Fluid Responsiveness After CArdiac Surgery (FRACAS): A Prospective Observational Study Using Peripheral Near-Infrared Spectroscopy.

OBJECTIVES To describe tissue oxygen saturation (StO2) in response to a vascular occlusion test using thenar eminence and forearm near-infrared spectroscopy (NIRS) and the association with volume responsiveness after cardiac surgery. DESIGN Single-center, prospective, observational cohort study. SETTING Cardiothoracic intensive care unit. PARTICIPANTS Seventy-six post-cardiac surgical adults. INTERVENTIONS Immediately before and 10 minutes after a 250-to-500 mL fluid bolus, StO2 was measured in response to a vascular occlusion test to calculate tissue deoxygenation (Rdes) and reoxygenation (Rres) rates. Concurrently, systemic hemodynamic, metabolic, and blood gas variables were collected. MEASUREMENTS AND MAIN RESULTS A total of 203 boluses were captured using thenar NIRS and 141 boluses using forearm NIRS. Approximately 25% of boluses increased cardiac output by ≥15% (volume responders). Thenar and forearm Rdes decreased in responders, but increased (thenar) or remained unchanged (forearm) in nonresponders. A logistic regression model of the association among StO2, Rdes and Rres, and volume responsiveness was significant for thenar measurements (p = 0.001) with an area under the receiver operating characteristic of 0.69 (95% confidence interval: 0.62-0.75). It also was significant (p = 0.02) for forearm measurements, with an area under the receiver operating characteristic of 0.71 (0.62-0.79). Rdes was an independent variable in both instances (odds ratio 0.31 [0.14-0.69], thenar; odds ratio 0.60 [0.45-0.80], forearm). Thenar and forearm NIRS variables were correlated poorly with cardiac output, stroke volume, systemic oxygen delivery and consumption index, mixed venous, and central venous oxygen saturation (Spearman׳s coefficients, r = 0.17-0.46, p < 0.002). CONCLUSION In post-cardiac surgical patients, thenar and forearm NIRS variables were associated with volume responsiveness although not achieving precision necessary for clinical management.

[1]  E. Butler,et al.  Peripheral Near-Infrared Spectroscopy: Methodologic Aspects and a Systematic Review in Post-Cardiac Surgical Patients. , 2017, Journal of cardiothoracic and vascular anesthesia.

[2]  Can Ince,et al.  Hemodynamic coherence and the rationale for monitoring the microcirculation , 2015, Critical Care.

[3]  J. Murkin,et al.  Microvascular reactivity and clinical outcomes in cardiac surgery , 2015, Critical Care.

[4]  M. Leaning,et al.  Applying mean systemic filling pressure to assess the response to fluid boluses in cardiac post-surgical patients , 2015, Intensive Care Medicine.

[5]  J. Morel,et al.  Tissue near infra red spectroscopy change is not correlated with patients' outcome in elective cardiac surgery , 2014, Acta anaesthesiologica Scandinavica.

[6]  J. Hanouz,et al.  Dynamic evaluation of near-infrared peripheral oximetry in healthy volunteers: a comparison between INVOS and EQUANOX. , 2013, Journal of critical care.

[7]  J. Mesquida,et al.  Skeletal Muscle Oxygen Saturation (StO2) Measured by Near-Infrared Spectroscopy in the Critically Ill Patients , 2013, BioMed research international.

[8]  M. Jozwiak,et al.  Lactate and Venoarterial Carbon Dioxide Difference/Arterial-Venous Oxygen Difference Ratio, but Not Central Venous Oxygen Saturation, Predict Increase in Oxygen Consumption in Fluid Responders* , 2013, Critical care medicine.

[9]  J. Hanouz,et al.  Cerebral and somatic near-infrared spectroscopy measurements during fluid challenge in cardiac surgery patients: a descriptive pilot study. , 2013, Journal of cardiothoracic and vascular anesthesia.

[10]  Xavier Monnet,et al.  Assessment of volume responsiveness during mechanical ventilation: recent advances , 2013, Critical Care.

[11]  M. Pinsky,et al.  Thenar oxygen saturation during weaning from mechanical ventilation: an observational study , 2013, European Respiratory Journal.

[12]  I. Vasileiadis,et al.  Microcirculation and Macrocirculation in Cardiac Surgical Patients , 2012, Critical care research and practice.

[13]  Rinaldo Bellomo,et al.  Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care , 2012, Annals of Intensive Care.

[14]  M. I. Monge García,et al.  Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver , 2012, Annals of Intensive Care.

[15]  M. Pinsky,et al.  Prognostic implications of tissue oxygen saturation in human septic shock , 2012, Intensive Care Medicine.

[16]  Benoit Vallet,et al.  Use of near-infrared spectroscopy during a vascular occlusion test to assess the microcirculatory response during fluid challenge , 2011, Critical care.

[17]  Taka-aki Nakada,et al.  Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality* , 2011, Critical care medicine.

[18]  M. Wolf,et al.  500 ml of blood loss does not decrease non-invasive tissue oxygen saturation (StO2) as measured by near infrared spectroscopy - A hypothesis generating pilot study in healthy adult women , 2010, Journal of trauma management & outcomes.

[19]  R. Cavallazzi,et al.  Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature* , 2009, Critical care medicine.

[20]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2008, Journal of clinical epidemiology.

[21]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2007, Preventive medicine.

[22]  A. Groeneveld,et al.  Correlates of thenar near-infrared spectroscopy-derived tissue O2 saturation after cardiac surgery. , 2007, Interactive cardiovascular and thoracic surgery.

[23]  Dean E. Myers,et al.  DYNAMIC NEAR-INFRARED SPECTROSCOPY MEASUREMENTS IN PATIENTS WITH SEVERE SEPSIS , 2007, Shock.

[24]  Gordon R Bernard,et al.  Comparison of two fluid-management strategies in acute lung injury. , 2006, The New England journal of medicine.

[25]  H. Kehlet,et al.  Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. , 2006, Journal of the American College of Surgeons.

[26]  C. Schulman,et al.  Can near-infrared spectroscopy identify the severity of shock in trauma patients? , 2005, The Journal of trauma.

[27]  J. Vincent.  DO2/VO2 relationships , 2005 .

[28]  J. Teboul,et al.  Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. , 2002, Chest.