NIRS assessmentThe InSpectra StO2 Tissue Oxygenation Monitor (model 650; Hutchinson Technology, Hutchinson, MN, USA) with probes spaced at 15 mm was utilized to obtain StO2 measurements. The measurements were taken at the thenar eminence during the resuscitation phase. Following a minimum initial five-minute stabilization selleck Vandetanib period, we assessed the initial StO2 measurement and then performed a VOT procedure using an automated tourniquet (Delfi Tourniquet System; Delfi Medical Innovations, Inc, Vancouver, BC, Canada), which was insufflated to 50 mmHg over the patient’s SBP for a period of three minutes. After three minutes, the cuff was quickly removed.

The subsequent StO2 tracing was analyzed offline to record the following NIRS-derived metrics (see Figure Figure1)1) (1) StO2 initial, the baseline StO2 recorded after a five-minute stabilization period; (2) StO2 occlusion, the steady-state rate of occlusion (StO2%/second), represented by the descending slope during the ischemic period; and (3) StO2 recovery, the steady-state recovery slope during the reoxygenation phase after the tourniquet was released. The StO2 measurements were imported into a Microsoft Excel software file (Microsoft Corporation, Redmond, WA, USA), and the slopes were derived by (1) drawing a best-fit line for the steady-state slope for the respective metric and (2) calculating the slope.OutcomesWe examined the association of StO2 parameters in relation to three patient-oriented outcomes: (1) presence of shock, as defined above, assessed at the time of enrollment; (2) in-hospital mortality, defined as vital signs status at hospital discharge; and (3) organ dysfunction at 24 hours assessed on the basis of the SOFA scores calculated at the time of enrollment and 24 hours later [6].

Consistent with prior publications, we defined Dacomitinib organ dysfunction as a SOFA score �� 2, which was our primary outcome of interest. The use of a threshold SOFA score �� 2 for an ill patient has previously been established [8-10]. All patients in the control group with missing SOFA scores at 24 hours (discharge was the primary reason for missing data) were assumed to have a SOFA score < 2. For patients enrolled with a history of chronic renal insufficiency or end-stage renal disease, the renal SOFA score was not included in the total SOFA score.Data analysisDescriptive statistics (means, standard deviations, medians or proportions with percentiles) were reported for demographics, clinical characteristics, vital signs and laboratory values stratified by the three cohorts.