Near-infrared spectroscopy for evaluation of global and skeletal muscle tissue oxygenation

Abstract

Non-invasive clinical examination has well-recognized limitations in detecting compensated and uncompensated low flow states and their severity. This paper describes the principles of near-infrared absorption spectroscopy (NIRS) and the basis for its proposed use in heart failure/cardiogenic and septic shock to assess global and regional tissue oxygenation. The vascular occlusion test is explained. Limitations of NIRS, current controversies, and what is necessary in the future to make this technology a part of the initial and ongoing assessment of a patient are also discussed. The ultimate goal of such techniques is to prevent miss-assessment and inadequate resuscitation of patients, two major factors in the development of multisystem organ failure and death.

Keywords: Heart failure; Near-infrared spectroscopy; Shock; Skeletal muscle.

Figures

Figure 1

Vascular occlusion test: An original thenar tissue oxygen saturation (StO2) recording after arterial upper arm cuffing, and cuffing release (upper arm ischemia reperfusion test). During the upper arm ischemia reperfusion test, several StO2 parameters can be studied: average StO2 before arterial cuffing/occlusion; StO2 downslope during cuffing-the deoxygenation rate (∆down StO2)/s); StO2 upslope (∆up StO2)/s); hyperemia (overshoot of StO2 above baseline).