title: The prognostic value of muscle StO2 in septic patients.
abstract: OBJECTIVE
  To quantify sepsis-induced alterations in changes in muscle tissue oxygenation (StO(2)) after an ischemic challenge using near-infrared spectroscopy (NIRS), and to test the hypothesis that these alterations are related to outcome.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Thirty-one-bed, university hospital Department of Intensive Care.
  
  
  METHODS
  Seventy-two patients with severe sepsis or septic shock, 18 hemodynamically stable, acutely ill patients without infection, and 18 healthy volunteers.
  
  
  METHODS
  Three-minute occlusion of the brachial artery using a cuff inflated 50[Symbol: see text]mmHg above systolic arterial pressure.
  
  
  RESULTS
  Thenar eminence StO(2) was measured continuously by NIRS before (StO(2)baseline), during, and after the 3-min occlusion. Changes in StO(2) were assessed by the slope of increase in StO(2) during the first 14 s following the ischemic period and by the difference between the maximum StO(2) and StO(2)baseline (Delta). The slope was lower in septic patients than in controls and volunteers [2.3 (1.3-3.6), 4.8 (3.5-6.0), and 4.7 (3.2-6.3) %/s, p < 0.001]. Delta was also significantly lower in septic patients than in the other groups. Slopes were lower in septic patients with than without shock [2.0 (1.2-2.9) vs 3.2 (1.8-4.5) %/s, p < 0.05]. In 52 septic patients, in whom the slope was obtained every 24 h for 48 h, slopes were higher in survivors than in non-survivors and tended to increase in survivors but not in non-survivors.
  
  
  CONCLUSIONS
  Altered recovery in StO(2) after an ischemic challenge is frequent in septic patients and more pronounced in the presence of shock. The presence and persistence of these alterations in the first 24[Symbol: see text]h of sepsis are associated with worse outcome.
authors.affiliation: Erasme University Hospital, Free University of Brussels, Department of Intensive Care, Route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Creteur
authors.forename: Tiziana
authors.initials: T
authors.lastname: Carollo
authors.forename: Giulia
authors.initials: G
authors.lastname: Soldati
authors.forename: Gustavo
authors.initials: G
authors.lastname: Buchele
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000378:metabolism*; D010100:Oxygen / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000378:metabolism* / Q000401:mortality*; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen