Prognosis value of dynamic variation of tissue oxygen saturation during severe cardiogenic shock

Abstract

Introduction: To evaluate the prognosis value of dynamic thenar O 2 saturation (StO 2) response using a vascular occlusion test (VOT) during cardiogenic shock. Methods: A retrospective clinical observational analysis was performed on adult patients treated for severe cardiogenic shock in a surgical ICU. The non-invasive InSpectra near-infrared spectrometer was used to assess the eff ect of VOT on thenar eminence StO 2. The VOT manoeuvre was repeated within the first 24 hours of admission. StO 2 VOT-induced changes were compared between surviving and nonsurviving patients between the first 8 hours and the next 16 hours. (Figure Presented) Results: Ten patients suff ering from cardiogenic shock (age 59.8 +/- 13.8 years; APACHE score 21.3 +/- 5.9) were treated with inotropes (n = 7) and/ or circulatory mechanical assistance (four IABP, three ELS, one LVAD) and vasopressors (n = 9). Mortality in the ICU was 50%. Hemodynamic and metabolic parameters were not different between survivors and nonsurvivors (Table 1). The post-VOT StO 2 recovery slope tended to be faster within the first 8 hours in survivors than in nonsurvivors (2.8 +/- 1.1 vs. 1.7 +/- 0.4%/s, P = 0.09) and improved significantly in the H8 to H24 period (4.5 +/- 1.2 vs. 2 +/- 1.1%/s, P = 0.007). The post-VOT StO 2 recovery slope increased significantly within the first 24 hours in all survivors (Figure 1). Conclusions: Our Results: suggest that, in patients treated for cardiogenic shock, rapid improvement in the post-VOT StO 2 recovery slope is associated with a better prognosis.