Can Near-Infrared Spectroscopy Identify the Severity of Shock in Trauma Patients?

Crookes, Bruce; Cohn, Stephen M.; Bloch, Scott A.; Amortegui, Jose D.; Manning, Ronald J.; Li, Pam; Proctor, Matthew S.; Hallal, Ali; Blackbourne, Lorne H.; Benjamin, Robert; Soffer, Dror; Habib, Fahim; Schulman, Carl I.; Duncan, Robert C.; Proctor, Kenneth G.

doi:10.1097/01.ta.0000158269.68409.1c

Cited by 186 publications

(165 citation statements)

References 21 publications

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“…Preliminary reports regarding regional CO 2 measurement in sensible microvascular beds, as manifestation of hypoperfusion, are promising [71][72][73]. Measurement of oxygen tension or saturation in certain tissues has permitted the identification of occult hypoperfusion in animal studies and in some limited clinical experiences published [71,[74][75][76][77][78]. Unfortunately, these methods have not been fully evaluated, and none of them has reached widespread use.…”

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confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…A prospective non-randomized observational human study of volunteers and patients admitted to a level 1 trauma centre established a normal range for thenar eminence StO 2 and showed it could be used to identify the patients in severe shock. However, this study did not attempt to examine the effect of resuscitation on StO 2 [82]. A prospective, blinded cohort study of patients admitted to a level 1 trauma centre has demonstrated that initial StO 2 values correlated with shock index and was predictive of the development of subsequent multi-organ dysfunction syndrome [83].…”

Section: Point Of Care Testing and Monitoring In Trauma Resuscitationmentioning

confidence: 99%

Resuscitation and coagulation in the severely injured trauma patient

Midwinter

Woolley

2011

Phil. Trans. R. Soc. B

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Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

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“…The NIRS devices are usually portable, permitting bedside monitoring. There have been recently exploratory studies using NIRS for shock monitor [4,[9][10][11][12][13][14][15]. Some of them were carried out on animal models [12,13] or healthy human subjects [14].…”

Section: Introductionmentioning

confidence: 99%

“…Some of them were carried out on animal models [12,13] or healthy human subjects [14]. A few were performed in patients either invasively with optical sensors inserted into subcutaneous and intramuscular sites [4,15] or noninvasively with optical probes placed on the peripheral muscles [9][10][11]. However, shock usually results in a poor peripheral blood circulation [5], leading to an insensitive measurement.…”

Section: Introductionmentioning

confidence: 99%

“…PO 2 has been used for monitoring shock in an uncontrolled study with a small number of patients [4]. ScvO 2 [8] and SaO 2 are accepted to be accurate and objective for shock monitoring [9], and ScvO 2 is commonly regarded as a gold standard [8]. However, the invasive and intermittent procedures to obtain these acceptable indicators (i.e., PO 2 , ScvO 2 , SaO 2 ) limit the use for continuous shock monitoring.…”

Section: Introductionmentioning

confidence: 99%

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Bedside monitoring of patients with shock using a portable spatially-resolved near-infrared spectroscopy

Duan

et al. 2015

Biomed. Opt. Express

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Clinical monitoring of shock mainly depends on blood-oxygenindices obtained from invasive blood sample tests. The central internal jugular central vein oxygenation level (ScvO 2 ) has been considered as a gold standard indicator for shock prediction. We developed a noninvasive spatially-resolved near-infrared spectroscopy (SR-NIRS) to measure tissue blood oxygen saturation (StO 2 ) surrounding the region of taking blood sample for the ScvO 2 test in 25 patients with shock. StO 2 values were found to be highly correlated (r = 0.84, p < 0.001) with ScvO 2 levels and the concordance coefficient of 0.80 is high. The results suggest the potential of noninvasive SR-NIRS for bedside shock monitoring.

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Can Near-Infrared Spectroscopy Identify the Severity of Shock in Trauma Patients?

Abstract: Decreased thenar muscle tissue oxygen saturation reflects the presence of severe hypoperfusion and near-infrared spectroscopy may be a novel method for rapidly and noninvasively assessing changes in tissue dysoxia.

Cited by 186 publications

References 21 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Resuscitation and coagulation in the severely injured trauma patient

Bedside monitoring of patients with shock using a portable spatially-resolved near-infrared spectroscopy

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