Document Detail


StO(2) guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial.
MedLine Citation:
PMID:  23381608     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
The scientific community has agreed upon developing accurate monitoring of tissue perfusion and oxygenation to improve the management of subjects with sepsis. This pilot study aimed to investigate the feasibility of targeting tissue oxygen saturation (StO(2)) in addition to the currently recommended resuscitation goals, central venous pressure, mean arterial pressure and central venous oxygen saturation, in patients with severe sepsis or septic shock. A pilot, single-centre, randomised, non-blinded trial recruited 30 subjects with severe sepsis upon intensive care unit admission at an academic medical centre in France. Subjects were randomly assigned to a 6 h resuscitation strategy following the Surviving Sepsis Campaign guidelines with (experimental) or without (control) StO(2). StO(2) was measured over several muscles (masseter, deltoid and pectoral or thenar muscles), and a StO(2) above 80 % over at least 2 muscles was the therapeutic goal. The primary outcome was evaluated as follows: 7-day mortality or worsening of SOFA score between day 7 and study onset, i.e., DSOFA > 0). Thirty subjects were included in the study over a period of 40 weeks. Fifteen subjects were included in each group. Monitoring of StO(2) over three areas was performed in the experimental group. However, measures over the pectoral muscle provided poor results. At study day 7, there were 5/15 (33.3 %) subjects who died or had a DSOFA > 0 in the experimental arm and 4/15 (26.6 %) who died or had a DSOFA > 0 in the control arm (p = 1.00). This pilot study was the first randomised controlled trial using an algorithm derived from the SSC recommendations, which included StO(2) as a treatment goal. However, the protocol showed no clear trend for or against targeting StO(2).
Authors:
Olivier Nardi; Andrea Polito; Jérôme Aboab; Gwenhael Colin; Virginie Maxime; Bernard Clair; Diane Friedman; David Orlikowski; Tarek Sharshar; Djillali Annane
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-5
Journal Detail:
Title:  Journal of clinical monitoring and computing     Volume:  -     ISSN:  1573-2614     ISO Abbreviation:  J Clin Monit Comput     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9806357     Medline TA:  J Clin Monit Comput     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), 104 boulevard Raymond Poincaré, 92380, Garches, France, olivier.nardi@yahoo.fr.
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