Tissue Oxygen Saturation Predicts the Development of Organ Dysfunction During Traumatic Shock Resuscitation

Cohn, Stephen M.; Nathens, Avery B.; Moore, Frederick A.; Rhee, Peter; Puyana, Juan Carlos; Moore, Ernest E.; Beilman, Greg J.

doi:10.1097/ta.0b013e31802eb817

Cited by 262 publications

(225 citation statements)

References 18 publications

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“…Septic shock often results due to microcirculatory alterations despite adequate fluid resuscitation and maintenance of adequate perfusion pressures [4] .Multiple organ dysfunction syndrome is likely to develop if both macro and microcirculatory functioning is not restored early [7,8] . The physiologic foundation for minimum StO 2 (tissue oxygenation) rests on the theory that peripheral hypoperfusion is a marker for a worsening patient condition as it coincides with the body's shunting of blood to the internal organs and away from the periphery [9] . The hallmark of multiple organ dysfunction syndrome is the development of progressive physiologic dysfunction in two or more organ systems after an acute threat to systemic homeostasis, with the respiratory, renal, hepatic, cardiovascular, and hematologic systems being most commonly affected [7] .…”

Section: Review Of the Literaturementioning

confidence: 99%

Early recognition and rapid intervention of sepsis: Implementation of a focused educational initiative emphasizing early goal-directed therapy in the emergency department

Moser

2014

JNEP

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Introduction: Prompt recognition of Systemic Inflammatory Response Syndrome (SIRS)/sepsis and early initiation of goal-directed therapy in the emergency department is vital for improved patient outcomes. The aim of this educational initiative was to implement an educational program detailing the imperative steps within the "golden hour" of early recognition and intervention of SIRS/sepsis in the emergency department and analyze the effectiveness of the intervention.Methodology: This performance improvement project was the program evaluation of a mandatory educational initiative, incorporating a retrospective, repeated measures, test-retest, time series design for registered nurses working in the emergency department who were specifically trained in the emergency department triage (n = 38), at an emergency department between January 2008-March 2008. Conclusions/Significance:Results of the statistical analysis showed a positive change between pre-test (t1) and initial post-test (t2) scores, (t1 and t2) p = .000, (95% CI -5.072, -3.402), indicating understanding of the educational material provided and between (t1) and one-month post-test (t3) scores, (t1 and t3) p = .0001, (95% CI -5.345, -3.780), showing retention of the educational material. The educational initiative implemented in the emergency department was beneficial in educating the nurses and resulted in practice change at the facility. As a result, the educational initiative was implemented as a house-wide annual nursing competency. The initiative was instrumental in the development of a house-wide interprofessional, collaborative sepsis task force.

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Section: Review Of the Literaturementioning

confidence: 99%

Early recognition and rapid intervention of sepsis: Implementation of a focused educational initiative emphasizing early goal-directed therapy in the emergency department

Moser

2014

JNEP

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“…Near-infrared spectroscopy (NIRS) is widely recognized as a non-invasive method to monitor oxygen saturation of tissue (StO 2 ) [5]. In recent years, StO 2 -derived variables obtained by means of an arterial vascular occlusion test (VOT) have been used to evaluate the microcirculatory profile of patients with various clinical conditions [6][7][8][9]. To study the effects of prolonged ischemia on skeletal muscle microcirculation in humans using noninvasive methods, we assessed microvascular reperfusion with NIRS in orthopedic hand surgery procedures that required tourniquetinduced bloodless conditions.…”

