Thinking Out-of-the-Box: A Non-Standard Application of Standard Pulse-Oximetry and Standard Near-Infrared Spectroscopy in a COVID-19 Patient
Open Access
- 9 October 2020
- journal article
- research article
- Published by SAGE Publications in Journal of Intensive Care Medicine
- Vol. 36 (3), 376-380
- https://doi.org/10.1177/0885066620965167
Abstract
Purpose of this report is to describe the feasibility of lingual pulse oximetry and lingual near-infrared spectroscopy (NIRS) in a COVID-19 patient to assess lingual tissue viability after several days of mechanical ventilation in the prone position. In a COVID-19 ICU-patient, the tongue became grotesquely swollen, hardened and protruding from the oral cavity after 20 h of mechanical ventilation uninterrupted in the prone position. To assess the doubtful viability of the tongue, pulse-oximetric hemoglobin O2-saturation (SpO2; Nellcor, OxiMax MAX-NI, Covidien, MA, USA) and NIRS-based, regional tissue O2-saturation measurements (rSO2; SenSmart, Nonin, MN, USA) were performed at the tongue. At the tongue, regular pulse-oximetric waveforms with a pulse-oximetric hemoglobin O2-saturation (SpO2) of 88% were recorded, i.e. only slightly lower than the SpO2 reading at the extremities at that time (90%). Lingual NIRS-based rSO2 measurements yielded stable tissue rSO2-values of 76-78%, i.e. values expected also in other adequately perfused and oxygenated (muscle-) tissues. Despite the alarming, clinical finding of a grotesquely swollen, rubber-hard tongue and clinical concerns on the adequacy of the tongue perfusion and oxygenation, our measurements of both arterial pulsatility (SpO2) and NIRS-based tissue oxygenation (rSO2) suggested adequate perfusion and oxygenation of the tongue, rendering non-vitality of the tongue, e.g. by lingual venous thrombosis, unlikely. To our knowledge, this is the first clinical report of lingual rSO2 measurement.Keywords
This publication has 30 references indexed in Scilit:
- Tongue swelling and necrosis after brain tumor surgeryAsian Journal of Neurosurgery, 2012
- Monitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applicationsJournal of Clinical Monitoring and Computing, 2012
- From system to organ to cell: oxygenation and perfusion measurement in anesthesia and critical careJournal of Clinical Monitoring and Computing, 2012
- Two Observations Raising Questions about Risk Factors of Cutaneous Necrosis Induced by Terlipressin (Glypressin®)Dermatology, 2009
- Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: Incidence and risk factors*Critical Care Medicine, 2003
- Massive lingual swelling following palatoplastyAnaesthesia, 1995
- Apparent massive tongue swelling A complication of orotracheal intubation on the Intensive Care UnitAnaesthesia, 1994
- Influence of Sensor Site Location on Pulse Oximetry Kinetics in ChildrenAnesthesia & Analgesia, 1993
- Tongue oximetry in children with extensive thermal injury: comparison with peripheral oximetryCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1992
- Glossal Pulse OximetryAnesthesia & Analgesia, 1989