Non-invasive tools for guiding hemodynamic resuscitation in septic shock: the perfusion vs metabolic issue
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COMMENTARY
Non‑invasive tools for guiding hemodynamic resuscitation in septic shock: the perfusion vs metabolic issue Jaume Mesquida1 Received: 7 October 2020 / Accepted: 20 November 2020 © Springer Nature B.V. 2020
Abstract Transcutaneous oxygen pressure reflects the balance between cardiac output, arterial oxygenation, and the metabolic rate of the tissue. In septic shock, it allows a real time assessment of the adequacy of tissue perfusion, and therefore it has been proposed as a non-invasive tool to guide the hemodynamic resuscitation process. However, its value is limited in those situations where cardiac output has been optimized, but tissue dysoxia persists as results of an impairment in oxygen utilization. Keywords Transcutaneous oxygen pressure · Oxygen challenge test · Sepsis · Lactate clearance · Tissue oxygenation Intensive care medicine is constantly evolving towards less-invasive or even non-invasive strategies for managing critically ill patients. As referred to hemodynamic monitoring, in addition to less-invasive systems for estimating cardiac output, there is great interest in technologies capable of monitoring peripheral tissue wellness [1]. Over the last decades, several regional tissue oxygenation parameters obtained using non-invasive technologies, such as nearinfrared spectroscopy or transcutaneous oxygenation electrodes, have demonstrated their association with clinical outcomes in septic patients, independently of global circulatory parameters [2, 3]. In order to incorporate these non-invasive technologies into clinical practice, other than providing safe, reliable, sensitive and accurate data, we need to understand the physiological meaning of the information obtained. In the present issue of J Clin Monit Comput, Dr. Xu and coworkers have presented the results of their study entitled “Transcutaneous oxygen pressure-related variables as noninvasive indicators of low lactate clearance in sepsis patients after resuscitation” [4], exploring the relationship between lactate clearance and the evolution of transcutaneous oxygen pressure ( PtcO2) within the first 6 h of ICU admission of septic patients. The Authors observed significant correlations between lactate clearance and some PtcO2-related * Jaume Mesquida [email protected] 1
Critical Care Department, Parc Taulí Hospital Universitari. Institut D’Investigació I Innovació Parc Taulí I3PT, 1, 08208 Sabadell, Spain
tcO2 parameters, such as P tcO2 at 6 h, or the evolution of P and the response of PtcO2 to increasing the fraction of inspired oxygen (FiO2) within the 6-h resuscitation period. However, such correlations were rather limited, but that might not be surprising if we consider the physiological meaning of the parameters in the equation. Transcutaneous partial pressure of oxygen (PtcO2), as well as partial pressure of oxygen measured in other tissues, represents the balance between local oxygen delivery and consumption at a given time, and therefore depends on blood flow, arterial oxygenation, and the metabolic rate of
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