Circulatory shock affects every third patient in intensive care units and is associated with high mortality. Near-infrared spectroscopy (NIRS) could serve as a means for monitoring tissue perfusion in circulatory shock.
Purpose:
To assess the evidence of NIRS monitoring in circulatory shock, we conducted a systematic review of the literature.
Methods:
The study protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO). We searched PubMed, Ovid MEDLINE, Scopus, and EBM Reviews databases. The reference lists of included articles, last volumes of key journals, and NIRS monitor manufacturers’ webpages were searched manually. Two reviewers independently selected included studies. The quality of studies was assessed. The qualitative synthesis was guided by 3 questions: First, does NIRS monitoring improve patient-centered outcomes in adult circulatory shock patient? Second, do NIRS-derived parameters predict patient-centered outcomes, such as mortality and organ dysfunction, and third, does NIRS monitoring give additional information to guide treatment decisions?
Main Results:
Eighteen observational studies with 927 patients were included. Because of considerable clinical heterogeneity of the data, we were not able to perform a meta-analysis. Also, due to lack of randomized controlled trials, the first review question could not be answered. Based on the current review, baseline tissue oxygen saturation (StO2) however seems to predict mortality and identify patients with most severe forms of circulatory shock.
Conclusions:
Near-infrared spectroscopy-derived StO2 can predict mortality in circulatory shock, but high-quality data on the impact of NIRS monitoring are lacking. Furthermore, the marked heterogeneity of the studies makes combining the results of individual studies difficult. Standardization of methodology and clinical randomized trials are needed before wider clinical use.
SakrYReinhartKVincentJL, et al.Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med. 2006;34(3):589–597.
2.
JawadILuksicIRafnssonSB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Global Health. 2012;2(1):010404.
3.
CecconiMDe BackerDAntonelliM, et al.Consensus on circulatory shock and hemodynamic monitoring. Task force of the European society of intensive care medicine. Intensive Care Med. 2014;40(12):1795–1815.
4.
JobsisFF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977;198(4323):1264–1267.
LiuHChanceBHielscherAHJacquesSLTittelFK. Influence of blood vessels on the measurement of hemoglobin oxygenation as determined by time-resolved reflectance spectroscopy. Med Phys. 1995;22(8):1209–1217.
7.
BezemerRLimaAMyersD, et al.Assessment of tissue oxygen saturation during a vascular occlusion test using near-infrared spectroscopy: the role of probe spacing and measurement site studied in healthy volunteers. Crit Care. 2009;13(suppl 5):S4.
8.
ManciniDMBolingerLLiHKendrickKChanceBWilsonJR. Validation of near-infrared spectroscopy in humans. J Appl Physiol (1985). 1994;77(6):2740–2747.
9.
ChanMJChungTGlassfordNJBellomoR. Near-infrared spectroscopy in adult cardiac surgery patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2017;31(4):1155–1165.
10.
LiberatiAAltmanDGTetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–34.
11.
HigginsJPTGreenS, Cochrane collaboration. Cochrane handbook for systematic reviews of interventions. In: [Oxford]: Cochrane Collaboration; 2011: http://handbook-5-1.cochrane.org/. Accessed January 2, 2017.
12.
Centre for Reviews and Dissemination UoY. Systematic Reviews: CRD’s guidance for undertaking reviews in health care. York, England: CRD, University of York; 2009.
13.
SaricLVucicKDragicevicK, et al.Comparison of conference abstracts and full-text publications of randomized controlled trials presented at four consecutive world congresses of pain: reporting quality and agreement of results. Eur J Pain. 2019;23(1):107–116.
14.
BeilmanGJBlondetJJNelsonTR, et al.Early hypothermia in severely injured trauma patients is a significant risk factor for multiple organ dysfunction syndrome but not mortality.[Erratum appears in Ann Surg. 2009 Oct;250(4):661]. Ann Surg. 2009;249(5):845–850.
15.
CohnSMNathensABMooreFA, et al.Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma. 2007;62(1):44–54.
