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Monitorage par spectroscopie proche infrarouge lors d’une chirurgie cardiaque : un concept prometteur ?

2011; Elsevier BV; Volume: 30; Issue: 7-8 Linguagem: Inglês

10.1016/j.annfar.2011.04.012

ISSN

1769-6623

Autores

Nils Siegenthaler, Raphaël Giraud, Vincent Piriou, Karim Bendjelid,

Tópico(s)

Non-Invasive Vital Sign Monitoring

Resumo

The main goal of this study was to assess whether maximal fluid infusion improves both oxygen delivery (DO2) and micro-circulatory parameters during hemodilution. The secondary objective was to assess the ability of baseline micro-circulatory parameters to predict oxygen consumption (VO2) response following fluid infusion.In a postoperative cardiac ICU, patients received repeated fluid infusion until stroke volume (SV) was maximized. Before and after each fluid expansion, macro- (DO2, VO2) and micro-circulatory oxygenation parameters were recorded [central venous oxygen saturation (ScVO2), blood lactate, difference in veno-arterial carbon dioxide tension (P(v-a)CO2), somatic and cerebral oxygen saturation (rSO2)]. Patients were classified as VO2-Responders or VO2-Non-Responders according to an increase in VO2 above or below 15%, respectively.After maximal fluid infusion, all patients showed improved macro- and micro-circulatory oxygenation parameters, but VO2-Responders had lower values (especially for ScVO2 and cerebral rSO2). Only baseline ScVO2 and cerebral rSO2 were useful to predict the VO2 response to maximal fluid infusion (ROCAUC 0.80 (95% CI: 0.54–0.95, P = 0.012) and 0.83 (95% CI: 0.57–0.96, P = 0.001).Maximal fluid infusion improves macro- and micro-circulatory oxygenation parameters. For VO2-Responders, only ScVO2 and cerebral rSO2 could serve as markers of tissue hypoxia.

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