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Objective To explore the value of percutaneous oxygen partial pressure monitoring in prognosis evaluation of patients with acute heart failure (AHF). Methods A total of 91 patients with AHF due to various reasons admitted to the emergency department of the First Affiliated Hospital of China Medical University from July 2017 to June 2018 were enrolled. Dynamic monitoring data of arterial blood gas, percutaneous oxygen partial pressure monitoring and noninvasive cardiac output monitoring (NICOM) of all of the patients at the time of diagnosis (before treatment) and 6 hours after treatment were recorded, including arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), blood lactic acid (Lac), percutaneous oxygen partial pressure (TcPO2), percutaneous carbon dioxide partial pressure (TcPCO2), cardiac output (CO) and stroke volume (SV). The 10-minute oxygen challenge test value (OCT), oxygen and carbon dioxide offsets were calculated. The patients were divided into survival group and non-survival group according to 28-day survival situation, and the differences in above parameters were compared between the two groups. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of percutaneous partial oxygen pressure monitoring for the prognosis of patients with AHF. Results All the 91 patients were enrolled in the analysis, among whom 26 died on 28 days and 65 survived, with a mortality of 28.6%. Before treatment, 10-minute OCT in the non-survival group was significantly lower than that in the survival group [mmHg (1 mmHg = 0.133 kPa):41.0±3.9 vs. 45.6±3.2, P < 0.01], and the carbon dioxide offset was significantly higher than that in the survival group [(0.51±0.11)% vs. (0.37±0.11)%, P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2, TcPO2, TcPCO2, oxygen offset, CO, SV or Lac between the two groups. After 6 hours of treatment, TcPCO2, oxygen offset and carbon dioxide offset in the non-survival group were significantly higher than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, oxygen offset: (0.25±0.05)% vs. (0.22±0.06)%, carbon dioxide offset: (0.29±0.12)% vs. (0.16±0.13)%, all P < 0.05], TcPO2, 10-minute OCT, CO and SV were significantly lower than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, 10-minute OCT (mmHg): 49.1±4.5 vs. 53.6±5.5, CO (L/min):4.9±0.5 vs. 5.3±0.5, SV (mL): 57.8±3.5 vs. 64.4±4.8, all P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2 or Lac between the two groups. ROC curve analysis showed that the area under the ROC curve (AUC) of 10-minute OCT onset predicting the 28-day death of patients with AHF was 0.802; when the optimal cut-off value was 43.5 mmHg, the sensitivity and specificity was 77.3% and 68.0%, respectively. The AUC of carbon dioxide offset was 0.812; when the optimal cut-off value was 0.46%, the sensitivity and specificity was 86.4% and 68.0%, respectively. Conclusions Percutaneous oxygen partial pressure monitoring can be used as a reliable indicator for prognosis evaluation of patients with AHF. Increased carbon dioxide offset and decreased 10-minute OCT suggest poor prognosis, and the prognosis of patients with AHF should be evaluated by dynamic monitoring.
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Objective To evaluate the significance of oxygen stress test in 10 minutes after fluid resuscitation in the incidence and prognosis of acute kidney injury (AKI) in septic shock patients.Methods From January 2014 to December 2017,fifty-eight patients with septic shock were enrolled.The 10 min oxygen challenge test was conducted using transcutaneous oximetry just before (T0) and 6 h (T1) after initiation of fluid resuscitation,and 10 min oxygen challenge test data(10 min OCT) at TO and T1 were then calculated,respectively.The enrolled patients were divided into L group (10 min OCT＜66 mmHg,32 cases) and H group (10 min OCT ≥66 mmHg,26 cases)according to the 10 min OCT value at T1.The hemodynamic variables and oxygen metabolism indexes,dose of vasoactive agents,10 min OCT at T0 and T1 were recorded,incidence and severity of septic shock-associated AKI,frequency of continuous renal replacement therapy,ICU mortality and 28 d mortality were compared between two groups,the risk factors associated with prognosis were analyzed using COX regression model.Results The hemodynamic variables and oxygen metabolism indexes and dose of vasoactive agents were comparable between two groups at TO and T1 (P ＜ 0.05).The incidence of septic shock-associated AKI (78.1％ (25/32) vs.50.0％ (13/26),x2 =6.365),proportion of phase 3 AKI (53.1％ (17/32) vs.26.9％ (7/26),x2 =8.016) and frequency of continuous renal replacement therapy (46.9％ (15/32) vs.23.1％ (6/26),x2 =5.764) was higher in L group than those in H group(P＜0.05),and similarly were the ICU mortality (23.1％ (6/26)vs.53.1％ (17/32),x2 =7.134,P ＜ 0.05) and 28 d mortality (30.8％ (8/26) vs.62.5％ (20/32),x2 =6.067,P ＜0.05).Therefore,the 6 h 10 min OCT≥66 mmHg was a protective factor to improve the ICU mortality(RR =0.013,95％CI:0.021-0.396,P＜0.05) and 28 d mortality(RR=0.018,95％CI:0.009-0.280,P＜0.05) in patients with septic shock-associated AKI.Conclusion 10 min OCT imposes substantial imquence on the incidence,severity and prognosis of patients with septic shock-associated AKI,oxygen challenge test could improve the treatment of septic shock-associated AKI.