16.
MooreFANelsonTMcKinleyBA, et al.Massive transfusion in trauma patients: Tissue hemoglobin oxygen saturation predicts poor outcome. J Trauma. 2008;64(4):1010–1023.
17.
DuretJPottecherJBouzatP, et al.Skeletal muscle oxygenation in severe trauma patients during haemorrhagic shock resuscitation. Crit Care. 2015;19:141.
18.
ConradMPerezPThivilierCLevyB. Early prediction of norepinephrine dependency and refractory septic shock with a multimodal approach of vascular failure. J Crit Care. 2015;30(4):739–743.
19.
StrahovnikIPodbregarM. Measurement of skeletal muscle tissue oxygenation in the critically ill. Signa Vitae. 2008;3(1):43–50.
20.
Ait-OufellaHJoffreJBoellePY, et al.Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock. Intensive Care Med. 2012;38(6):976–983.
21.
GeorgerJFHamzaouiOChaariAMaizelJRichardCTeboulJL. Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients. Intensive Care Med. 2010;36(11):1882–1889.
22.
HeyerLMebazaaAGayatE, et al.Cardiac troponin and skeletal muscle oxygenation in severe post-partum haemorrhage. Crit Care. 2009;13(suppl 5):S8.
23.
PayenDLuengoCHeyerL, et al.Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome?Crit Care. 2009;13(suppl 5):S6.
24.
Marin-CorralJClaveriasLBodiM, et al.Prognostic value of brachioradialis muscle oxygen saturation index and vascular occlusion test in septic shock patients. Med Intensiva. 2016;40(4):208–215.
25.
MesquidaJEspinalCGruartmonerG, et al.Prognostic implications of tissue oxygen saturation in human septic shock. Intensive Care Med. 2012;38(4):592–597.
26.
MesquidaJGruartmonerGMartinezML, et al.Thenar oxygen saturation and invasive oxygen delivery measurements in critically ill patients in early septic shock. Shock. 2011;35(5):456–459.
27.
RodriguezALisboaTMartin-LoechesI, et al.Mortality and regional oxygen saturation index in septic shock patients: a pilot study. J Trauma. 2011;70(5):1145–1152.
28.
ThooftAFavoryRSalgadoDR, et al.Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care. 2011;15(5):R222.
29.
Orbegozo CortesDPufleaFDe BackerDCreteurJVincentJL. Near infrared spectroscopy (NIRS) to assess the effects of local ischemic preconditioning in the muscle of healthy volunteers and critically ill patients. Microvasc Res. 2015;102:25–32.
30.
Al TayarAAbouelelaAMohiuddeenK. Can the cerebral regional oxygen saturation be a perfusion parameter in shock?J Crit Care. 2016;38:164–167.
31.
CrookesBACohnSMBlochS, et al.Can near-infrared spectroscopy identify the severity of shock in trauma patients?J Trauma. 2005;58(4):806–813; discussion 813-806.
32.
WoodMSongAMasloveD, et al.Brain tissue oxygenation in patients with septic shock: a feasibility study. Can J Neurol Sci. 2016;43(1):65–73.
33.
BindraJPhamPChuanAJaegerMAnemanA. Is impaired cerebrovascular autoregulation associated with outcome in patients admitted to the ICU with early septic shock?Crit Care Resusc. 2016;18(2):98–101.
34.
BoneRCBalkRACerraFB, et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest. 1992;101(6):1644–1655.
35.
DellingerRPLevyMMCarletJM, et al.Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327.
36.
LevyMMMDFFinkMPMDFMarshallJCMD, et al.2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 2003;31(4):1250–1256.
37.
NardiOPolitoAAboabJ, et al.StO2 guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial. J Clin Monit Comput. 2013;27(3):215–221.
38.
NardiOZavalaEMartinC, et al.Targeting skeletal muscle tissue oxygenation (StO2) in adults with severe sepsis and septic shock: a randomised controlled trial (OTO-StS Study). BMJ Open. 2018;8(3):e017581.
