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Erschienen in:
01.04.2012 | Original
Prognostic implications of tissue oxygen saturation in human septic shock
Erschienen in: Intensive Care Medicine | Ausgabe 4/2012
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Purpose
To analyze the prognostic value of tissue oxygen saturation (StO2) in septic shock patients with restored mean arterial pressure (MAP).
Methods
This was a prospective observational study of patients admitted to the ICU in the early phase of septic shock, after restoration of MAP. Demographic data, severity score, hemodynamics, blood lactate, acid–base status, and StO2 were measured at inclusion followed by a transient vascular occlusion test (VOT) to obtain the StO2-deoxygenation (DeOx) and StO2-reoxygenation (ReOx) rates. Sequential organ failure assessment (SOFA) score was measured at inclusion and after 24 h.
Results
Thirty-three patients were studied. StO2 was 76 ± 10%, DeOx −12.2 ± 4.2%/min, and ReOx 3.02 ± 1.70%/s. MAP showed a significant correlation with VOT-derived slopes (r = −0.4, p = 0.04 for DeOx; and r = 0.55, p < 0.01 for ReOx). After 24 h, 17 patients (52%) had improved SOFA scores. Patients who did not improve their SOFA showed less negative DeOx values at inclusion. The association between DeOx and SOFA evolution was not affected by MAP. Both DeOx and ReOx impairment correlated with longer ICU stay (r = 0.44, p = 0.05; and r = −0.43, p = 0.05, respectively).
Conclusions
In a population of septic shock patients with restored MAP, impaired DeOx was associated with no improvement in organ failures after 24 h. Decrements in DeOx and ReOx were associated with longer ICU stay. DeOx and ReOx were linked to MAP, and thus, their interpretation needs to be made relative to MAP.