Myoglobin saturation as an intracellular indicator for transfusion need in oncology patients.

Objectives: This study aims to demonstrate the potential of myoglobin saturation as an indicator of oxygen delivery adequacy to help determine the need for red cell transfusion.

Background: Modern blood management approaches have been established to optimise use of red blood cells for transfusions in patients with anaemia. However, most approaches make recommendations to transfuse based on haemoglobin or haematocrit levels and do not directly address adequacy of oxygen delivery.

Noninvasive Cellular Oxygenation Measurement During Graded Hypoxia Using Visible-Near-Infrared Spectroscopy.

In critically ill patients, direct knowledge of intracellular pO would allow for identification of cellular hypoxia, which when prolonged leads to organ failure. We have developed a visible-near-infrared optical system that noninvasively measures myoglobin saturation, which is directly related to intracellular pO, from the surface of the skin. We used an animal model of graded hypoxia from low levels of inspired oxygen ( = 5) and verified that low intracellular pO is correlated with high steady-state serum lactate values.

Assessment of muscle oxygenation in children with congenital heart disease.

Background: Adaptive responses to congenital heart disease result in altered muscle perfusion and muscle metabolism. Such changes may be detectable using noninvasive spectroscopic monitors.

Aims: In this study we aimed to determine if resting muscle oxygen saturation (MOx) is lower in children with acyanotic or cyanotic congenital heart disease than in healthy children and to identify differences in muscle oxygen consumption in children with cyanotic and acyanotic congenital heart disease.

Muscle oxygenation as an indicator of shock severity in patients with suspected severe sepsis or septic shock.

Purpose: The aim of this pilot study was to evaluate the potential of a new noninvasive optical measurement of muscle oxygenation (MOx) to identify shock severity in patients with suspected sepsis.

Methods: We enrolled 51 adult patients in the emergency department (ED) who presented with possible sepsis using traditional Systematic Inflammatory Response Syndrome criteria or who triggered a "Code Sepsis." Noninvasive MOx measurements were made from the first dorsal interosseous muscles of the hand once potential sepsis/septic shock was identified, as soon as possible after admission to the ED.

Muscle Oxygenation as an Early Predictor of Shock Severity in Trauma Patients.

Introduction: We evaluated the potential utility of a new prototype noninvasive muscle oxygenation (MOx) measurement for the identification of shock severity in a population of patients admitted to the trauma resuscitation rooms of a Level I regional trauma center. The goal of this project was to correlate MOx with shock severity as defined by standard measures of shock: systolic blood pressure, heart rate, and lactate.

Methods: Optical spectra were collected from subjects by placement of a custom-designed optical probe over the first dorsal interosseous muscles on the back of the hand.

Muscle oxygenation measurement in humans by noninvasive optical spectroscopy and Locally Weighted Regression.

We have developed a method to make real-time, continuous, noninvasive measurements of muscle oxygenation (Mox) from the surface of the skin. A key development was measurement in both the visible and near infrared (NIR) regions. Measurement of both oxygenated and deoxygenated myoglobin and hemoglobin resulted in a more accurate measurement of Mox than could be achieved with measurement of only the deoxygenated components, as in traditional near-infrared spectroscopy (NIRS).

Direct optical measurement of intraoperative myocardial oxygenation during congenital heart surgery.

This study demonstrates use of novel technology to measure cellular oxygenation during corrective congenital heart surgery. Cellular oxygenation was measured using a custom-designed optical probe placed on the free wall of the right ventricle. Cellular oxygenation, determined from myoglobin saturation, was calculated using multiwavelength analysis.

Simultaneous optical spectroscopic measurement of hemoglobin and myoglobin saturations and cytochrome aa3 oxidation in vivo.

A method to simultaneously measure oxygenation in vascular, intracellular, and mitochondrial spaces from optical spectra acquired from muscle has been developed. In order to validate the method, optical spectra in the visible and near-infrared regions (600-850 nm) were acquired from solutions of myoglobin, hemoglobin, and cytochrome oxidase that included Intralipid as a light scatterer. Spectra were also acquired from the rabbit forelimb.

Mitochondrial function in vivo: spectroscopy provides window on cellular energetics.

Mitochondria integrate the key metabolic fluxes in the cell. This role places this organelle at the center of cellular energetics and, hence, mitochondrial dysfunction underlies a growing number of human disorders and age-related degenerative diseases. Here we present novel analytical and technical methods for evaluating mitochondrial metabolism and (dys)function in human muscle in vivo.

Accurate myoglobin oxygen saturation by optical spectroscopy measured in blood-perfused rat muscle.

Optical spectra were acquired from myoglobin and hemoglobin solutions and from the tibialis anterior muscle of Sprague-Dawley rats in the visible region (515 to 660 nm). Validation studies were performed on the in vitro spectra to demonstrate that partial least squares analysis of second-derivative spectra yields accurate measurements of myoglobin saturation in the presence of varying hemoglobin concentrations and saturations. When hemoglobin concentrations were varied between 0.

Optical spectroscopy demonstrates elevated intracellular oxygenation in an endotoxic model of sepsis in the perfused heart.

Recent clinical studies of patients with sepsis have shown that the delivery of adequate oxygen alone does not necessarily result in improved organ function or survival. This study was undertaken to determine if optical spectroscopy could detect higher intracellular oxygenations in isolated, perfused guinea pig hearts that have been treated with endotoxin (lipopolysaccharide [LPS]) than in controls. Four hours after intraperitoneal injection with LPS, adult guinea pigs were anesthetized, and hearts were excised and perfused in the Langendorff manner.

Myocardial oxygenation and adenosine release in isolated guinea pig hearts during changes in contractility.

Previous work from this laboratory using near-infrared optical spectroscopy of myoglobin has shown that approximately 20% of the myocardium is hypoxic in buffer-perfused hearts that are perfused with fully oxygenated buffer at 37 degrees C. The present study was undertaken to determine cardiac myoglobin saturation in buffer-perfused hearts when cardiac contractility was increased with epinephrine and decreased during cardiac arrest with KCl. Infusion of epinephrine to achieve a doubling of contractility, as measured by left ventricular maximum pressure change over time (dP/dt), resulted in a decrease in mean myoglobin saturation from 79% at baseline to 65% and a decrease in coronary venous oxygen tension from 155 mmHg at baseline to 85 mmHg.