Physiologic Determinants of Near-Infrared Spectroscopy-Derived Cerebral and Tissue Oxygen Saturation Measurements in Critically Ill Patients.

Q4 Medicine Critical care explorations Pub Date : 2024-05-10 eCollection Date: 2024-05-01 DOI:10.1097/CCE.0000000000001094
Neil Cody, Ian Bradbury, Ross R McMullan, Gerard Quinn, Aisling O'Neill, Kathryn Ward, Justine McCann, Daniel F McAuley, Jonathan A Silversides
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Abstract

Objectives: Near-infrared spectroscopy (NIRS) is a potentially valuable modality to monitor the adequacy of oxygen delivery to the brain and other tissues in critically ill patients, but little is known about the physiologic determinants of NIRS-derived tissue oxygen saturations. The purpose of this study was to assess the contribution of routinely measured physiologic parameters to tissue oxygen saturation measured by NIRS.

Design: An observational sub-study of patients enrolled in the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) randomized feasibility trial.

Setting: Two ICUs in the United Kingdom.

Patients: Patients were recruited for the RADAR-2 study, which compared a conservative approach to fluid therapy and deresuscitation with usual care. Those included in this sub-study underwent continuous NIRS monitoring of cerebral oxygen saturations (SctO2) and quadriceps muscle tissue saturations (SmtO2).

Intervention: Synchronized and continuous mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (oxygen saturation, Spo2) measurements were recorded alongside NIRS data. Arterial Paco2, Pao2, and hemoglobin concentration were recorded 12 hourly. Linear mixed effect models were used to investigate the association between these physiologic variables and cerebral and muscle tissue oxygen saturations.

Measurements and main results: Sixty-six patients were included in the analysis. Linear mixed models demonstrated that Paco2, Spo2, MAP, and HR were weakly associated with SctO2 but only explained 7.1% of the total variation. Spo2 and MAP were associated with SmtO2, but together only explained 0.8% of its total variation. The remaining variability was predominantly accounted for by between-subject differences.

Conclusions: Our findings demonstrated that only a small proportion of variability in NIRS-derived cerebral and tissue oximetry measurements could be explained by routinely measured physiologic variables. We conclude that for NIRS to be a useful monitoring modality in critical care, considerable further research is required to understand physiologic determinants and prognostic significance.

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重症患者近红外光谱法得出的大脑和组织血氧饱和度测量值的生理决定因素
目的:近红外光谱(NIRS)是监测重症患者脑部和其他组织供氧是否充足的一种有潜在价值的方法,但人们对 NIRS 导出的组织氧饱和度的生理决定因素知之甚少。本研究的目的是评估常规测量的生理参数对 NIRS 测量的组织氧饱和度的贡献:设计:对参加复苏后积极去复苏作用-2(RADAR-2)随机可行性试验的患者进行观察性子研究:地点:英国两家重症监护室:RADAR-2研究比较了液体疗法和复苏的保守方法与常规护理。参与该子研究的患者接受了连续的近红外血氧饱和度(SctO2)和股四头肌组织饱和度(SmtO2)监测:干预措施:在记录 NIRS 数据的同时,同步连续记录平均动脉压 (MAP)、心率 (HR) 和脉搏血氧仪(血氧饱和度,Spo2)的测量值。每 12 小时记录一次动脉 Paco2、Pao2 和血红蛋白浓度。线性混合效应模型用于研究这些生理变量与大脑和肌肉组织血氧饱和度之间的关系:有 66 名患者参与了分析。线性混合模型显示,Paco2、Spo2、MAP 和 HR 与 SctO2 的关系较弱,但只能解释总变化的 7.1%。Spo2 和 MAP 与 SmtO2 相关,但二者只能解释其总变化的 0.8%。其余的变异主要是由受试者之间的差异造成的:我们的研究结果表明,常规测量的生理变量只能解释一小部分 NIRS 导出的大脑和组织血氧测量的变异性。我们的结论是,要使近红外成像技术成为重症监护中一种有用的监测模式,还需要进行大量的进一步研究,以了解生理决定因素和预后意义。
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5.70
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