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confidence: 99%

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

Tujjar

Gaudio

Tofani

et al. 2016

J Clin Monit Comput

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Near-infrared spectroscopy (NIRS) has been used to detect in vivo microvascular alterations by means of a vascular occlusion test. We sought to analyse by NIRS the microcirculatory profile of patients undergoing prolonged tourniquet-induced bloodless condition for extremity surgery, and compare the results with time of ischemia and comorbidities. We conducted a prospective observational study on 42 patients undergoing upper limb surgery. Regional anaesthesia was achieved and ischemia was induced by a tourniquet cuffed at 250 mmHg. The probe of a NIRS monitor (InSpectra 325, Hutchiston, USA) was placed on the brachial muscle, and muscle oxygen saturation (StO 2 ) was recorded continuously before anaesthesia, during and after surgery. The following variables were recorded: baseline StO 2 , StO 2 desaturation slope during occlusion (dSlope, units/s), resaturation rate following ischemia (RR, units/s), hyperaemic peak (peak, units), and duration of the hyperaemic period following ischemia (hyperaemic time, s). Values of dSlope were similar among all patients. RR and hyperaemic time were significantly correlated with the duration of ischemia, but not with comorbidities [p = 0.007 CI (-35.64 to -13.1), and p \ 0.001 CI (0.049-0.159), respectively]. Grouping patients by duration of ischemia (30, 60, or 90 min), we found a significant decrease in RR after 60 and 90 min (p \ 0.001 and p = 0.03, respectively). Hyperaemic peak was lower in the 90 min group (83.9 ± 6.8 vs.91.2 ± 5.7 %, p = 0.02) whereas the hyperaemic time was significantly increased (595 ± 136 vs. 429 ± 107 min, p \ 0.001). Alterations of skeletal muscle microcirculation were correlated with the duration of ischemia, but not with comorbidities. We observed an initial impairment of the microcirculatory recovery at 90 min of ischemia.

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“…The compensated shock state can lead to multiple organ dysfunction syndrome (MODS), the leading cause of death in surgical intensive care units [4]. Tissue perfusion or acidosis and oxygen consumption are better criteria to guide adequacy of resuscitation and to predict the development of MODS [5]. In particular, the small intestine has been demonstrated to be the organ most sensitive to hemorrhagic shock, and it is therefore the ideal target for monitoring [6].…”

Section: Introductionmentioning

confidence: 99%

In-silico and in-vitro investigation of a photonic monitor for intestinal perfusion and oxygenation

Robinson

Butcher

Wilson

et al. 2017

Biomed. Opt. Express

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Abstract:The quantification of visceral organ oxygenation after trauma-related systemic hypovolemia and shock is critical to enable effective resuscitation. In this work, a photoplethysmography-based (PPG) sensor was specifically designed for probing the perfusion and oxygenation condition of intestinal tissue with the ultimate goal to monitor patients post trauma to guide resuscitation. Through Monte Carlo modeling, suitable optofluidic phantoms were determined, the wavelength and separation distance for the sensor was optimized, and sensor performance for the quantification of tissue perfusion and oxygenation was tested on the in-vitro phantom. In particular, the Monte Carlo simulated both a standard block three-layer model and a more realistic model including villi. Measurements were collected on the designed three layer optofluidic phantom and the results taken with the small form factor PPG device showed a marked improvement when using shorter visible wavelengths over the more conventional longer visible wavelengths. Overall, in this work a Monte Carlo model was developed, an optofluidic phantom was built, and a small form factor PPG sensor was developed and characterized using the phantom for perfusion and oxygenation over the visible wavelength range. The results show promise that this small form factor PPG sensor could be used as a future guide to shock-related resuscitation.

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Tissue Oxygen Saturation Predicts the Development of Organ Dysfunction During Traumatic Shock Resuscitation

Abstract: NIRS-derived muscle StO2 measurements perform similarly to BD in identifying poor perfusion and predicting the development of MODS or death after severe torso trauma, yet have the additional advantages of being continuous and noninvasive.

Cited by 262 publications

References 18 publications

Early recognition and rapid intervention of sepsis: Implementation of a focused educational initiative emphasizing early goal-directed therapy in the emergency department

Early recognition and rapid intervention of sepsis: Implementation of a focused educational initiative emphasizing early goal-directed therapy in the emergency department

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

In-silico and in-vitro investigation of a photonic monitor for intestinal perfusion and oxygenation

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