Massive Transfusion in Trauma Patients: Tissue Hemoglobin Oxygen Saturation Predicts Poor Outcome

Moore, Frederick A.; Nelson, Teresa; McKinley, Bruce A.; Moore, Ernest E.; Nathens, Avery B.; Rhee, Peter; Puyana, Juan Carlos; Beilman, Greg J.; Cohn, Stephen M.; McCarthy, Janet; Jonas, Rachelle B.; Johnston, Joseph A.; Lopez, Peter P.; Nathen, Avery B.; Nuxoll, Dian; Tang, Hailong; Sangthong, Burapat; Constantinou, Constantinos; Polanco, Patricio M.; Peitzman, Andrew B.; Huls, Stephanie; Johnson, Jeffrey L.; Cothren, Catherine C.; Thorson, Melissa; Beal, Alan; Ronald, G. Pearl; Gentilello, Larry M.; Meyer, Anthony A.; Anderson, Leann; Gallea, Barbara L.; Rupp, Diane; Saar, Becky; McGraw, Michelle; Díaz, Victoria; Carlson, Kristi; Wheatley, Greg

doi:10.1097/ta.0b013e31816a2417

Cited by 96 publications

(101 citation statements)

References 30 publications

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“…Furthermore, mean stO 2 less than 75% during surgery was associated with prolonged duration of mechanical ventilation. This association between lower stO 2 and poor outcome is consistent with the results of other studies in other groups of patients 13,15,16,18,25 and could be explained by peripheral hypoperfusion as a surrogate first measure of regional hypoperfusion, 18 caused by the shunting of blood from the peripheral regions of the body to the internal organs during circulatory compromise. 7 Thus, our results provide further evidence that in patients undergoing cardiac surgery, reduced thenar eminence stO 2 (at least in early anesthesia and on return to the ICU) may be associated with greater postoperative morbidity, as defined by POMs, on postoperative days 3 and 15.…”

Section: Discussionsupporting

confidence: 81%

“…13,15,16 similarly, measurement of thenar stO 2 has been validated as a noninvasive measure of the adequacy of peripheral perfusion during cardiac surgery. 17 However, although reduced stO 2 indicates poorer outcome in other shock states, 18 the relationship between stO 2 and outcome remains largely unexplored in patients who have cardiac surgery. The purpose of our study was to characterize the pattern of change in stO 2 in cardiac surgery patients and to explore its association with postoperative outcome.…”

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confidence: 99%

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Tissue Oxygen Saturation and Outcome after Cardiac Surgery

Sanders¹,

Toor²,

Yurik³

et al. 2011

American Journal of Critical Care

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Tissue Oxygen Saturation and Outcome after Cardiac Surgery

Sanders¹,

Toor²,

Yurik³

et al. 2011

American Journal of Critical Care

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“…Currently NIRS is used mainly to evaluate cerebral tissue oxygen saturation (rSO 2 ) in real-time during cardiovascular procedures, during hemorrhagic shock or in patients with subarachnoid hemorrhage [3][4][5][6][7][8][9]. Besides, NIRS has also become a prospective tool in terms of patient progress and outcome, development of organ dysfunction and resuscitation [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of near-infrared spectroscopy under apnea-dependent hypoxia in humans

Eichhorn

Erdfelder

Kessler

et al. 2015

J Clin Monit Comput

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In this study we investigated the responsiveness of near-infrared spectroscopy (NIRS) recordings measuring regional cerebral tissue oxygenation (rSO2) during hypoxia in apneic divers. The goal was to mimic dynamic hypoxia as present during cardiopulmonary resuscitation, laryngospasm, airway obstruction, or the "cannot ventilate cannot intubate" situation. Ten experienced apneic divers performed maximal breath hold maneuvers under dry conditions. SpO2 was measured by Masimo™ pulse oximetry on the forefinger of the left hand. NIRS was measured by NONIN Medical's EQUANOX™ on the forehead or above the musculus quadriceps femoris. Following apnea median cerebral rSO2 and SpO2 values decreased significantly from 71 to 54 and from 100 to 65%, respectively. As soon as cerebral rSO2 and SpO2 values decreased monotonically the correlation between normalized cerebral rSO2 and SpO2 values was highly significant (Pearson correlation coefficient = 0.893). Prior to correlation analyses, the values were normalized by dividing them by the individual means of stable pre-apneic measurements. Cerebral rSO2 measured re-saturation after termination of apnea significantly earlier (10 s, SD = 3.6 s) compared to SpO2 monitoring (21 s, SD = 4.4 s) [t(9) = 7.703, p < 0.001, r(2) = 0.868]. Our data demonstrate that NIRS monitoring reliably measures dynamic changes in cerebral tissue oxygen saturation, and identifies successful re-saturation faster than SpO2. Measuring cerebral rSO2 may prove beneficial in case of respiratory emergencies and during pulseless situations where SpO2 monitoring is impossible.

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“…In a randomized study, transfusion with red blood cells at a lower threshold was associated with decreased survival among trauma patients when compared to a more conservative threshold [17]. Furthermore, massive transfusion (C10 units in 24 h) in the setting of trauma was independently associated with poor survival [18]. In the setting of ACS and PCI, blood transfusion has been associated with an increase in mortality [19][20][21].…”

Section: Association Of Transfusion and Poor Outcomesmentioning

confidence: 96%

Transfusion associated microchimerism: a heretofore little recognized complication following transfusion

Kunadian

Zorkun

Gibson

et al. 2008

J Thromb Thrombolysis

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Potent antiplatelet and antithrombotic agents have significantly reduced mortality in the setting of acute coronary syndromes and percutaneous coronary intervention. However these agents are associated with increased bleeding which is in turn associated with adverse clinical outcomes. In many centers, transfusion is often used to correct for blood loss. Blood transfusion in the setting of acute coronary syndrome has been associated with adverse clinical outcomes including increased mortality. Transfusion associated microchimerism (TA-MC) is a newly recognized complication of blood transfusion. There is engraftment of the donor's hematopoietic stem cells in patients who then develop microchimerism. This article discusses the association of bleeding/blood transfusion with adverse outcomes and the potential role of TA-MC in clinical outcomes.

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Massive Transfusion in Trauma Patients: Tissue Hemoglobin Oxygen Saturation Predicts Poor Outcome

Cited by 96 publications

References 30 publications

Tissue Oxygen Saturation and Outcome after Cardiac Surgery

Tissue Oxygen Saturation and Outcome after Cardiac Surgery

Evaluation of near-infrared spectroscopy under apnea-dependent hypoxia in humans

Transfusion associated microchimerism: a heretofore little recognized complication following transfusion

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