Abstract
PurposeThe aim of this pilot study was to evaluate the potential of a new noninvasive optical measurement of muscle oxygenation (MOx) to identify shock severity in patients with suspected sepsis.MethodsWe enrolled 51 adult patients in the emergency department (ED) who presented with possible sepsis using traditional Systematic Inflammatory Response Syndrome criteria or who triggered a “Code Sepsis.” Noninvasive MOx measurements were made from the first dorsal interosseous muscles of the hand once potential sepsis/septic shock was identified, as soon as possible after admission to the ED. Shock severity was defined by concurrent systolic blood pressure, heart rate, and serum lactate levels. MOx was also measured in a control group of 17 healthy adults.ResultsMean (± SD) MOx in the healthy control group was 91.0 ± 5.5% (n = 17). Patients with mild, moderate, and severe shock had mean MOx values of 79.4 ± 21.2%, 48.6 ± 28.6%, and 42.2 ± 4.7%, respectively. Mean MOx for the mild and moderate shock severity categories were statistically different from healthy controls and from each other based on two-sample t-tests (p < 0.05).ConclusionsWe demonstrate that noninvasive measurement of MOx was associated with clinical assessment of shock severity in suspected severe sepsis or septic shock. The ability of MOx to detect even mild septic shock has meaningful implications for emergency care, where decisions about triage and therapy must be made quickly and accurately. Future longitudinal studies may validate these findings and the value of MOx in monitoring patient status as treatment is administered.
Highlights
Identification of severe sepsis is one of the most important factors in improving clinical outcome [1]
We demonstrate that noninvasive measurement of muscle oxygenation (MOx) was associated with clinical assessment of shock severity in suspected severe sepsis or septic shock
Despite effort focused on these issues, a good clinical indicator that can accurately identify inadequate perfusion in severe sepsis and that can serve as an index from which to titrate therapy remains elusive
Summary
Identification of severe sepsis is one of the most important factors in improving clinical outcome [1]. In 2001, the introduction of early goal-directed therapy (EGDT) [2] began a systematic approach to treatment of the patient with suspected severe sepsis. Despite effort focused on these issues, a good clinical indicator that can accurately identify inadequate perfusion in severe sepsis and that can serve as an index from which to titrate therapy remains elusive. The lack of an accurate marker for hypoperfusion in sepsis was one factor leading recent multicenter studies to question the efficacy of the original EGDT protocol [3, 4]. The need for a new clinical marker identifying hypoperfusion in patients with severe sepsis or septic shock fueled the design of this study
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