Abstract
According to current critical care management guidelines, the overall hemodynamic optimization process seeks to restore macrocirculatory oxygenation, pressure, and flow variables. However, there is increasing evidence demonstrating that, despite normalization of these global parameters, microcirculatory and regional perfusion alterations might occur, and persistence of these alterations has been associated with worse prognosis. Such observations have led to great interest in testing new technologies capable of evaluating the microcirculation. Near-infrared spectroscopy (NIRS) measures tissue oxygen saturation (StO2) and has been proposed as a noninvasive system for monitoring regional circulation. The present review aims to summarize the existing evidence on NIRS and its potential clinical utility in different scenarios of critically ill patients.
Highlights
Tissue hypoxia, as results of oxygen supply-demand imbalance at the cellular level, defines circulatory insufficiency or shock
There is overwhelming evidence demonstrating that, despite normalization of these global tissue hypoxia markers, perfusion disorders might persist at the microcirculatory level [2, 3]. Persistence of these alterations has been independently associated with further development of multiple organ failure (MOF) and poor outcome [4, 5]
This review aims to summarize what, today, has shown this technology in the field of the critically ill patients
Summary
As results of oxygen supply-demand imbalance at the cellular level, defines circulatory insufficiency or shock. There are several technologies available for the evaluation of the microcirculation [6], which can be classified into two main groups: (a) firstly, direct methods, which allow the visualization of the microvascular bed (such as videomicroscopy); and (b) secondly, indirect methods based on measures of tissue oxygenation, as surrogates of microcirculatory perfusion. The lack of standardization of the VOT has led to great difficulties when trying to compare results from different studies This fundamental issue represents an important limitation of the test, along with the variety of sampled depths and sites used to measure the StO2 response to ischemia [14, 25]. Future consensus should be applied to the location and depth of measurement of StO2 [14]
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