Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock

Sepsis is a leading cause of death despite appropriate management. There is increasing evidence that microcirculatory alterations might persist independently from macrohemodynamic improvement and are related to clinical evolution. Future efforts need to be directed towards microperfusion monitoring...

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Autores: Masip, Jordi, Mesquida Febrer, Jaume|||0000-0003-3670-5021, Luengo, Cecilia, Gili, Gisela, Gomà, Gemma|||0000-0002-1890-4855, Ferrer, Ricard|||0000-0002-4859-4747, Teboul, Jean Louis, Payen, Didier, Artigas Raventós, Antoni|||0000-0002-8029-1017
Tipo de recurso: artículo
Fecha de publicación:2013
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:184944
Acceso en línea:https://ddd.uab.cat/record/184944
https://dx.doi.org/urn:doi:10.1186/2110-5820-3-30
Access Level:acceso abierto
Palabra clave:Severe sepsis
Septic shock
Tissue oxygen saturation
Near-infrared spectroscopy
Drotrecogin alfa activated
Outcome
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spelling Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shockMasip, JordiMesquida Febrer, Jaume|||0000-0003-3670-5021Luengo, CeciliaGili, GiselaGomà, Gemma|||0000-0002-1890-4855Ferrer, Ricard|||0000-0002-4859-4747Teboul, Jean LouisPayen, DidierArtigas Raventós, Antoni|||0000-0002-8029-1017Severe sepsisSeptic shockTissue oxygen saturationNear-infrared spectroscopyDrotrecogin alfa activatedOutcomeSepsis is a leading cause of death despite appropriate management. There is increasing evidence that microcirculatory alterations might persist independently from macrohemodynamic improvement and are related to clinical evolution. Future efforts need to be directed towards microperfusion monitoring and treatment. This study explored the utility of thenar muscle oxygen saturation (StO) and its changes during a transient vascular occlusion test (VOT) to measure the microcirculatory response to drotrecogin alfa (activated) (DrotAA) in septic patients. A prospective, observational study was performed in three general intensive care units at three university hospitals. We studied 58 patients with recent onset of severe sepsis or septic shock and at least two organ dysfunctions. Thirty-two patients were treated with DrotAA and 26 were not treated because of formal contraindication. StO was monitored using near-infrared spectroscopy (NIRS), and VOT was performed to obtain deoxygenation (DeOx) and reoxygenation (ReOx) slopes. Measurements were obtained before DrotAA was started and were repeated daily for a 96-hour period. Patients' characteristics, outcome, severity, and baseline values of StO, DeOx, and ReOx did not differ between groups. Treated patients significantly improved DeOx and ReOx values over time, whereas control patients did not. In treated patients, ReOx improvements were correlated to norepinephrine dose reductions. Early clinical response (SOFA improvement after 48 hours of treatment) was not associated to changes in VOT-derived slopes. In the treated group, the relative improvement of DeOx within 48 hours was able to predict mortality (AUC 0.91, p < 0.01). In patients with severe sepsis or septic shock, DrotAA infusion was associated with improvement in regional tissue oxygenation. The degree of DeOx amelioration after 2 days in treated patients predicted mortality with high sensitivity and specificity. Thus, StO derived variables might be useful to evaluate the microcirculatory response to treatment of septic shock.Universitat Autònoma de Barcelona 22013-01-0120132013-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/184944https://dx.doi.org/urn:doi:10.1186/2110-5820-3-30reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:1849442026-06-06T12:50:31Z
dc.title.none.fl_str_mv Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
title Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
spellingShingle Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
Masip, Jordi
Severe sepsis
Septic shock
Tissue oxygen saturation
Near-infrared spectroscopy
Drotrecogin alfa activated
Outcome
title_short Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
title_full Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
title_fullStr Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
title_full_unstemmed Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
title_sort Near-infrared spectroscopy StO monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock
dc.creator.none.fl_str_mv Masip, Jordi
Mesquida Febrer, Jaume|||0000-0003-3670-5021
Luengo, Cecilia
Gili, Gisela
Gomà, Gemma|||0000-0002-1890-4855
Ferrer, Ricard|||0000-0002-4859-4747
Teboul, Jean Louis
Payen, Didier
Artigas Raventós, Antoni|||0000-0002-8029-1017
author Masip, Jordi
author_facet Masip, Jordi
Mesquida Febrer, Jaume|||0000-0003-3670-5021
Luengo, Cecilia
Gili, Gisela
Gomà, Gemma|||0000-0002-1890-4855
Ferrer, Ricard|||0000-0002-4859-4747
Teboul, Jean Louis
Payen, Didier
Artigas Raventós, Antoni|||0000-0002-8029-1017
author_role author
author2 Mesquida Febrer, Jaume|||0000-0003-3670-5021
Luengo, Cecilia
Gili, Gisela
Gomà, Gemma|||0000-0002-1890-4855
Ferrer, Ricard|||0000-0002-4859-4747
Teboul, Jean Louis
Payen, Didier
Artigas Raventós, Antoni|||0000-0002-8029-1017
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Severe sepsis
Septic shock
Tissue oxygen saturation
Near-infrared spectroscopy
Drotrecogin alfa activated
Outcome
topic Severe sepsis
Septic shock
Tissue oxygen saturation
Near-infrared spectroscopy
Drotrecogin alfa activated
Outcome
description Sepsis is a leading cause of death despite appropriate management. There is increasing evidence that microcirculatory alterations might persist independently from macrohemodynamic improvement and are related to clinical evolution. Future efforts need to be directed towards microperfusion monitoring and treatment. This study explored the utility of thenar muscle oxygen saturation (StO) and its changes during a transient vascular occlusion test (VOT) to measure the microcirculatory response to drotrecogin alfa (activated) (DrotAA) in septic patients. A prospective, observational study was performed in three general intensive care units at three university hospitals. We studied 58 patients with recent onset of severe sepsis or septic shock and at least two organ dysfunctions. Thirty-two patients were treated with DrotAA and 26 were not treated because of formal contraindication. StO was monitored using near-infrared spectroscopy (NIRS), and VOT was performed to obtain deoxygenation (DeOx) and reoxygenation (ReOx) slopes. Measurements were obtained before DrotAA was started and were repeated daily for a 96-hour period. Patients' characteristics, outcome, severity, and baseline values of StO, DeOx, and ReOx did not differ between groups. Treated patients significantly improved DeOx and ReOx values over time, whereas control patients did not. In treated patients, ReOx improvements were correlated to norepinephrine dose reductions. Early clinical response (SOFA improvement after 48 hours of treatment) was not associated to changes in VOT-derived slopes. In the treated group, the relative improvement of DeOx within 48 hours was able to predict mortality (AUC 0.91, p < 0.01). In patients with severe sepsis or septic shock, DrotAA infusion was associated with improvement in regional tissue oxygenation. The degree of DeOx amelioration after 2 days in treated patients predicted mortality with high sensitivity and specificity. Thus, StO derived variables might be useful to evaluate the microcirculatory response to treatment of septic shock.
publishDate 2013
dc.date.none.fl_str_mv 2
2013-01-01
2013
2013-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/184944
https://dx.doi.org/urn:doi:10.1186/2110-5820-3-30
url https://ddd.uab.cat/record/184944
https://dx.doi.org/urn:doi:10.1186/2110-5820-3-30
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
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