Increased tissue water in patients with severe sepsis affects tissue oxygenation measured by near-infrared spectroscopy: a prospective, observational case-control study

Chin-Kuo Lin; Shaw-Woei Leu; Ying-Huang Tsai; Shao-Kui Zhou; Chieh-Mo Lin; Shu-Yi Huang; Che-Chia Chang; Meng-Chin Ho; Wei-Chun Lee; Min-Chi Chen; Ming-Szu Hung; Yu-Ching Lin; Jhe-Ruei Li; Bor-Shyh Lin

doi:10.21037/qims-22-127

Increased tissue water in patients with severe sepsis affects tissue oxygenation measured by near-infrared spectroscopy: a prospective, observational case-control study

Quant Imaging Med Surg. 2022 Oct;12(10):4953-4967. doi: 10.21037/qims-22-127.

Authors

Chin-Kuo Lin^{1

2}, Shaw-Woei Leu³, Ying-Huang Tsai^{4

5}, Shao-Kui Zhou⁶, Chieh-Mo Lin^{1

2

7}, Shu-Yi Huang^{1

7}, Che-Chia Chang¹, Meng-Chin Ho¹, Wei-Chun Lee¹, Min-Chi Chen^{8

9}, Ming-Szu Hung^{1

10

11

12}, Yu-Ching Lin^{1

11

12}, Jhe-Ruei Li⁶, Bor-Shyh Lin⁶

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi.
² Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan.
³ Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan.
⁴ Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou.
⁵ Department of Respiratory Care, College of Medicine, Chang Gung University, Taoyuan.
⁶ Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan.
⁷ Department of Nursing, Chang Gung University of Science and Technology, Chiayi.
⁸ Department of Public Health, Biostatistics Consulting Center, College of Medicine, Chang Gung University, Guishan, Taoyuan.
⁹ Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi.
¹⁰ Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi.
¹¹ Department of Medicine, College of Medicine, Chang Gung University, Taoyuan.
¹² Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi.

Abstract

Background: Tissue oedema affects tissue perfusion and interferes with the monitoring of tissue oxygenation in patients with severe sepsis. However, the underlying mechanisms remain unclear. We used a wireless near-infrared spectroscopy (NIRS) device that transmits tri-wavelength light to quantify tissue haemoglobin (Hb) and water (H₂O) content. We estimated tissue H₂O in severe sepsis patients and healthy controls, compared their difference, and investigated the correlation of tissue H₂O with systemic haemodynamics and its impact on tissue oxygenation.

Methods: Seventy-seven adult patients with new-onset severe sepsis admitted to the intensive care unit within 72 h and 30 healthy volunteers (controls) were enrolled. The NIRS device was placed on the participant's leg to estimate the relative tissue concentrations of oxy-Hb ([HbO₂]), deoxy-Hb ([HbR]), total Hb ([HbT]), and H₂O ([H₂O]) at rest for three consecutive days. Two-sample t-test or Mann-Whitney U test, chi-square test, and generalised estimating equations (GEEs) were used for comparisons.

Results: In severe sepsis patients, the [H₂O] in the anterior tibia was higher [mean (standard deviation, 95% confidence interval), 10.57 (3.37, 9.81-11.34) vs. 7.40 (1.89, 6.70-8.11)] and the [HbO₂], [HbT], and tissue Hb oxygen saturation (StO₂) were lower [0.20 (0.01, 0.20-0.20) vs. 0.22 (0.01, 0.22-0.23), 0.42 (0.02, 0.42-0.43) vs. 0.44 (0.02, 0.44-0.45), and 47.25% (1.97%, 46.80-47.70%) vs. 49.88% (1.26%, 49.41-50.35%), respectively] than in healthy controls in first-day measurements. GEE analysis revealed significant differences in [H₂O], [HbO₂], [HbT], and StO₂ between groups over three consecutive days (all P≤0.001). In addition, [HbO₂] and StO₂ levels gradually decreased over time in the patient group. A negative correlation was observed between [H₂O] and [HbO₂] and StO₂, which became more obvious over time (day 1: r=-0.51 and r=-0.42, respectively; both P<0.01; day 3: r=-0.67 and r=-0.63, respectively, both P<0.01). Systolic arterial pressure was positively related to [H₂O] (r=0.51, P<0.05, on day 1) but was not associated with tissue oxygenation parameters.

Conclusions: NIRS can be used to quantify tissue H₂O. Severe sepsis patients have increased tissue H₂O, which responds to changes in arterial blood pressure and affects tissue oxygenation.

Keywords: Sepsis; microcirculation; near-infrared spectroscopy (NIRS); tissue oedema; tissue oxygenation.