title: Association between static and dynamic thenar near-infrared spectroscopy and mortality in patients with sepsis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Oxygen delivery and consumption disturbances are frequently seen with critically illness, potentially leading to pathologic changes in tissue oxygenation (StO2). Near-infrared spectroscopy (NIRS) is a potentially useful method to monitor StO2, but the role of NIRS in prognostication of septic patients is uncertain. The aim of this study was to systematically review the literature and evaluate static and dynamic NIRS in patients with sepsis.
  
  
  METHODS
  This is a systematic review and meta-analysis of publications between 1966 and 2013. The MEDLINE and EMBASE databases were searched for studies on StO2 in patients with severe sepsis or septic shock. Meta-analysis was limited to studies about static and dynamic variables derived from NIRS in patients with sepsis. The association between StO2, reperfusion slope (Rres), occlusion slope, and maximum StO2 minus basal StO2 (ΔStO2) and prognosis in septic patients was evaluated.
  
  
  RESULTS
  The search identified 20 articles (962 participants; 717 with severe sepsis or septic shock, and 245 healthy controls). Compared with healthy controls, septic patients had lower levels of StO2 (78.27% [4.91%] vs. 82.02% [3.57%], p = 0.012), Rres (2.75% [0.63%] vs. 5.19% [2.86%] per second, p = 0.003), and ΔStO2 (7.86% [0.11%] vs. 12.53% [2.65%], p = 0.011). Survivors from sepsis presents higher levels of StO2 (81.68% [4.68%] vs. 74.54% [5.31%], p = 0.02) and Rres (3.37% [0.44%] vs. 2.16% [0.51%] per second, p = 0.016).
  
  
  CONCLUSIONS
  Septic patients have lower levels of StO2, Rres and ΔStO2, and survivors from sepsis present higher levels of StO2 and Rres compared with nonsurvivors.
  
  
  METHODS
  Systematic review/meta-analysis, level III.
authors.affiliation: From the Medical Intensive Care Unit (A.S.N., V.G..M.P., J.A.M., D.C.E.), ABC Medical School (FMABC), Santo André; and Department of Critical Care Medicine (A.S.N.), Hospital Israelita Albert Einstein, São Paulo, Brazil; and Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (M.J.S., A.S.N), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Ary Serpa
authors.initials: AS
authors.lastname: Neto
authors.forename: Victor Galvão Moura
authors.initials: VG
authors.lastname: Pereira
authors.forename: José Antônio
authors.initials: JA
authors.lastname: Manetta
authors.forename: Daniel Crepaldi
authors.initials: DC
authors.lastname: Espósito
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D010100:Oxygen / Q000032:analysis; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen