool for monitoring microcirculatory changes following fluid resuscitation. : Sixty-three fluid-responsive patients with sepsis were randomized to receive either 20% albumin or crystalloid. NIRS-VOT and sublingual SDF measurements were obtained at baseline and 60 min post-resuscitation. The reoxygenation slope (ReOx) derived from NIRS was calculated and compared with clinical severity scores and SDF-derived microcirculatory parameters. : ReOx significantly increased from baseline to 60 min in the albumin group ( = 0.025), but not in the crystalloid group. However, between-group differences at 60 min were not statistically significant. ReOx at 60 min was inversely correlated with APACHE II score (ρ = -0.325) and lactate (ρ = -0.277) and showed a weak inverse trend with norepinephrine dose. AUROC for ICU survival based on ReOx was 0.616. NIRS ReOx showed weak correlations with SDF parameters, including the number of crossings ( = 0.03) and the consensus proportion of perfused vessels (CPPV; = 0.004). : NIRS-VOT detected microcirculatory trends after albumin administration but showed limited agreement with SDF imaging. These findings suggest that NIRS and SDF assess different physiological domains. Further studies are warranted to define the clinical utility of NIRS as a microcirculation monitoring tool (Clinicaltrials.gov: NCT05357339).
在感染性休克中，微循环功能障碍会导致器官衰竭和死亡。虽然侧流暗视野（SDF）成像术是评估微血管灌注的参考方法，但其操作复杂限制了常规应用。本研究评估了采用血管阻塞试验（VOT）的近红外光谱（NIRS）作为在液体复苏后监测微循环变化的一种潜在床旁工具。：63名有液体反应性的脓毒症患者被随机分组，分别接受20%白蛋白或晶体液治疗。在基线期和复苏后60分钟时进行NIRS-VOT和舌下SDF测量。计算从NIRS得出的再氧合斜率（ReOx），并与临床严重程度评分和SDF得出的微循环参数进行比较。：白蛋白组的ReOx从基线期到60分钟时显著增加（P = 0.025），而晶体液组则未增加。然而，60分钟时组间差异无统计学意义。60分钟时的ReOx与急性生理与慢性健康状况评分系统II（APACHE II）评分（ρ = -0.325）和乳酸（ρ = -0.277）呈负相关，且与去甲肾上腺素剂量呈弱负相关趋势。基于ReOx的重症监护病房（ICU）生存率的受试者工作特征曲线下面积（AUROC）为0.616。NIRS的ReOx与SDF参数，包括交叉数（P = 0.03）和灌注血管的一致性比例（CPPV；P = 0.004）呈弱相关。：NIRS-VOT检测到白蛋白给药后的微循环趋势，但与SDF成像的一致性有限。这些发现表明NIRS和SDF评估的是不同的生理领域。有必要进一步研究以确定NIRS作为微循环监测工具的临床实用性（Clinicaltrials.gov：NCT05357339）。