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Objective To evaluate the value of microcirculation and oxygen metabolism evaluation (MicrOME)in acute kidney injury(AKI) evaluation in patients with septic shock after resuscitation. Methods Consecutive patients with septic shock after resuscitation and mechanical ventilation were enrolled from October 2016 to February 2017 in ICU at Peking Union Medical College Hospital.Patients were divided into 3 groups based on 10 min transcutaneous oxygen challenge test transcutaneous partial pressure of oxygen(PtcO2)and venoarterial pressure of carbon dioxide difference(Pv-aCO2)/arteriovenous O2 content difference(Ca-vO2)by blood gas analysis, i.e. group A [ΔPtcO2>66 mmHg(1 mmHg=0.133 kPa) and Pv-aCO2/Ca-vO2≤1.23], group B (ΔPtcO2≤66 mmHg), group C (ΔPtcO2>66 mmHg and Pv-aCO2/Ca-vO2>1.23). Heart rate,mean arterial pressure,central venous pressure,noradrenaline dose,lactate,Pv-aCO2,Ca-vO2, lactate clearance, central venous oxygen saturation(ScvO2) and liquid equilibrium were assessed after resuscitation.AKI staging based on Kidney Disease Global Improving Outcomes (KDIGO) clinical practice guideline was analyzed. The predictive value of lactate,ScvO2,Pv-aCO2/Ca-vO2 to progression of AKI after resuscitation was determined using receiver operating characteristic(ROC)curve analysis.Results A total of 49 septic shock patients were enrolled including 30 males and 19 females with mean age of (61.10±17.10) years old.There were 19 patients in group A,21 patients in group B, and 9 patients in group C. Acute physiology and chronic health evaluation Ⅱ score was 20.92±7.19 and sequential organ failure assessment score 12.02±3.28. There were 4 patients with AKI and 1 progressed in group A,11 patients with AKI and 2 progressed in group B, 6 patients with AKI and 4 progressed in group C. The cutoff value of Pv-aCO2/Ca-vO2 was equal or more than 2.20 for predicting progression of AKI,resulting in a sensitivity of 85.7％ and a specificity of 73.8％.Conclusion MicrOME is a significant parameter to predict the progression of AKI in patients with septic shock after resuscitation. Pv-aCO2/Ca-vO2 is also a good predictive factor.
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Objective To evaluate the prognostic value of transcutaneous oximetry in patients with septic shock.Methods Fifty-three patients with septic shock were enrolled prospectively from January 2013 to December 2015.Transcutaneous oximetry were used to determine the results of 10 min oxygen challenge tests (OCT) carried out at beginning(0 h) and at 6 h after fluid resuscitation respectively.The 10-min OCT value (10 min OCT) and oxygen challenge index(OCI) were calculated.The APACHE Ⅱ and SOFA score,hemodynamic variables,oxygen metabolism indexes,dose of vasoactive agents,10 min OCT,and OCI at 0 h and at 6 h were recorded.Patients were assigned into survival group and death group according to the 28 d survival.The differences in demographics and clinical data were compared between groups.The role of 10 min OCT and OCI in predicting death was evaluated by receiver operating characteristic curves(ROC).The Kaplan-Meier surviving curve was created and the survival of the patients was analyzed by the Log-rank test.Risk factors associated with the prognosis were analyzed using the multiple logistic regression analysis.Results There were 29 patients in the survival group and 24 patients in the death group.Compared with death group,10 min OCT[(77.55±18.48)mmHg vs.(51.30±21.60)mmHg] and OCI [(0.78±0.13) vs.(0.59±0.15)] at 6 h in survival group were significantly higher(P＜0.05),while APACHE Ⅱ [(12.48±5.69) vs.(17.25±8.79)] and SOFA [(5.79±1.72) vs.(10.10±2.52)] in survival group were significantly lower than those in death group(P＜0.01).The area under the ROC curve of 10 min OCT at 6 h and OCI at 6 h for predicting 28 d death were 0.86±0.05(95％CI:0.76-0.87,P＜0.01) and 0.79±0.08(95％CI:0.64-0.95,P＜0.01),respectively.The optimal cutoff point for 10 min OCT at 6 h was 72.00 mmHg with the sensitivity of 76.84％ and specificity of 85.03％.The optimal cutoff point for OCI at 6 h was 0.76 with the sensitivity of 76.84％ and specificity of 77.47％.Kaplan-Meier survival analysis showed that 28 d survival rate in high level of 10 min OCT at 6 h and high level of OCI at 6 h were significantly higher than that in low level of 10 min OCT at 6 h(70.86％ vs.31.82％,x2=7.96,P＜0.01)and low level of OCI at 6 h (75.00％ vs.32.00％,x2=9.86,P＜0.01).Multivariate logistic regression analysis showed that both 10 min OCT at 6 h (OR=0.92,95％CI:0.88-0.96,P＜0.05) and OCI at 6 h (OR=0.01,95％CI:0.001-0.023,P＜0.05) were independent risk factors associated with 28 d mortality of patients with septic shock.Conclusions The 10 min OCT and OCI were reliable predictors for the prognosis of patients with septic shock.
