Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation

Stephen M. Cohn; Avery B. Nathens; Frederick A. Moore; Peter Rhee; Juan Carlos Puyana; Ernest E. Moore; Gregory J. Beilman; Janet McCarthy; Rachelle Babbitt Jonas; Joseph Johnston; Peter Lopez; Dian Nuxoll; Huawei Tang; Bruce A. McKinley; Burapat Sangthong; Constantinos Constantinou; Patricio Polanco; Andrew B. Peitzman; Stephanie Huls; Jeffrey L. Johnson; Catherine C. Cothren; Melissa Thorson; Alan Beal; Teresa Nelson; Ronald G. Pearl; Larry M. Gentilello; Anthony A. Meyer; LeAnn Anderson; Barbara Gallea; Diane Rupp; Becky Saar; Michelle McGraw; Virginia Diaz; Kristi Carlson; Greg Wheatley

doi:10.1097/TA.0b013e31802eb817

Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation

Stephen M. Cohn, Avery B. Nathens, Frederick A. Moore, Peter Rhee, Juan Carlos Puyana, Ernest E. Moore, Gregory J. Beilman, Janet McCarthy, Rachelle Babbitt Jonas, Joseph Johnston, Peter Lopez, Dian Nuxoll, Huawei Tang, Bruce A. McKinley, Burapat Sangthong, Constantinos Constantinou, Patricio Polanco, Andrew B. Peitzman, Stephanie Huls, Jeffrey L. JohnsonCatherine C. Cothren, Melissa Thorson, Alan Beal, Teresa Nelson, Ronald G. Pearl, Larry M. Gentilello, Anthony A. Meyer, LeAnn Anderson, Barbara Gallea, Diane Rupp, Becky Saar, Michelle McGraw, Virginia Diaz, Kristi Carlson, Greg Wheatley

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Abstract

BACKGROUND: Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock. METHODS: The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements. RESULTS: Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death. CONCLUSIONS: 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.

Original language	English (US)
Pages (from-to)	44-54
Number of pages	11
Journal	Journal of Trauma - Injury, Infection and Critical Care
Volume	62
Issue number	1
DOIs	https://doi.org/10.1097/TA.0b013e31802eb817
State	Published - Jan 2007

Keywords

Base deficit
Monitoring of resuscitation
Multiple organ dysfunction
Near-infrared spectroscopy
Shock
Tissue oxygen saturation

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Cohn, S. M., Nathens, A. B., Moore, F. A., Rhee, P., Puyana, J. C., Moore, E. E., Beilman, G. J., McCarthy, J., Jonas, R. B., Johnston, J., Lopez, P., Nuxoll, D., Tang, H., McKinley, B. A., Sangthong, B., Constantinou, C., Polanco, P., Peitzman, A. B., Huls, S., ... Wheatley, G. (2007). Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. Journal of Trauma - Injury, Infection and Critical Care, 62(1), 44-54. https://doi.org/10.1097/TA.0b013e31802eb817

Cohn, SM, Nathens, AB, Moore, FA, Rhee, P, Puyana, JC, Moore, EE, Beilman, GJ, McCarthy, J, Jonas, RB, Johnston, J, Lopez, P, Nuxoll, D, Tang, H, McKinley, BA, Sangthong, B, Constantinou, C, Polanco, P, Peitzman, AB, Huls, S, Johnson, JL, Cothren, CC, Thorson, M, Beal, A, Nelson, T, Pearl, RG, Gentilello, LM, Meyer, AA, Anderson, L, Gallea, B, Rupp, D, Saar, B, McGraw, M, Diaz, V, Carlson, K & Wheatley, G 2007, 'Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation', Journal of Trauma - Injury, Infection and Critical Care, vol. 62, no. 1, pp. 44-54. https://doi.org/10.1097/TA.0b013e31802eb817

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title = "Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation",

abstract = "BACKGROUND: Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock. METHODS: The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements. RESULTS: Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death. CONCLUSIONS: 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.",

keywords = "Base deficit, Monitoring of resuscitation, Multiple organ dysfunction, Near-infrared spectroscopy, Shock, Tissue oxygen saturation",

author = "Cohn, {Stephen M.} and Nathens, {Avery B.} and Moore, {Frederick A.} and Peter Rhee and Puyana, {Juan Carlos} and Moore, {Ernest E.} and Beilman, {Gregory J.} and Janet McCarthy and Jonas, {Rachelle Babbitt} and Joseph Johnston and Peter Lopez and Dian Nuxoll and Huawei Tang and McKinley, {Bruce A.} and Burapat Sangthong and Constantinos Constantinou and Patricio Polanco and Peitzman, {Andrew B.} and Stephanie Huls and Johnson, {Jeffrey L.} and Cothren, {Catherine C.} and Melissa Thorson and Alan Beal and Teresa Nelson and Pearl, {Ronald G.} and Gentilello, {Larry M.} and Meyer, {Anthony A.} and LeAnn Anderson and Barbara Gallea and Diane Rupp and Becky Saar and Michelle McGraw and Virginia Diaz and Kristi Carlson and Greg Wheatley",

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T1 - Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation

AU - Cohn, Stephen M.

AU - Nathens, Avery B.

AU - Moore, Frederick A.

AU - Rhee, Peter

AU - Puyana, Juan Carlos

AU - Moore, Ernest E.

AU - Beilman, Gregory J.

AU - McCarthy, Janet

AU - Jonas, Rachelle Babbitt

AU - Johnston, Joseph

AU - Lopez, Peter

AU - Nuxoll, Dian

AU - Tang, Huawei

AU - McKinley, Bruce A.

AU - Sangthong, Burapat

AU - Constantinou, Constantinos

AU - Polanco, Patricio

AU - Peitzman, Andrew B.

AU - Huls, Stephanie

AU - Johnson, Jeffrey L.

AU - Cothren, Catherine C.

AU - Thorson, Melissa

AU - Beal, Alan

AU - Nelson, Teresa

AU - Pearl, Ronald G.

AU - Gentilello, Larry M.

AU - Meyer, Anthony A.

AU - Anderson, LeAnn

AU - Gallea, Barbara

AU - Rupp, Diane

AU - Saar, Becky

AU - McGraw, Michelle

AU - Diaz, Virginia

AU - Carlson, Kristi

AU - Wheatley, Greg

PY - 2007/1

Y1 - 2007/1

N2 - BACKGROUND: Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock. METHODS: The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements. RESULTS: Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death. CONCLUSIONS: 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.

AB - BACKGROUND: Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock. METHODS: The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements. RESULTS: Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death. CONCLUSIONS: 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.

KW - Base deficit

KW - Monitoring of resuscitation

KW - Multiple organ dysfunction

KW - Near-infrared spectroscopy

KW - Shock

KW - Tissue oxygen saturation

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Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation

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