title: Peripheral tissue oxygenation improves during ED treatment of acute heart failure.
abstract: OBJECTIVE
  The objective of the study was to quantitatively characterize peripheral tissue microvascular oxygenation during emergency department (ED) treatment of acute heart failure (HF).
  
  
  METHODS
  This prospective, observational study enrolled acutely decompensated HF patients presenting to an urban ED and stable, asymptomatic HF patients evaluated in an outpatient cardiology clinic. Stable, pre-ED treatment, and post-ED treatment microvascular oxygen extraction ratios (OER(M)s) were calculated, defined as SaO(2) - StO(2)/0.8*SaO(2), where SaO(2) is pulse oximetry-derived arterial hemoglobin saturation and StO(2) is the tissue hemoglobin oxygen saturation measured with differential absorption spectroscopy. The OER(M) measurements were analyzed using repeated-measures analysis of variance. Pulse oximetry, patient demographics, HF etiology, serum B-type natriuretic peptide, and hemoglobin were measured along with a visual analogue scale to assess patient baseline characteristics and response to ED treatment (P < .05 was considered significant for all testing).
  
  
  RESULTS
  The OER(M) for the stable HF group (n = 45) was 0.65 (SE = 0.07). The pre- and posttreatment OER(M)s for the ED HF group (n = 46) were 0.92 (SE = 0.07) and 0.75 (SE = 0.06), respectively. Whereas the pretreatment ED OER(M) was higher than the stable patient OER(M) (P = .001), the posttreatment ED OER(M) was not significantly different from the stable patient measurement (P = .271).
  
  
  CONCLUSIONS
  Oxygen extraction in acute HF is significantly increased, but approaches values found in the stable HF population after ED treatment. The OER(M) may deserve closer examination as a possible goal-directed variable in the treatment of acute HF.
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Medical College of Virginia Campus, Richmond, VA 23238-0401, USA. chogan@mcvh-vcu.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hogan
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Ward
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kontos
authors.forename: Leroy R
authors.initials: LR
authors.lastname: Thacker
authors.forename: Roland
authors.initials: R
authors.lastname: Pittman
mesh_terms: D000208:Acute Disease; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010092:Oximetry; D011446:Prospective Studies
chemical_list: D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain