Tissue Oxygenation in Postoperative Patients: A Pilot Study

اكسيژناسيون بافت بيماران بعد از عمل: يك مطالعه مقدماتي

اهداف: بافت اكسيژن اشباع (StO2) نظارت است فن آوري غير تهاجمي است كه به عنوان علائم هشدار دهنده اوليه hypoperfusion محيطي در بيماران مبتلا به شوك گزارش شده است. مواد & مواد و روش ها: اين مطالعه مشاهده الگوهاي ارزش StO2 در بزرگسالان 31 نظر هموديناميك ثبات، بعد از بررسي. يافته ها: اول، آخرين و ارزش به ترتيب StO2 به طور متوسط: 80.71% + 9.16 80.94% + 7.07؛ و 80.56% + 7.18. با اين حال، ميانگين حداقل در ابتدا، آخرين و ارزش به ترتيب StO2 به طور متوسط: 55% و 67% و 65% است. هنگامي كه حداقل ارزش هاي StO2 براي تفاوت در ميزان بروز عوارض بعد از عمل آزمايش شد، تفاوت معني داري وجود دارد (x = 76.9 7.44، حدود 59-92 چي صفحه, df 18, p = 0.020). نتيجه گيري: در حالي كه بيماران بعد از عمل سطح پايدار StO2 ارزش در دوران بهبودي اوليه خود را حفظ، كه قطره هاي ناگهاني در ارزش هاي StO2 ممكن است sensit گزارش مورد نشان ميدهد.

Aims: In the absence of a gold standard for the clinical diagnosis of shock, clinicians traditionally rely on measurements of vital signs, arterial oxygen saturation of hemoglobin (SaO2), serum lactate, and arterial base deficit. Yet values derived from these measurements may remain relatively normal during the early stages of shock while the patient’s condition is indeed deteriorating, and the evolution from mild to severe shock can be subtle or extremely rapid. Tissue oxygen saturation (StO2) monitoring is a noninvasive technology that has been reported to function as an early warning sign of tissue hypoxia, as systemic blood flow is redistributed to critical organs, primarily in patients with hemorrhagic and traumatic shock, but also in patients with septic shock and in those undergoing cardiac surgery. This pilot study examined the strength of the relationship between initial postoperative StO2 values and the development of complications in adult patients. Methods: This observational, prospective study was carried out in a convenience sample of 31 hemodynamically stable, postoperative adults admitted to the Post-Anesthesia Care Unit (PACU) and Cardiothoracic Care Intensive Care Unit (CTICU) at a 643-bed Level I trauma medical center in the Northeastern region of the United States during 2012. Institutional Review Board approval was obtained from the university and the medical center. Patients were approached in the preoperative holding area, the study was explained, and patients were shown the equipment that would be used in the study. After the patient had been admitted to either the PACU or CTICU, the investigators waited until the bedside nurse performed an initial assessment of hemodynamic stability. Following calibration of the in spectra monitor, the StO2 probe was placed adhesively on the thenar eminence of the patient’s hand. The StO2 data was monitored continuously, downloaded to a laptop computer, and recorded manually every 15 minutes for at least 2 hours. Results: The first, last, and average StO2 values were, respectively: 80.71%+9.16; 80.94%+7.07; and, 80.56% +7.18. However, the mean minimum values of the first, last, and average StO2 values were, respectively: 55%, 67%, and 65%. When minimum StO2 values were tested for differences in the incidence of postoperative complications, there was a significant difference (x=76.9+7.44, range 59-92; Chi Sq, df 18, p=0.020). Conclusions: While postoperative patients maintained a stable level of StO2 values during their early recovery, a case report illustrates that sudden drops in StO2 values may be sensitive to the detection of the potential for complications.