Assessment of Microcirculatory Dysfunction by Measuring Subcutaneous Tissue Oxygen Saturation Using Near-Infrared Spectroscopy in Patients with Circulatory Failure.

Abstract

Background: Patients with circulatory failure have high mortality rates and require prompt assessment of microcirculation. Despite the improvement in hemodynamic parameters, microcirculatory dysfunction persists. We measured subcutaneous regional tissue oxygen saturation (rSO₂) with near-infrared spectroscopy (NIRS), which can assess microcirculation in patients with circulatory failure.

Methods: A finger-worn oximeter with NIRS measured rSO₂ in the forehead, thenar eminence, thumb, and knees. First, the rSO₂ was measured in healthy adult volunteers (n = 10). Circulatory failure was defined as a systolic blood pressure ≤ 90 mmHg and lactate ≥ 2 mmol/L. The study included 35 patients without circulatory failure and SOFA score of 0 at ICU admission and 38 patients with circulatory failure at ICU admission. Both groups included a single-center prospective study of patients who were transported to the ICU of the Nihon University Hospital. The rSO₂ was measured only on ICU admission in the non-circulatory failure group and later in the circulatory failure group.

Results: In the volunteer group, rSO₂ at each site was approximately 58%. The rSO₂ was significantly lower in the circulatory failure group than in the non-circulatory failure group (knee, p < 0.01). In the circulatory failure group, knee rSO₂ showed a significant negative correlation with SOFA score (Day 0, ρ = -0.37, p = 0.02; Day 1, ρ = -0.53, p < 0.01; Day 2, ρ = -0.60, p < 0.01).

Conclusions: Subcutaneous knee rSO₂ was associated with SOFA score and was considered an indicator of microcirculatory dysfunction and organ damage.