Muscle Oxygenation as an Early Predictor of Shock Severity in Trauma Patients

Arakaki, Lorilee S. L.; Bulger, Eileen M.; Ciesielski, Wayne A.; Carlbom, David; Fisk, Dana M.; Sheehan, Kellie; Asplund, Karin M.; Schenkman, Kenneth A.

doi:10.1097/shk.0000000000000787

Cited by 11 publications

(12 citation statements)

References 26 publications

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“…Determination of clinical shock severity was based on maximum heart rate, minimum systolic pressure, and maximum lactate values during the hour subsequent to the start of optical data collection, as previously described [ 18 ]. Table 1 shows the scoring system used to determine shock severity.…”

Section: Methodsmentioning

confidence: 99%

Muscle oxygenation as an indicator of shock severity in patients with suspected severe sepsis or septic shock

et al. 2017

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PurposeThe aim of this pilot study was to evaluate the potential of a new noninvasive optical measurement of muscle oxygenation (MOx) to identify shock severity in patients with suspected sepsis.MethodsWe enrolled 51 adult patients in the emergency department (ED) who presented with possible sepsis using traditional Systematic Inflammatory Response Syndrome criteria or who triggered a “Code Sepsis.” Noninvasive MOx measurements were made from the first dorsal interosseous muscles of the hand once potential sepsis/septic shock was identified, as soon as possible after admission to the ED. Shock severity was defined by concurrent systolic blood pressure, heart rate, and serum lactate levels. MOx was also measured in a control group of 17 healthy adults.ResultsMean (± SD) MOx in the healthy control group was 91.0 ± 5.5% (n = 17). Patients with mild, moderate, and severe shock had mean MOx values of 79.4 ± 21.2%, 48.6 ± 28.6%, and 42.2 ± 4.7%, respectively. Mean MOx for the mild and moderate shock severity categories were statistically different from healthy controls and from each other based on two-sample t-tests (p < 0.05).ConclusionsWe demonstrate that noninvasive measurement of MOx was associated with clinical assessment of shock severity in suspected severe sepsis or septic shock. The ability of MOx to detect even mild septic shock has meaningful implications for emergency care, where decisions about triage and therapy must be made quickly and accurately. Future longitudinal studies may validate these findings and the value of MOx in monitoring patient status as treatment is administered.

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Section: Methodsmentioning

confidence: 99%

Muscle oxygenation as an indicator of shock severity in patients with suspected severe sepsis or septic shock

et al. 2017

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“…Optical measurement of peripheral muscle oxygenation using visible and near infrared optical spectroscopy has been demonstrated as an early predictor of shock severity. 8,13,17 While the study concluded that mild, moderate, and severe shock could be detected and were statistically different from healthy patients, mild shock could not be differentiated from moderate shock. Peripheral muscle oxygenation is also used by some centers to guide resuscitation.…”

Section: Introductionmentioning

confidence: 87%

“…Systemic indicators, however, may not adequately detect the severity of tissue acidosis, remaining oxygen debt, and insufficient organ perfusion due to physiological compensatory responses. In particular, systemic blood pressure and oxygen saturation have been found to lack the necessary sensitivity 8,9 for adequate hemorrhagic shock resuscitation. Despite normalization of systemic indicators, a state of compensated shock develops in 85% of patients.…”

Section: Introductionmentioning

confidence: 99%

In vivo performance of a visible wavelength optical sensor for monitoring intestinal perfusion and oxygenation

et al. 2018

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Traumatic injury resulting in hemorrhage is a prevalent cause of death worldwide. The current standard of care for trauma patients is to restore hemostasis by controlling bleeding and administering intravenous volume resuscitation. Adequate resuscitation to restore tissue blood flow and oxygenation is critical within the first hours following admission to assess severity and avoid complications. However, current clinical methods for guiding resuscitation are not sensitive or specific enough to adequately understand the patient condition. To better address the shortcomings of the current methods, an approach to monitor intestinal perfusion and oxygenation using a multiwavelength (470, 560, and 630 nm) optical sensor has been developed based on photoplethysmography and reflectance spectroscopy. Specifically, two sensors were developed using three wavelengths to measure relative changes in the small intestine. Using vessel occlusion, systemic changes in oxygenation input, and induction of hemorrhagic shock, the capabilities and sensitivity of the sensor were explored in vivo. Pulsatile and nonpulsatile components of the red, blue, and green wavelength signals were analyzed for all three protocols (occlusion, systemic oxygenation changes, and shock) and were shown to differentiate perfusion and oxygenation changes in the jejunum. The blue and green signals produced better correlation to perfusion changes during occlusion and shock, while the red and blue signals, using a new correlation algorithm, produced better data for assessing changes in oxygenation induced both systemically and locally during shock. The conventional modulation ratio method was found to be an ineffective measure of oxygenation in the intestine due to noise and an algorithm was developed based on the Pearson correlation coefficient. The method utilized the difference in phase between two different wavelength signals to assess oxygen content. A combination of measures from the three wavelengths provided verification of oxygenation and perfusion states, and showed promise for the development of a clinical monitor.

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“… 6 , 132 Noninvasive measurement of muscle oxygenation based on optical spectroscopy (in contrast to near-infrared spectroscopy that determines transcutaneous oxygen saturation, an optical spectroscopy measurement does not require assumptions about the ratio of arterial to venous blood) may provide the most objective measure of shock and the best predictor of DCR. 133 – 136 …”

Section: Damage Control Resuscitationmentioning

confidence: 99%

Optimizing transfusion strategies in damage control resuscitation: current insights

Pohlman

Fecher

Arreola-Garcia

2018

JBM

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From clinical and laboratory studies of specific coagulation defects induced by injury, damage control resuscitation (DCR) emerged as the most effective management strategy for hemorrhagic shock. DCR of the trauma patient who has sustained massive blood loss consists of 1) hemorrhage control; 2) permissive hypotension; and 3) the prevention and correction of trauma-induced coagulopathies, referred to collectively here as acute coagulopathy of trauma (ACOT). Trauma patients with ACOT have higher transfusion requirements, may eventually require massive transfusion, and are at higher risk of exsanguinating. Distinct impairments in the hemostatic system associated with trauma include acquired quantitative and qualitative platelet defects, hypocoagulable and hypercoagulable states, and dysregulation of the fibrinolytic system giving rise to hyperfibrinolysis or a phenomenon referred to as fibrinolytic shutdown. Furthermore, ACOT is a component of a systemic host defense dysregulation syndrome that bears several phenotypic features comparable with other acute systemic physiological insults such as sepsis, myocardial infarction, and postcardiac arrest syndrome. Progress in the science of resuscitation has been continuing at an accelerated rate, and clinicians who manage catastrophic blood loss may be incompletely informed of important advances that pertain to DCR. Therefore, we review recent findings that further characterize the pathophysiology of ACOT and describe the application of this new information to optimization of resuscitation strategies for the patient in hemorrhagic shock.

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Muscle Oxygenation as an Early Predictor of Shock Severity in Trauma Patients

Cited by 11 publications

References 26 publications

Muscle oxygenation as an indicator of shock severity in patients with suspected severe sepsis or septic shock

Muscle oxygenation as an indicator of shock severity in patients with suspected severe sepsis or septic shock

In vivo performance of a visible wavelength optical sensor for monitoring intestinal perfusion and oxygenation

Optimizing transfusion strategies in damage control resuscitation: current insights

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