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The prognostic value of tissue oxygen saturation in emergency department patients with severe sepsis or septic shock
  1. Christiane Vorwerk1,
  2. Timothy J Coats2
  1. 1Emergency Department, Queen Alexandra Hospital, Portsmouth, UK
  2. 2Emergency Department, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Dr Christiane Vorwerk, Emergency Department, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK; ciss{at}doctors.org.uk

Abstract

Objectives To determine the derangement of muscle tissue oxygen saturation (StO2) in the early phase of emergency department (ED) sepsis management and its relationship to 30-day mortality in patients with severe sepsis or septic shock.

Methods A prospective cohort study conducted in the ED of a university hospital. Patients were included if they had a clinical diagnosis of severe sepsis or septic shock. Thenar muscle tissue StO2 on arrival in the ED and its change with usual ED sepsis management was measured using near-infrared spectroscopy. A follow-up measurement was obtained after 24 h of treatment. All patients were followed for 30 days.

Results 49 patients were included, of which 24 (49%) died. There was no difference in mean StO2 on arrival in the ED between survivors and non-survivors (72% vs 72%; p=0.97). Following ED treatment the mean StO2 of survivors improved significantly to 78% (p<0.05) while StO2 remained persistently low in non-survivors (p=0.94). Persistently low StO2 (<75%) despite initial resuscitative treatment was associated with a twofold increase in mortality (RR of death 2.1%; 95% CI 1.2% to 3.5%).

Conclusion Patients with severe sepsis/septic shock have abnormal muscle tissue StO2 upon arrival in the ED. Inability to normalise StO2 with ED sepsis management is associated with a poor outcome. The role of StO2 as an early prognostic and potential therapeutic biomarker in severe sepsis or septic shock warrants further exploration.

  • Emergency department
  • environmental medicine
  • ethics
  • forensic legal medicine
  • haematology
  • hyperbaric medicine
  • infection
  • mortality
  • non-invasive
  • paediatric injury
  • prehospital care
  • research
  • resuscitation
  • sepsis
  • septic shock
  • statistics
  • tissue oxygen saturation
  • trauma
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Footnotes

  • Presentations Initial results from this study were presented at the College of Emergency Medicine Scientific Conference 2009, London and at the 31st International Symposium on Intensive Care and Emergency Medicine 2011, Brussels.

  • Funding This work was supported by a College of Emergency Medicine Research grant, 2007.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the National Research Ethics Service (ref 07/H0403/121) and the University Hospital of Leicester Research and Development Department.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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