OBJECTIVES: To determine the derangement of muscle tissue oxygen saturation (StO(2)) in the early phase of emergency department (ED) sepsis management and its relationship to 30-day mortality in patients with severe sepsis or septic shock. METHODS: A prospective cohort study conducted in the ED of a university hospital. Patients were included if they had a clinical diagnosis of severe sepsis or septic shock. Thenar muscle tissue StO(2) on arrival in the ED and its change with usual ED sepsis management was measured using near-infrared spectroscopy. A follow-up measurement was obtained after 24 h of treatment. All patients were followed for 30 days. RESULTS: 49 patients were included, of which 24 (49%) died. There was no difference in mean StO(2) on arrival in the ED between survivors and non-survivors (72% vs 72%; p=0.97). Following ED treatment the mean StO(2) of survivors improved significantly to 78% (p<0.05) while StO(2) remained persistently low in non-survivors (p=0.94). Persistently low StO(2) (<75%) despite initial resuscitative treatment was associated with a twofold increase in mortality (RR of death 2.1%; 95% CI 1.2% to 3.5%). CONCLUSION: Patients with severe sepsis/septic shock have abnormal muscle tissue StO(2) upon arrival in the ED. Inability to normalise StO(2) with ED sepsis management is associated with a poor outcome. The role of StO(2) as an early prognostic and potential therapeutic biomarker in severe sepsis or septic shock warrants further exploration.
OBJECTIVES: To determine the derangement of muscle tissue oxygen saturation (StO(2)) in the early phase of emergency department (ED) sepsis management and its relationship to 30-day mortality in patients with severe sepsis or septic shock. METHODS: A prospective cohort study conducted in the ED of a university hospital. Patients were included if they had a clinical diagnosis of severe sepsis or septic shock. Thenar muscle tissue StO(2) on arrival in the ED and its change with usual ED sepsis management was measured using near-infrared spectroscopy. A follow-up measurement was obtained after 24 h of treatment. All patients were followed for 30 days. RESULTS: 49 patients were included, of which 24 (49%) died. There was no difference in mean StO(2) on arrival in the ED between survivors and non-survivors (72% vs 72%; p=0.97). Following ED treatment the mean StO(2) of survivors improved significantly to 78% (p<0.05) while StO(2) remained persistently low in non-survivors (p=0.94). Persistently low StO(2) (<75%) despite initial resuscitative treatment was associated with a twofold increase in mortality (RR of death 2.1%; 95% CI 1.2% to 3.5%). CONCLUSION:Patients with severe sepsis/septic shock have abnormal muscle tissue StO(2) upon arrival in the ED. Inability to normalise StO(2) with ED sepsis management is associated with a poor outcome. The role of StO(2) as an early prognostic and potential therapeutic biomarker in severe sepsis or septic shock warrants further exploration.
Authors: Mohammad A Khasawneh; Martin D Zielinski; Donald H Jenkins; Scott P Zietlow; Henry J Schiller; Mariela Rivera Journal: World J Surg Date: 2014-08 Impact factor: 3.352
Authors: Ravi Shankar Samraj; Dalia Lopez-Colon; Maria Kerrigan; Frederick J Fricker; Biagio A Pietra; Mark Bleiweis; Dipankar Gupta Journal: Pediatr Cardiol Date: 2019-05-16 Impact factor: 1.838
Authors: Olivier Nardi; Elizabeth Zavala; Claude Martin; Serafim Nanas; Thomas Scheeren; Andrea Polito; Xavi Borrat; Djillali Annane Journal: BMJ Open Date: 2018-03-19 Impact factor: 2.692
Authors: Danillo Menezes Dos Santos; Jullyana S S Quintans; Lucindo J Quintans-Junior; Valter J Santana-Filho; Cláudio Leinig Pereira da Cunha; Igor Alexandre Cortes Menezes; Márcio R Viana Santos Journal: Braz J Anesthesiol Date: 2019-12-09