Tissue oxygen saturation as an early indicator of delayed lactate clearance after cardiac surgery: a prospective observational study

BMC Anesthesiology

Research Article

Oliver Grottke¹  Gereon Schälte¹  Rolf Rossaint²  Steffen Rex³  Katja Dommann⁴  Rüdger Kopp⁴  Gernot Marx⁵  Jan Spillner⁶ 

[1] Department of Anaesthesiology, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany;Department of Anaesthesiology, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany;Department of Intensive Care, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany;Department of Anaesthesiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium;Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium;Department of Intensive Care, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany;Department of Intensive Care, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany;Department of Anaesthesiology, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany;Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany;

关键词: Cardiac Surgical Procedure;    Microcirculation;    Lactic acid;    Haemodynamics;    Tissue oxygenation;   

DOI  :  10.1186/s12871-015-0140-7

 received in 2015-07-24, accepted in 2015-10-24,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundIn this observational study near infrared spectroscopy (NIRS) was evaluated as a non-invasive monitor of impaired tissue oxygenation (StO2) after cardiac surgery. StO2, cardiac output, mixed venous oxygen saturation and mean arterial pressure were compared with lactate clearance as established measure for sufficient tissue perfusion and oxygen metabolism.MethodsForty patients after cardiac surgery (24 aortocoronary bypass grafting, 5 heart valve, 3 ascending aorta and 8 combined procedures) were monitored until postoperative day 1 with NIRS of the thenar muscle (InSpectra™ StO2-monitor, Hutchinson Technology), a pulmonary-artery catheter and intermittent blood gas analyses for the assessment of lactate clearance.ResultsStO2 was reduced 4 h after surgery (75 ± 6 %), but recovered at day 1 (84 ± 5 %), while lactate concentration remained increased. Using uni- and multivariate regression analysis, minimum StO2 (r = 0.46, p <0.01) and cardiac index (r = 0.40, p <0.05) correlated with lactate clearance at day 1, while minimum mixed venous saturation and mean arterial pressure did not. In a receiver-operating characteristics (ROC) analysis, minimum StO2 (with a threshold of 75 %) predicted a lactate clearance <10 % at day 1 with an area under the ROC-curve of 0.83, a sensitivity of 78 % and a specificity of 88 %. In the subgroup with StO2  <75 %, troponin and creatine kinase MB were significantly increased at day 1.ConclusionsStO2 below 75 % in the first hours after surgery was a better early indicator of persistent impaired lactate clearance at day 1 than cardiac index, mixed venous oxygen saturation or mean arterial pressure.

【 授权许可】

CC BY   
© Kopp et al. 2015