The use of a vascular occlusion test combined with near-infrared spectroscopy in perioperative care: a systematic review

Abstract

In the perioperative phase oxygen delivery and consumption can be influenced by different factors, i.e. type of surgery, anesthetic and cardiovascular drugs, or fluids. By combining near-infrared spectroscopy (NIRS) monitoring of regional tissue oxygen saturation (StO 2 ) with an ischemic provocation test, the vascular occlusion test (VOT), local tissue oxygen consumption and vascular reactivity at the microcirculatory level can be assessed. This systematic review aims to give an overview of the clinical information that VOT-derived NIRS values can provide in the perioperative period. After performing a systematic literature search, we included 29 articles. It was not possible to perform a meta-analysis because of the lack of comparable data and the observational nature of the majority of the included articles. We have clustered the found articles in two groups: non-cardiac surgery and cardiac surgery. We found that VOT-derived NIRS values show a wide variability and are influenced by the effects of anesthetics, cardiovascular drugs, fluids, and by the type of surgery. Additionally, deviations in VOT-derived NIRS values are also associated with adverse patients' outcomes, such as postoperative complications, prolonged mechanical ventilation and prolonged hospital length of stay. However, given the variability in VOT-derived NIRS values, clinical applicability remains elusive. Future clinical interventional trials might provide additional insight into the potential of VOT associated with NIRS to optimize perioperative care by targeting specific interventions to optimize the function of the microvasculature.

Non-Invasive Monitoring of Microvascular Oxygenation and Reactive Hyperemia using Hybrid, Near-Infrared Diffuse Optical Spectroscopy for Critical Care

“…In order to assess the microcirculation at the ICU, NIRS is often utilized with a vascular occlusion test (VOT), which is an ischemic challenge that is performed by blocking the blood supply to the probed peripheral muscle for a certain duration (a few minutes) 28 , 29 , 30 , 31 , 32 . Most commonly, it is executed by inflating a tourniquet wrapped around the upper arm above the systolic pressure 33 . During the VOT, the clinicians assess the response of the microvascular blood oxygenation to changes in blood flow to derive oxygen metabolism at rest and reactive hyperemia 34 .…”

Assessment of Microvascular Hemodynamic Adaptations in Finger Flexors of Climbers

“…Therefore, the usual intermittent isometric contractions of the finger flexors performed by climbers could trigger structural and functional adaptations of microcirculatory vessels and mitochondrial biogenesis, thereby enhancing finger flexor resistance to fatigue by improving their O 2 supply and consumption capabilities, respectively. Vascular occlusion tests (VOT) have been used as an efficient and comfortable method to explore microvasculature function under resting conditions [12][13][14][15]. During VOT, a local ischemic environment is produced in the muscle tissue by placing and inflating a pressure cuff or a tourniquet at the proximal end of the limb and restricting blood flow for a certain period of time.…”

Near-infrared spectroscopy system for quantitative characterization of four biomarkers in biotissue oxygenation

“…This increase displayed a linear correlation with the dosage of laser energy supplied to the targeted region of the patient's body. In addition, the integration of NIRS technology alongside arterial and venous occlusions has facilitated the real-time assessment of muscle blood flow and peripheral oxygen utilization during activities such as handgrip exercises and various physiological tests [2][3][4][5] . These results demonstrate the great potential of NIRS as a non-invasive tool not only to unravel the intricate mechanisms underpinning photobiomodulation but also to appraise the dynamic effects of LLLT in vivo.…”