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Objective To investigate the prognostic value of oxygen challenge test (OCT) for patients with cardiogenic shock receiving extracorporeal membrane oxygenation (ECMO). Methods A retrospective analysis was conducted. Seventy-eight patients diagnosed with cardiogenic shock receiving veno-arterial (V-A) ECMO admitted to Department of intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from June 2012 to May 2017 were enrolled. Ten-minute OCT was implemented by transcutaneous oximetry at 6 hours after ECMO initiation. The basic data of patients (gender, age, primary disease); the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, left ventricular ejection fraction (LVEF), mean arterial pressure (MAP) at the start of ECMO treatment; arterial blood gas analysis index, dose of vasoactive agents, transcutaneous oxygen pressure (PtO2), 10-minute OCT value (OCT10), oxygen challenge index (OCI) at 6 hours after ECMO initiation; and the ECMO support time, duration of mechanical ventilation and its parameters, and application of intra-aortic balloon pump (IABP) within 60 days were recorded. Patients were divided into the survival group and the death group according to their 60-day mortality status, and the differences between the two groups were compared. Receiver operating characteristic curve (ROC) analysis was used to analyze the prognostic value of OCT10 and OCI. According to the best boundary value of OCT10and OCI, Kaplan-Meier survival curve was drawn and the 60-day cumulative survival rate was compared. The risk factors affecting prognosis were analyzed by multivariate Logistic regression. Results Sixty-seven patients were finally enrolled in the study, with 31 in the survival group and 36 in the death group. Compared with the survival group, APACHE Ⅱ score, SOFA score, use of IABP in death group were higher, PtO2, OCT10and OCI were lower, and duration of ECMO and ventilation were longer, but there was no significant difference in gender, age, primary disease, LVEF, MAP, ventilator settings, dose of vasoactive agents, or results of arterial blood gas between the two groups. OCT10, OCI, APACHE Ⅱ score and SOFA score were predictive values for 60-day deaths, and the area under ROC curve (AUC) of OCT10was 0.866±0.042 [95% confidence interval (95%CI) = 0.760-0.937], the AUC of OCI was 0.829±0.051 (95%CI = 0.717-0.910), the AUC of APACHE Ⅱ score was 0.860±0.043 (95%CI = 0.754-0.933), and the AUC of SOFA score was 0.821±0.049 (95%CI = 0.708-0.904) (all P < 0.01). The cut-off point for OCT10was ≥70.0 mmHg (1 mmHg = 0.133 kPa) with the sensitivity of 91.67% and the specificity of 67.74%. The cut-off point for OCI was ≥0.68 with the sensitivity of 88.68% and the specificity of 71.58%. According to the cut-off point for OCT10or OCI, the 60-day cumulative survival rate of patients with high OCT10was significantly higher than that of low OCT10[58.06% (18/31) vs. 36.11% (13/36), χ2= 5.425, P = 0.020];the survival rate in high OCI group was significantly higher than that in low OCI group [55.17% (16/29) vs. 39.47% (15/38), χ2= 5.119, P = 0.024]. It was shown by multivariate Logistic regression that OCT10[odds ratio (OR) = 0.883, 95%CI = 0.791-0.965, P = 0.006] and OCI (OR = 0.011, 95%CI = 0.001-0.087, P = 0.005) were independent risk factors for 60-day mortality. Conclusion OCT could predict the prognosis of patients with cardiogenic shock receiving ECMO.
