Oxygen Tissue Saturation Is Lower in Nonsurvivors than in Survivors after Early Resuscitation of Septic Shock

• Published in: Anesthesiology (Philadelphia) Vol. 111; no. 2; pp. 366 - 371
• Main Authors: LEONE, Marc, BLIDI, Sami, ANTONINI, François, MEYSSIGNAC, Bertrand, BORDON, Sébastien, GARCIN, Frédéric, CHARVET, Aude, BLASCO, Valéry, ALBANESE, Jacques, MARTIN, Claude
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-08-2009
• Subjects: Adult; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Capillaries - pathology; Carbon Dioxide - blood; Cohort Studies; Creatinine - blood; Female; Hemodynamics - physiology; Humans; Intensive Care Units; Male; Medical sciences; Middle Aged; Muscle, Skeletal - metabolism; Oximetry; Oxygen - blood; Oxygen Consumption - physiology; Resuscitation; Retrospective Studies; ROC Curve; Shock, Septic - metabolism; Shock, Septic - mortality; Shock, Septic - physiopathology; Spectroscopy, Near-Infrared; Survival Analysis; Survivors; Shock; Infection; Oxygen; Survivor; Saturation; Anesthesia; Resuscitation
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/aln.0b013e3181aae72d

Growing evidence suggests that the microvascular dysfunction is the key element of the pathogenesis of septic shock. This study's purpose was to explore whether the outcome of septic shock patients after early resuscitation using early goal-directed therapy is related to their muscle tissue oxygenation.
Tissue oxygen saturation (Sto2) was monitored in septic shock patients using a tissue spectrometer (InSpectra Model 325; Hutchinson Technology, Hutchinson, MN). For the purpose of this retrospective study, the Sto2 values were collected at the first measurement done after the macrohemodynamic variables (mean arterial pressure, urine output, central venous saturation in oxygen) were optimized.
After the hemodynamic variables were corrected, no difference was observed between the nonsurvivors and survivors, with the exception of pulse oximetry saturation (94% [92-97%] vs. 97% [94-99%], P = 0.04). The Sto2 values were significantly lower in the nonsurvivors than in the survivors (73% [68-82%] vs. 84% [81-90%], P = 0.02). No correlations were found between the Sto2 and Spo2 (P = 0.7).
In septic shock patients, tissue oxygen saturation below 78% is associated with increased mortality at day 28. Further investigations are required to determine whether the correction of an impaired level of tissue oxygen saturation may improve the outcome of these patients.