title: Prognostic value of brachioradialis muscle oxygen saturation index and vascular occlusion test in septic shock patients.
abstract: OBJECTIVE
  To compare rSO2 (muscle oxygen saturation index) static and dynamic variables obtained by NIRS (Near Infrared Spectroscopy) in brachioradialis muscle of septic shock patients and its prognostic implications.
  
  
  METHODS
  Prospective and observational study.
  
  
  METHODS
  Intensive care unit.
  
  
  METHODS
  Septic shock patients and healthy volunteers.
  
  
  METHODS
  The probe of a NIRS device (INVOS 5100) was placed on the brachioradialis muscle during a vascular occlusion test (VOT).
  
  
  METHODS
  Baseline, minimum and maximum rSO2 values, deoxygenation rate (DeOx), reoxygenation slope (ReOx) and delta value.
  
  
  RESULTS
  Septic shock patients (n=35) had lower baseline rSO2 (63.8±12.2 vs. 69.3±3.3%, p<0.05), slower DeOx (-0.54±0.31 vs. -0.91±0.35%/s, p=0.001), slower ReOx (2.67±2.17 vs. 9.46±3.5%/s, p<0.001) and lower delta (3.25±5.71 vs. 15.1±3.9%, p<0.001) when compared to healthy subjects (n=20). Among septic shock patients, non-survivors showed lower baseline rSO2 (57.0±9.6 vs. 69.8±11.3%, p=0.001), lower minimum rSO2 (36.0±12.8 vs. 51.3±14.8%, p<0.01) and lower maximum rSO2 values (60.6±10.6 vs. 73.3±11.2%, p<0.01). Baseline rSO2 was a good mortality predictor (AUC 0.79; 95%CI: 0.63-0.94, p<0.01). Dynamic parameters obtained with VOT did not improve the results.
  
  
  CONCLUSIONS
  Septic shock patients present an important alteration of microcirculation that can be evaluated by NIRS with prognostic implications. Monitoring microvascular reactivity in the brachioradialis muscle using VOT with our device does not seem to improve the prognostic value of baseline rSO2.
authors.affiliation: Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain. Electronic address: jmarincorral@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Marín-Corral
authors.affiliation: Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Claverias
authors.affiliation: Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bodí
authors.affiliation: Respiratory Department - Hospital del Mar - IMIM. Department CEXS, UPF, Barcelona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Pascual
authors.affiliation: Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina; Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Dubin
authors.affiliation: Respiratory Department - Hospital del Mar - IMIM. Department CEXS, UPF, Barcelona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gea
authors.affiliation: Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001916:Brachial Artery; D005260:Female; D005542:Forearm / Q000098:blood supply*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000737:chemistry; D010100:Oxygen / Q000032:analysis*; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000378:metabolism* / Q000401:mortality; D019265:Spectroscopy, Near-Infrared; D014111:Tourniquets
chemical_list: D010100:Oxygen
keywords: Espectroscopia cercana al infrarojo; Microcirculación; Microcirculation; Mortalidad; Mortality; Near-infrared spectroscopy; Oxigenación tisular; Prognosis; Pronóstico; Septic shock; Shock séptico; Tissue oxygenation