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Tissue Oximetry and Clinical Outcomes

Bickler, Philip MD, PhD; Feiner, John MD; Rollins, Mark MD, PhD; Meng, Lingzhong MD

doi: 10.1213/ANE.0000000000001348
Technology, Computing, and Simulation: Narrative Review Article

A number of different technologies have been developed to measure tissue oxygenation, with the goal of identifying tissue hypoxia and guiding therapy to prevent patient harm. In specific cases, tissue oximetry may provide clear indications of decreases in tissue oxygenation such as that occurring during acute brain ischemia. However, the causation between tissue hemoglobin-oxygen desaturation in one organ (eg, brain or muscle) and global outcomes such as mortality, intensive care unit length of stay, and remote organ dysfunction remains more speculative. In this review, we describe the current state of evidence for predicting clinical outcomes from tissue oximetry and identify several issues that need to be addressed to clarify the link between tissue oxygenation and outcomes. We focus primarily on the expanding use of near-infrared spectroscopy to assess a venous-weighted mixture of venous and arterial hemoglobin-oxygen saturation deep in tissues such as brain and muscle. Our analysis finds that more work is needed in several areas: establishing threshold prediction values for tissue desaturation–related injury in specific organs, defining the types of interventions required to correct changes in tissue oxygenation, and defining the effect of interventions on outcomes. Furthermore, well-designed prospective studies that test the hypothesis that monitoring oxygenation status in one organ predicts outcomes related to other organs need to be done. Finally, we call for more work that defines regional variations in tissue oxygenation and improves technology for measuring and even imaging oxygenation status in critical organs. Such studies will contribute to establishing that monitoring and imaging of tissue oxygenation will become routine in the care of high-risk patients because the monitors will provide outputs that direct therapy to improve clinical outcomes.

Published ahead of print June 15, 2016.

From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.

Published ahead of print June 15, 2016.

Accepted for publication March 1, 2016.

Funding: Funded by the University of California San Francisco (UCSF) Hypoxia Research Laboratory from funds derived from the validation and testing of pulse oximeters. No sponsor directly funded the study or participated in study design. None of the authors have financial interests in clinical monitoring companies. Casmed Inc has provided patient sensors for a tissue oximetry study at UCSF.

Conflict of Interest: See Disclosures at the end of the article.

This article was presented as part of the international symposium “Innovations and Advances in Monitoring Perfusion, Oxygenation and Ventilation” (IAMPOV) held at St. Luke’s International University, Tokyo, Japan, October 3, 2015.

Reprints will not be available from the authors.

Address correspondence to Philip Bickler, MD, PhD, Department of Anesthesia and Perioperative Care, University of California San Francisco, 513 Parnassus Ave, Box 0542, San Francisco, CA 94143. Address e-mail to philip.bickler@ucsf.edu.

© 2017 International Anesthesia Research Society
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