Effect of hemorrhage and resuscitation on subcutaneous, conjunctival, and transcutaneous oxygen tension in relation to hemodynamic variables

Gottrup, Finn; Gellett, Søren; Kirkegaard, L; Hansen, Ebbe Stender; Johansen, Gunnar

doi:10.1097/00003246-198909000-00013

Cited by 32 publications

(7 citation statements)

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“…These observations are consistent with a fall in O 2 delivery related to decreases in cardiac output and arterial O 2 content. Decreases in tissue oxygenation following hemorrhage have been reported by other groups in peripheral tissues, such as skeletal muscle (6) and conjunctiva, (6,18,42), and in deeper tissues, such as the liver and gut (28,33,48).…”

Section: Resultsmentioning

confidence: 67%

“…Renal cortical and bladder tPO 2 showed less consistency. It has been used in clinical studies of heart failure, sepsis, blood loss, and the adequacy of resuscitation from a variety of sites, including conjunctiva (42), subcutaneous tissue (18), and skeletal muscle (4). However, the relevance of changes in these more peripheral beds with regard to deeper, "vital" organs, such as the liver and kidney, has not been previously addressed.…”

Section: Resultsmentioning

confidence: 99%

“…Decreases in tPO 2 across numerous organ beds during low O 2 transport states, such as hemorrhage, hypoxemia, and heart failure, imply an inability of the regional O 2 supply to match continuing metabolic demands. These beds range from conjunctiva (18,42), subcutaneous tissue (15), bladder (44), and muscle (6,28) to deeper organs, such as the liver (33,48) and kidney (51). The fall from baseline levels generally corresponds to the severity of the insult (27,44).…”

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confidence: 99%

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Tissue oxygen monitoring in rodent models of shock

Dyson¹,

Stidwill²,

Taylor³

et al. 2007

American Journal of Physiology-Heart and Circulatory Physiology

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Tissue Po(2) (tPo(2)) reflects the balance between local O(2) supply and demand and, thus, could be a useful monitoring modality. However, the consistency and amplitude of the tPo(2) response in different organs during different cardiorespiratory insults is unknown. Therefore, we investigated the effects of endotoxemia, hemorrhage, and hypoxemia on tPo(2) measured in deep and peripheral organ beds. We compared arterial pressure, blood gas and lactate levels, descending aortic and renal blood flow, and tPo(2) in skeletal muscle, bladder epithelium, liver, and renal cortex during 1) LPS infusion (10 mg/kg), 2) sequential removal of 10% of circulating blood volume, and 3) reductions in inspired O(2) concentration in an anesthetized Wistar rat model with values measured in sham-operated animals. Different patterns were seen in each of the shock states, with condition-specific variations in the degree of acidemia, lactatemia, and tissue O(2) responses between organs. Endotoxemia resulted in a rise in bladder tPo(2) and an early fall in liver tPo(2) but no significant change in muscle and renal cortical tPo(2). Progressive hemorrhage, however, produced proportional declines in liver, muscle, and bladder tPo(2), but renal cortical tPo(2) was maintained until profound blood loss had occurred. By contrast, progressive hypoxemia resulted in proportional decreases in tPo(2) in all organ beds. This study highlights the heterogeneity of responses in different organ beds during different shock states that are likely related to local changes in O(2) supply and utilization. Whole body monitoring is not generally reflective of these changes.

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Section: Resultsmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Tissue oxygen monitoring in rodent models of shock

Dyson¹,

Stidwill²,

Taylor³

et al. 2007

American Journal of Physiology-Heart and Circulatory Physiology

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“…During hemorrhage PO 2 falls in parallel in both the subcutis and the intestines [10]. When studied in the setting of hemorrhagic shock, subcutaneous PO 2 is a sensitive indicator of volume loss [145‐147]. Furthermore, it is very slow to return to baseline after volume restoration, which may help ensure that resuscitation is not prematurely ended.…”

Section: Organ‐specific Monitoringmentioning

confidence: 99%

Endpoints of Resuscitation for the Victim of Trauma

Ward

Ivatury

Barbee

2001

J Intensive Care Med

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Useful resuscitation endpoints must serve both to diagnose the need for and to ensure the ongoing adequacy of resuscitation. To this end, traditional measures of organ perfusion are now widely appreciated to be grossly inadequate. Useful endpoints or milestones range from the global, to the regional, to the cellular specific. Understanding the basic principles of perfusion‐related dysoxia in trauma and hemorrhage and its potential rapid transition to involve inflammatory and immune responses on cellular oxygen utilization will aid the clinician in choosing and appropriately interpreting endpoint monitoring data. There also appears to be an optimal window of opportunity for monitoring to help mitigate the development of more complicated inflammatory states. This article reviews the underlying need for endpoint selection (both global and regional, biochemical and functional) and monitoring during resuscitation of the polytrauma patient. At this juncture it appears that early use of a blend of global markers such as lactate and base deficit coupled with an available sensitive regional monitor such as gastric tonometry may offer the best combination of current technology to guard against early perfusion‐related dysoxia. Future techniques involving optical spectroscopy offer the exciting potential to assess oxygenation at the cellular level. This may aid in ultra‐early detection and resolution of perfusion‐related dysoxia in addition to recognizing its transition to more complex inflammatory‐mediated circulatory and metabolic failure.

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“…The method has the advantage of being noninvasive and continuous, and heating of the area beneath the sensor is not necessary. The conjunctival oxygen tension (Pcj0 2 ) has been found to be linearly correlated to arterial blood oxygen tension (PaO^) during hypoxic, normoxic and hyperoxic conditions in hemo dynamic stable subjects and animals with nor mal cardiac output and intravascular volume [4,6,7], and is sensitive to blood volume defi cit and tissue perfusion [2,3,8], In an animal study a close relationship between subcuta neous and PcjOi during hemorrhage was found [2], Subcutaneous oxygen tension has been found to be a good predictor of tissue perfusion [9], and during hypovolemia PcjC>2 therefore seems to reflect tissue perfusion.…”

mentioning

confidence: 99%

Conjunctival Oxygen Tension Measurements for Assessment of Tissue Oxygen Tension during Pulmonary Surgery

Asmussen¹,

Gellett

Pilegaard³

et al. 1994

Eur Surg Res

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Conjunctival oxygen tension (PcjO₂) and routine cardiorespiratory parameters were measured in 8 patients during pulmonary surgery. In each patient we found a close relationship between PcjO₂ and arterial blood oxygen tension (PaO₂), and for all patients the correlation coefficient was 0.962. The mean values of the ratio between PcjO₂ and PaO₂ in each patient were ranging between 0.46 and 0.55. We conclude that PcjO₂ measurements represent a useful and reliable method for evaluation of peripheral oxygenation and perfusion during pulmonary surgery. Furthermore, the method has been found useful for estimation of arterial blood oxygen tension in hemodynamically stable patients during anesthesia.

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Effect of hemorrhage and resuscitation on subcutaneous, conjunctival, and transcutaneous oxygen tension in relation to hemodynamic variables

Cited by 32 publications

References 0 publications

Tissue oxygen monitoring in rodent models of shock

Tissue oxygen monitoring in rodent models of shock

Endpoints of Resuscitation for the Victim of Trauma

Conjunctival Oxygen Tension Measurements for Assessment of Tissue Oxygen Tension during Pulmonary Surgery

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