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KMID : 0385920160270030223
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Journal of the Korean Society of Emergency Medicine
2016 Volume.27 No. 3 p.223 ~ p.230
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Correlation between Tissue Oxygen Saturation and Global Oxygenation Parameters in Emergency Patients: A Pilot Clinical Study
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Yoon Young-Woong
Cho Young-Mo
Kim Hyung-Bin
Ryu Ji-Ho
Park Maeng-Real
Min Mun-Ki
Kim Yong-In
Park Sung-Wook
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Abstract
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Purpose: Near-infrared spectroscopy (NIRS) can noninvasively assess changes in tissue oxygen saturation (StO2). The primary concern of the current study is to determine whether StO2 can be used as a surrogate for global oxygenation parameters such as central venous oxygen saturation (ScvO2), lactic acid, and base deficit (BD) in patients presenting to the emergency department (ED).
Methods: This was a prospective, observational study in patients requiring central venous catheter placement, admitted to the ED with complaints classified as infectious and non-infectious etiology. The NIRS sensor (15 mm probe) was applied on the thenar eminence for at least 3 minutes and ScvO2, arterial lactic acid, and BD were measured during insertion of a central venous catheter. Data were analyzed using a simple correlation and Bland-Altman plot.
Results: A total of 120 patients were enrolled in the study and further classified as an infection (n=39) and a noninfection (n=81) group. Lactic acid BD showed significant correlation with StO2 in total and in non-infection patients but the degree of correlation was weak and these correlations were not observed in infection patients. Approximately 94% of the difference between StO2 and ScvO2 was placed within limit of agreement but there was a risk that StO2 may overestimate ScvO2 when ScvO2 becomes lower. When patients were assigned to two groups according to laboratory results (lactic acid 4.0 mmol/L; BD > 3.0 mmol/L; ScvO2 > 65% or 75%), no significant difference in StO2 was observed between the two groups.
Conclusion: In ED patients suspected of having systemic hypoperfusion, StO2 showed a weak correlation with lactic acid and BD in non-infection patients and no correlation in infection patients. In addition, as ScvO2 decreased, the difference between StO2 and ScvO2 showed a tendency to increase, and StO2 was much higher than ScvO2 at low ScvO2 level. Therefore, before using StO2 as surrogate for ScvO2, lactic acid and BD in critically ill patients presenting to the ED, further investigation should be conducted to overcome the limitations of NIRS addressed in this study.
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KEYWORD
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Microcirculation, Spectroscopy Near-Infrared, Tissue oxygen saturation
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