Tissue Oxygenation Monitoring as a Guide for Trauma Resuscitation

Abstract

Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome during trauma resuscitation. Detecting subtle changes in perfusion is crucial to ensure adequate tissue oxygenation and perfusion. Traditional methods of detecting physiological changes include measurements of blood pressure, heart rate, urine output, serum levels of lactate, mixed venous oxygen saturation, and central venous oxygen saturation. Continuous noninvasive monitoring of tissue oxygen saturation in muscle has the potential to indicate severity of shock, detect occult hypoperfusion, guide resuscitation, and be predictive of the need for interventions to prevent multiple organ dysfunction syndrome. Tissue oxygen saturation is being used in emergency departments, trauma rooms, operating rooms, and emergency medical services. Tissue oxygen saturation technology is just as effective as mixed venous oxygen saturation, central venous oxygen saturation, serum lactate, and Stewart approach with strong ion gap, yet tissue oxygen saturation assessment is also a direct, noninvasive microcirculatory measurement of oxygen saturation. (Critical Care Nurse. 2016;36[3]:12-19,70) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1 Insufficient oxygen to meet cellular demands leads to cellular ischemia, bacterial translocation, sepsis, worsening of shock, organ dysfunction, multiple system organ failure, and death.2 A balance must be maintained between oxygen delivery (DO 2 ) and oxygen consumption (VO 2 ) to minimize anaerobic metabolism, maintain normal metabolic processes, and meet the cellular requirements for the body.2 High baseline oxygen-extraction organs, such as the heart, are at high risk for ischemia if the VO 2 just meets the oxygen demand. Adequate physiological oxygen reserves need to be available in order to cope with increases in oxygen demand.

Metabolic response to maxillofacial trauma revisited: A retrospective study

“…Tissue hypoperfusion occurring in shock results in failure to meet the metabolic demands of various systems and development of multiorgan dysfunction syndrome. The findings are similar to the study conducted by Mitchell C[17] which emphasized that the continuous noninvasive monitoring of tissue oxygen saturation has the potential to indicate severity of shock, detect occult hypoperfusion, and also act as guide for trauma resuscitation.…”