Use of Near-Infrared Spectroscopy in Early Determination of Irreversible Hemorrhagic Shock

Abstract

SUMMARY

Measurement of acid–base resuscitation endpoints: lactate, base deficit, bicarbonate or what?

“…It allows the measurement of tissue oxygenation, pO 2 , pCO 2 and pH. In animal models of hemorrhagic shock, measurement of tissue oxygenation correlated closely with measured hemodynamic parameters and was better able to discriminate 'responder' from 'nonresponder' animals compared with lactate or global oxygen delivery [37 ]. McKinley et al [38] evaluated NIRS in severely injured trauma patients and found that measurement of tissue oxygenation correlated well with oxygen delivery, base deficit and lactate levels.…”

Specificity of Compensatory Reserve and Tissue Oxygenation as Early Predictors of Tolerance to Progressive Reductions in Central Blood Volume

“…We have previously shown that the compensatory reserve measured by the CRI has greater specificity when used to monitor individual patients compared with traditional vital signs (e.g., blood pressure, heart rate, arterial oxygen saturation) and stroke volume during actual or simulated hemorrhage in humans (7,8). Recently, increased attention has been given to the measurement of SmO 2 as a prognostic tool for early assessment of the status of patients with progressive hemorrhage (12,17,18). More specifically for the application to military medicine, the Committee on Tactical Combat Casualty Care is considering technology for the measurement of SmO2 and compensatory reserve as a medic tool to guide resuscitation (19).…”

Thresholded Area Over the Curve of Spectrometric Tissue Oxygen Saturation as an Indicator of Volume Resuscitability in Porcine Hemorrhagic Shock

“…9 -12 The dynamic changes in StO 2 under cuff inflation-induced forelimb ischemia may quantify cardiovascular reserve and correlate with clinical indices of severity in sepsis in a critical care setting, whereas the StO 2 values after a first resuscitation step predict outcome in an experimental model of hemorrhagic shock. 5,13,14 Recent results indicate that StO 2 debt may be predictive of later development of multiple organ dysfunction in trauma victims. 15 However, StO 2 measurements alone before any resuscitation or other intervention have not been shown to be predictive of VR, although this would be desirable in nonhospital emergency settings.…”

“…U nderstanding the transition from reversible to irreversible hemorrhagic shock has been the subject of numerous studies during the past decades. [1][2][3][4][5][6] A meaningful definition of irreversibility inherently needs to make explicit the therapeutic interventions under which the shock state fails to improve, such as volume resuscitation or pressor therapy.…”