39.
RamsinghDAlexanderBCannessonM. Clinical review: does it matter which hemodynamic monitoring system is used?Crit Care. 2013;17(2):208.
40.
MerzTMCioccariLFreyPM, et al.Continual hemodynamic monitoring with a single-use transesophageal echocardiography probe in critically ill patients with shock: a randomized controlled clinical trial. Intensive Care Med. 2019;45(8):1093–1102.
41.
RayPLe ManachYRiouBHouleTT. Statistical evaluation of a biomarker. Anesthesiology. 2010;112(4):1023–1040.
42.
BendahanNNealORoss-WhiteAMuscedereJBoydJG. Relationship between near-infrared spectroscopy-derived cerebral oxygenation and delirium in critically Ill patients: a systematic review. J Intensive Care Med. 2019;34(6):514–520.
43.
SakrYDuboisMJDe BackerDCreteurJVincentJL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32(9):1825–1831.
44.
HutchingsSDNaumannDNHopkinsP, et al.Microcirculatory impairment is associated with multiple organ dysfunction following traumatic hemorrhagic shock: the MICROSHOCK study. Crit Care Med. 2018;46(9):e889–e896.
45.
De BackerDCreteurJDuboisMJSakrYVincentJL. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J. 2004;147(1):91–99.
46.
JhanjiSLeeCWatsonDHindsCPearseRM. Microvascular flow and tissue oxygenation after major abdominal surgery: association with post-operative complications. Intensive Care Med. 2009;35(4):671–677.
47.
MayeurCCampardSRichardCTeboulJL. Comparison of four different vascular occlusion tests for assessing reactive hyperemia using near-infrared spectroscopy. Crit Care Med. 2011;39(4):695–701.
48.
JaeschkeRGuyattGHSackettDL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The evidence-based medicine working group. JAMA. 1994;271(9):703–707.
49.
IoannidisJPChewPLauJ. Standardized retrieval of side effects data for meta-analysis of safety outcomes. a feasibility study in acute sinusitis. J Clin Epidemiol. 2002;55(6):619–626.
50.
SteenhautKLapageKBoveTDe HertSMoermanA. Evaluation of different near-infrared spectroscopy technologies for assessment of tissue oxygen saturation during a vascular occlusion test. J Clin Monit Comput. 2017;31(6):1151–1158.
51.
LuengoCResche-RigonMDamoiselCKereverSCreteurJPayenD. Comparison of two different generations of “NIRS” devices and transducers in healthy volunteers and ICU patients. J Clin Monit Comput. 2013;27(1):71–79.
52.
ColinGNardiOPolitoA, et al.Masseter tissue oxygen saturation predicts normal central venous oxygen saturation during early goal-directed therapy and predicts mortality in patients with severe sepsis. Crit Care Med. 2012;40(2):435–440.
53.
PoezeM. Tissue-oxygenation assessment using near-infrared spectroscopy during severe sepsis: confounding effects of tissue edema on StO2 values. Intensive Care Med. 2006;32(5):788–789.
54.
SorensenHRasmussenPSiebenmannC, et al.Extra-cerebral oxygenation influence on near-infrared-spectroscopy-determined frontal lobe oxygenation in healthy volunteers: a comparison between INVOS-4100 and NIRO-200NX. Clin Physiol Funct Imaging. 2015;35(3):177–184.
55.
PichlerGWolfMRollC, et al.Recommendations to increase the validity and comparability of peripheral measurements by near infrared spectroscopy in neonates. ‘Round table’, section of haematology, oxygen transport and microcirculation, 48th annual meeting of ESPR, Prague 2007. Neonatology. 2008;94(4):320–322.
56.
HollerNUrlesbergerBMilederLBaikNSchwabergerBPichlerG. Peripheral muscle near-infrared spectroscopy in neonates: ready for clinical use? A systematic qualitative review of the literature. Neonatology. 2015;108(4):233–245.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
