Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients

Francis X Guyette, Hernando Gomez, Brian Suffoletto, Jorge Quintero, Jaume Mesquida, Hyung Kook Kim, David Hostler, Juan-Carlos Puyana, Michael R Pinsky, Francis X Guyette, Hernando Gomez, Brian Suffoletto, Jorge Quintero, Jaume Mesquida, Hyung Kook Kim, David Hostler, Juan-Carlos Puyana, Michael R Pinsky

Abstract

Background: Tissue oximetry (StO2) plus a vascular occlusion test is a noninvasive technology that targets indices of oxygen uptake and delivery. We hypothesize that prehospital tissue oximetric values and vascular occlusion test response can predict the need for in-hospital lifesaving interventions (LSI).

Methods: We conducted a prospective, blinded observational study to evaluate StO2 slopes to predict the need for LSI. We calculated the DeO2 slope using Pearson's coefficients of regression (r2) for the first 25% of descent and the ReO2 slope using the entire recovery interval. The primary outcome was LSI defined as the need for emergent operation or transfusion in the first 24 hours of hospitalization. We created multivariable logistic regression models using covariates of age, sex, vital signs, lactate, and mental status.

Results: We assessed StO2 in a convenience sample of 150 trauma patients from April to November of 2009. In-hospital mortality was 3% (95% confidence interval [CI], 1.1-7.6); 31% (95% CI, 24-39) were admitted to the intensive care unit, 6% (95% CI, 2.8-11.1) had an emergent operation, and 10% (95% CI, 5.7-15.9) required transfusion. Decreasing DeO2 was associated with a higher proportion of patients requiring LSI. In the multivariate model, the association between the need for LSI and DeO2, Glasgow Coma Scale, and age persists.

Conclusion: Prehospital DeO2 is associated with need for LSI in our trauma population. Further study of DeO2 is warranted to determine whether it can be used as an adjunct triage criterion or an endpoint for resuscitation.

Figures

Figure 1
Figure 1
(A) Scatter plot showing the relationship of DeO2 slope and lowest SBP. (B) Scatter plot showing the relationship of ReO2 slope and lowest SBP.
Figure 2
Figure 2
Receiver operating curve for DeO2 as a predictor of LSI.

References

    1. McGee S, Abernethy WB, 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999;281:1022–1029.
    1. Brasel KJ, Guse C, Gentilello LM, Nirula R. Heart rate: is it truly a vital sign? J Trauma. 2007;62:812–817.
    1. Lipsky AM, Gausche-Hill M, Henneman PL, et al. Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department. J Trauma. 2006;61:1228–1233.
    1. Eastridge BJ, Salinas J, McManus JG, et al. Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63:291–297.
    1. Henry MC, Hollander JE, Alicandro JM, Cassara G, O’Malley S, Thode HC., Jr Incremental benefit of individual American College of Surgeons trauma triage criteria. Acad Emerg Med. 1996;3:992–1000.
    1. Newgard CD, Rudser K, Hedges JR, et al. ROC Investigators. A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality. J Trauma. 2010;68:452–462.
    1. Claridge JA, Crabtree TD, Pelletier SJ, Butler K, Sawyer RG, Young JS. Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma. 2000;48:8–14.
    1. Crowl AC, Young JS, Kahler DM, Claridge JA, Chrzanowski DS, Pomphrey M. Occult hypoperfusion is associated with increased morbidity in patients undergoing early femur fracture fixation. J Trauma. 2000;48:260–267.
    1. Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD. Epidemiology of trauma deaths. Am J Surg. 1980;140:144–150.
    1. Holcomb JB, Niles SE, Miller CC, Hinds D, Duke JH, Moore FA. Prehospital physiologic data and lifesaving interventions in trauma patients. Mil Med. 2005;170:7–13.
    1. Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA. Manual vital signs reliably predict need for life-saving interventions in trauma patients. J Trauma. 2005;59:821–829.
    1. Cohn SM, Nathens AB, Moore FA, et al. StO2 in Trauma Patients Trial Investigators. Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma. 2007;62:44–54.
    1. Moore FA, Nelson T, McKinley BA, et al. StO2 Study Group. Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome. J Trauma. 2008;64:1010–1023.
    1. Gómez H, Torres A, Polanco P, et al. Use of non-invasive NIRS during a vascular occlusion test to assess dynamic tissue O(2) saturation response. Intensive Care Med. 2008;34:1600–1607.
    1. Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL. The prognostic value of muscle StO2 in septic patients. Intensive Care Med. 2007;33:1549–1556.
    1. Baker SP, O’Neill B, Haddon W, Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196.
    1. Mesquida J, Gruartmoner G, Martínez ML, et al. Thenar oxygen saturation and invasive oxygen delivery measurements in critically ill patients in early septic shock. Shock. 2011;35:456–459.
    1. Guyette F, Suffoletto B, Castillo JL, Quintero J, Callaway C, Puyana JC. Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study. J Trauma. 2011;70:782–786.
    1. Jacobs LM. Timing of fluid resuscitation in trauma. N Engl J Med. 1994;331:1153–1154.
    1. Napolitano LM. Resuscitation endpoints in trauma. TATM. 2005;6:6–14.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir