Continuous Muscle Tissue Oxygenation in Critically Injured Patients: A Prospective Observational Study

Ikossi, Danagra G.; Knudson, M. Margaret; Morabito, Diane; Cohen, Mitchell J.; Wan, Jennifer; Khaw, Linda; Stewart, Campbell J; Hemphill, Claude; Manley, Geoff

doi:10.1097/01.ta.0000239500.71419.58

Cited by 95 publications

(60 citation statements)

References 36 publications

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“…Because of better survival in patients with lactate[5 mmol/L, the authors even suggested a protective effect following brain injury. We did not observe such an effect, which may be either be due to more severe head injuries in our patients or as a result of occult hypoperfusion, a known risk factor for subsequent infectious complications [21,22].…”

Section: Discussionmentioning

confidence: 60%

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Dübendorfer

Billeter

Seifert

et al. 2012

Eur J Trauma Emerg Surg

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Objective Arterial lactate, base excess (BE), lactate clearance, and Sequential Organ Failure Assessment (SOFA) score have been shown to correlate with outcome in severely injured patients. The goal of the present study was to separately assess their predictive value in patients suffering from traumatic brain injury (TBI) as opposed to patients suffering from injuries not related to the brain. Materials and methods A total of 724 adult trauma patients with an Injury Severity Score (ISS) C 16 were grouped into patients without TBI (non-TBI), patients with isolated TBI (isolated TBI), and patients with a combination of TBI and non-TBI injuries (combined injuries). The predictive value of the above parameters was then analyzed using both uni-and multivariate analyses. Results The mean age of the patients was 39 years (77 % males), with a mean ISS of 32 (range 16-75). Mortality ranged from 14 % (non-TBI) to 24 % (combined injuries). Admission and serial lactate/BE values were higher in nonsurvivors of all groups (all p \ 0.01), but not in patients with isolated TBI. Admission SOFA scores were highest in nonsurvivors of all groups (p = 0.023); subsequently septic patients also showed elevated SOFA scores (p \ 0.01), except those with isolated TBI. In this group, SOFA score was the only parameter which showed significant differences between survivors and non-survivors. Receiver operating characteristic (ROC) analysis revealed lactate to be the best overall predictor for increased mortality and further septic complications, irrespective of the leading injury. Conclusion Lactate showed the best performance in predicting sepsis or death in all trauma patients except those with isolated TBI, and the differences were greatest in patients with substantial bleeding. Following isolated TBI, SOFA score was the only parameter which could differentiate survivors from non-survivors on admission, although the SOFA score, too, was not an independent predictor of death following multivariate analysis.

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Section: Discussionmentioning

confidence: 60%

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Dübendorfer

Billeter

Seifert

et al. 2012

Eur J Trauma Emerg Surg

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“…The current end points used to guide resuscitation, such as blood pressure, urine output, heart rate, base deficit, and serum lactate levels, are global markers that may underestimate occult tissue hypoperfusion. In the future, more sensitive measures of tissue oxygenation involving polarographic or near-infrared technologies 65 and markers of inflammation and coagulation 66,67 that better reveal the physiologic condition of a patient are likely to replace simple temporal distinctions. They will provide more accurate criteria with which to determine when a patient is ''ready'' for definitive internal fixation of a femoral shaft fracture or other major orthopaedic injuries.…”

Section: Discussionmentioning

confidence: 99%

Delayed Internal Fixation of Femoral Shaft Fracture Reduces Mortality Among Patients with Multisystem Trauma

Morshed

Miclau

Bembom

et al. 2009

The Journal of Bone and Joint Surgery-American Volume

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129

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“…3 Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome (MODS) during shock resuscitation. 4 Detecting subtle changes in perfusion is crucial to ensure adequate tissue oxygenation and perfusion. Assessments of blood pressure, heart rate, arterial oxygen saturation, central venous pressure, blood gases, urine output, and hemoglobin concentration are used by the trauma team during resuscitation.…”

Section: Authormentioning

confidence: 99%

Tissue Oxygenation Monitoring as a Guide for Trauma Resuscitation

Mitchell

2016

Critical Care Nurse

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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.

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Continuous Muscle Tissue Oxygenation in Critically Injured Patients: A Prospective Observational Study

Cited by 95 publications

References 36 publications

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Delayed Internal Fixation of Femoral Shaft Fracture Reduces Mortality Among Patients with Multisystem Trauma

Tissue Oxygenation Monitoring as a Guide for Trauma Resuscitation

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