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Objective To explore the influence of transcutaneous oximetry on septic shock-associated acute kidney injury (AKI) in intensive care unit (ICU).Methods Forty-nine patients with septic shock admitted in the ICU of Wuxi People's Hospital Affiliated to Nanjing Medical University were enrolled from January 2013 to December 2015.The 10 min oxygen challenge test was conducted using transcutaneous oximetry just before (0 h) and 6 h after initiation of fluid resuscitation,and 10 min oxygen challenge test data (10 min OCT) at 0 h and 6 h were then calculated,respectively.The enrolled patients were divided into low 10 min OCT group (10 min OCT ＜ 66 mmHg,L group) or high 10 min OCT group (10 min OCT ≥66 mmHg,H group) according to the 10 min OCT value at 6 h.The hemodynamic variables [mean arterial pressure (MAP),central venous pressure (CVP)],oxygen metabolism indexes [central venous oxygen saturation (ScvO2),arterial lactate (Lac)],dose of vasoactive agents,10 min OCT at 0 h and 6 h were recorded.APACHE Ⅱ score,incidence and severity of septic shock-associated AKI,frequency of CRRT,ICU mortality and 28 d mortality were compared between groups using SPSS 22.0 software,risk factors associated with prognosis were analyzed using COX regression model.Results There were 27 cases in L group and 22 cases in H group.The MAP,CVP,ScvO2,lactate level and dose of vasoactive agents were comparable between groups at 0 h or 6 h (P ＞ 0.05),while 10 min OCT at 6 h was higher in H group than that inLgroup [(77.6±18.5) mmHgvs.(51.3 ±21.6) mmHg,P＜0.05].The incidence of septic shock-associated AKI (77.8％ vs.50.0％,P ＜ 0.05),proportion of phase 3 AKI (44.4％vs.22.7％,P ＜0.05) and frequency of CRRT (48.1％ vs.22.7％,P ＜0.05) was higher in L group than those in H group,and similarly were the ICU mortality (51.8％ vs.22.7％,P ＜0.05) and 28 d mortality (63.0％ vs.31.8％,P ＜ 0.05).Therefore,the 6 h 10 min OCT ≥66 mmHg was a protective factor to improve the ICU mortality (RR =0.01,95％ CI:0.001-0.39,P ＜ 0.05) and 28 d mortality (RR =0.01,95％CI:0.001-0.27,P＜0.05) in patients with septic shock-associated AKI.Conclusions 10 min OCT imposes substantial influence on the incidence,severity and prognosis of patients with septic shockassociated AKI,oxygen challenge test could improve the treatment of septic shock-associated AKI.
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Objective To explore the influence of transcutaneous oximetry on septic shock-associated acute kidney injury (AKI) in intensive care unit (ICU).Methods Forty-nine patients with septic shock admitted in the ICU of Wuxi People's Hospital Affiliated to Nanjing Medical University were enrolled from January 2013 to December 2015.The 10 min oxygen challenge test was conducted using transcutaneous oximetry just before (0 h) and 6 h after initiation of fluid resuscitation,and 10 min oxygen challenge test data (10 min OCT) at 0 h and 6 h were then calculated,respectively.The enrolled patients were divided into low 10 min OCT group (10 min OCT ＜ 66 mmHg,L group) or high 10 min OCT group (10 min OCT ≥66 mmHg,H group) according to the 10 min OCT value at 6 h.The hemodynamic variables [mean arterial pressure (MAP),central venous pressure (CVP)],oxygen metabolism indexes [central venous oxygen saturation (ScvO2),arterial lactate (Lac)],dose of vasoactive agents,10 min OCT at 0 h and 6 h were recorded.APACHE Ⅱ score,incidence and severity of septic shock-associated AKI,frequency of CRRT,ICU mortality and 28 d mortality were compared between groups using SPSS 22.0 software,risk factors associated with prognosis were analyzed using COX regression model.Results There were 27 cases in L group and 22 cases in H group.The MAP,CVP,ScvO2,lactate level and dose of vasoactive agents were comparable between groups at 0 h or 6 h (P ＞ 0.05),while 10 min OCT at 6 h was higher in H group than that inLgroup [(77.6±18.5) mmHgvs.(51.3 ±21.6) mmHg,P＜0.05].The incidence of septic shock-associated AKI (77.8％ vs.50.0％,P ＜ 0.05),proportion of phase 3 AKI (44.4％vs.22.7％,P ＜0.05) and frequency of CRRT (48.1％ vs.22.7％,P ＜0.05) was higher in L group than those in H group,and similarly were the ICU mortality (51.8％ vs.22.7％,P ＜0.05) and 28 d mortality (63.0％ vs.31.8％,P ＜ 0.05).Therefore,the 6 h 10 min OCT ≥66 mmHg was a protective factor to improve the ICU mortality (RR =0.01,95％ CI:0.001-0.39,P ＜ 0.05) and 28 d mortality (RR =0.01,95％CI:0.001-0.27,P＜0.05) in patients with septic shock-associated AKI.Conclusions 10 min OCT imposes substantial influence on the incidence,severity and prognosis of patients with septic shockassociated AKI,oxygen challenge test could improve the treatment of septic shock-associated AKI.