Decreases in cerebral saturation in patients with septic shock are associated with increased risk of death: a prospective observational single center study

Abstract

BackgroundThe mortality rate from septic shock has been declining. Cerebral hypoxia, measured non-invasively with cerebral oximetry, has been correlated with neurologic and non-neurologic sequelae. Whether cerebral desaturations occur in septic shock patients and what consequences these may have is untested.MethodsAdult patients with septic shock had cerebral saturation monitoring initiated. The primary objective was to determine if the incidence and magnitude of cerebral desaturations in septic shock patients correlated with delirium. We also compared the incidence and magnitude of cerebral desaturations in patients with septic shock with patients undergoing high-risk non-cardiac surgical procedures, a group known to be at high risk for cerebral desaturations.ResultsFifteen patients were enrolled. Twelve (80 %) patients had a decrease in SctO2 below 65 %. Delirium was not associated with the area under the curve of an SctO2 of 65 % (p = 0.84).Patients who died of septic shock had more significant decreases in SctO2 than those who survived (p = 0.04).Decreased SctO2 was more common in patients with septic shock and was of greater magnitude than those undergoing high-risk non-cardiac surgery.ConclusionsCerebral desaturations occur more commonly and are of a greater magnitude in septic shock patients compared with those undergoing high-risk non-cardiac surgery. There did not appear to be a relationship between the incidence or magnitude of decreases in SctO2 and ICU delirium. Patients who died of septic shock had more significant decreases in SctO2 than patients who survived.

Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials

“…[7][8][9] It has been suggested that in cardiac surgery patients, in addition to those following cardiac arrest or with a diagnosis of sepsis, rSO 2 (\ 60%) may be associated with an increased risk of adverse outcomes. [10][11][12] An additional study in aortic arch surgery patients concluded that reduced intraoperative cerebral oxygen saturation was not only associated with extended hospital stay, but also increased overall hospital costs. 13 Furthermore, given an inherent increase in the physical and financial burden of patient care associated with cognitive dysfunction following surgery, 14 additional efforts directed towards cerebral monitoring and postoperative cognitive dysfunction (POCD) prevention are warranted.…”

Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

“…NIRS is a noninvasive technique that allows for measurement of the oxygenation state of hemoglobin and mitochondrial cytochromes. 16 The oxygenation status of cytochromes along the electron transport chain appears to provide the best estimate of cellular oxygenation. The technology for such measurement has been incorporated into devices capable of measuring the blood oxygen saturation in the brain.…”

“…Preoperative and postoperative creatinine clearance and peak creatinine clearance were calculated according to the formulas reported in the literature. 1 , 16 Our staff nephrologists determined the indication criteria for renal replacement therapy (RRT) for the patients undergoing CABG. These criteria included hyperkalemia (potassium of >6 mmol/L), anuria or oliguria (urine output of <0.5 mL/kg/h for 12 hours), and metabolic acidosis.…”

Pathomechanisms of Non-Traumatic Acute Brain Injury in Critically Ill Patients

“…Additionally, prolonged or intermittent hypoxia activates microglia, which is a trigger for neuroinflammation manifested as a so-called delayed post-anoxic encephalopathy [ 15 ]. A decrease in cerebral oxygen saturation is associated with delirium in septic shock patients [ 16 ]. Mikkelsen and colleagues also found relationships between lower PaO 2 on the day of admission to the ICU and cognitive impairment in general, and executive dysfunction specifically [ 17 ].…”