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Near-infrared spectroscopy in the assessment of suspected sepsis in the emergency department
  1. Stephen P J Macdonald1,2,3,
  2. Simon G A Brown1,2,4
  1. 1Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
  2. 2Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, Western Australia, Australia
  3. 3Department of Emergency Medicine, Armadale Health Service, Armadale, Western Australia, Australia
  4. 4Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Stephen Macdonald, Emergency Department, Armadale Health Service, PO Box 460, Armadale, WA 6992, Australia; Stephen.macdonald{at}health.wa.gov.au

Abstract

Background and aims The conventional approach to sepsis resuscitation involves early interventions targeting global oxygenation and macro-haemodynamic variables such as central venous and systemic arterial pressures. There is increasing recognition of the importance of microcirculatory changes in shock states, including sepsis, and the relationship of these to outcome. Near-infrared spectroscopy (NIRS) is a recently developed non-invasive technology that measures tissue oxygen saturations (StO2), which may be an indirect measure of the adequacy of the microcirculation. StO2 measurements, therefore, have the potential to identify patients who are at risk of progressing to organ dysfunction and could be used to guide resuscitation. This article reviews the current state of knowledge of NIRS in the setting of sepsis, examining its application, validity and prognostic value.

Methods A search of the relevant literature was performed using Medline, Embase and Cochrane databases, and a qualitative analysis was undertaken.

Results A limited number of observational studies, mostly conducted among patients with severe sepsis, have shown that NIRS may correlate with severity of illness but demonstrate a variable relationship between StO2 and outcome.

Conclusions Outstanding questions still remain as to whether NIRS can help to risk-stratify patients with suspected sepsis in the emergency department and the utility of StO2 as a resuscitation target.

  • infectious diseases
  • emergency department
  • resuscitation, clinical care

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