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

Research output: Contribution to journalArticle

224 Scopus citations

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 languageEnglish (US)
Pages (from-to)44-54
Number of pages11
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number1
DOIs
StatePublished - Jan 1 2007

    Fingerprint

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

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