Association between static and dynamic thenar near-infrared spectroscopy and mortality in patients with sepsis: A systematic review and meta-analysis

BACKGROUND: Oxygen delivery and consumption disturbances are frequently seen with critically illness, potentially leading to pathologic changes in tissue oxygenation (StO₂). Near-infrared spectroscopy (NIRS) is a potentially useful method to monitor StO₂, but the role of NIRS in prognostication of septic patients is uncertain. The aim of this study was to systematically review the literature and evaluate static and dynamic NIRS in patients with sepsis. METHODS: This is a systematic review and meta-analysis of publications between 1966 and 2013. The MEDLINE and EMBASE databases were searched for studies on StO₂ in patients with severe sepsis or septic shock. Meta-analysis was limited to studies about static and dynamic variables derived from NIRS in patients with sepsis. The association between StO ₂, reperfusion slope (Rres), occlusion slope, and maximum StO ₂ minus basal StO₂ (δStO₂) and prognosis in septic patients was evaluated. RESULTS: The search identified 20 articles (962 participants; 717 with severe sepsis or septic shock, and 245 healthy controls). Compared with healthy controls, septic patients had lower levels of StO₂ (78.27% [4.91%] vs. 82.02% [3.57%], p = 0.012), Rres (2.75% [0.63%] vs. 5.19% [2.86%] per second, p = 0.003), and δStO₂ (7.86% [0.11%] vs. 12.53% [2.65%], p = 0.011). Survivors from sepsis presents higher levels of StO₂ (81.68% [4.68%] vs. 74.54% [5.31%], p = 0.02) and Rres (3.37% [0.44%] vs. 2.16% [0.51%] per second, p = 0.016). CONCLUSION: Septic patients have lower levels of StO₂, Rres and δStO ₂, and survivors from sepsis present higher levels of StO₂ and Rres compared with nonsurvivors.