Thenar oxygen saturation measured by near infrared spectroscopy as a noninvasive predictor of low central venous oxygen saturation in septic patients.
OBJECTIVE
To validate thenar oxygen saturation (StO(2)) measured by near-infrared spectroscopy (NIRS) as a noninvasive estimation of central venous saturation (ScvO(2)) in septic patients.


METHODS
Prospective observational study.


METHODS
A 26-bed medical-surgical intensive care unit at a university-affiliated hospital.


METHODS
Patients consecutively admitted to the ICU in the early phase of severe sepsis and septic shock, after normalization of blood pressure with fluids and/or vasoactive drugs.


METHODS
We recorded demographic data, severity score, hemodynamic data, and blood lactate, as well as ScvO(2), and StO(2) measured simultaneously on inclusion. Patients were divided into two groups according to ScvO(2) values: group A, with ScvO(2) < 70%, and group B, with ScvO(2) > or = 70%.


RESULTS
Forty patients were studied. StO(2) was significantly lower in group A than in group B (74.7 +/- 13.0 vs. 83.3 +/- 6.2, P 0.018). No differences in age, severity score, hemodynamics, vasoactive drugs, or lactate were found between groups. Simultaneously measured ScvO(2) and StO(2) showed a significant Pearson correlation (r = 0.39, P 0.017). For a StO(2) value of 75%, sensitivity was 0.44, specificity 0.93, positive predictive value 0.92, and negative predictive value 0.52 for detecting ScvO(2) values lower than 70%.


CONCLUSIONS
StO(2) correlates with ScvO(2) in normotensive patients with severe sepsis or septic shock. We propose a StO(2) cut-off value of 75% as a specific, rapid, noninvasive first step for detecting patients with low ScvO(2) values. Further studies are necessary to analyze the role of noninvasive StO(2) measurement in future resuscitation algorithms.
Mesquida
Jaume
J
Critical Care Center, Hospital de Sabadell, Corporació Parc Tauli, Institut Universitari Parc Tauli, CIBER Enfermedades Respiratorias, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain. jmesquida@tauli.cat
Masip
Jordi
J
Gili
Gisela
G
Artigas
Antoni
A
Baigorri
Francisco
F
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007362:Intensive Care Units; D008833:Microcirculation; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012772:Shock, Septic / Q000503:physiopathology*; D019265:Spectroscopy, Near-Infrared; D014680:Veins
D010100:Oxygen