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

Stephen M. Cohn, Avery B. Nathens, Frederick A. Moore, Peter M 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 & 15 others 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

Research output: Contribution to journalArticle

215 Citations (Scopus)

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
Volume62
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

Fingerprint

Traumatic Shock
Multiple Organ Failure
Resuscitation
Oxygen
Torso
Near-Infrared Spectroscopy
Shock
Muscles
Trauma Centers
Wounds and Injuries
Perfusion
Prospective Studies

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

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

In: Journal of Trauma, Vol. 62, No. 1, 01.2007, p. 44-54.

Research output: Contribution to journalArticle

Cohn, SM, Nathens, AB, Moore, FA, Rhee, PM, 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, vol. 62, no. 1, pp. 44-54. https://doi.org/10.1097/TA.0b013e31802eb817
Cohn, Stephen M. ; Nathens, Avery B. ; Moore, Frederick A. ; Rhee, Peter M ; Puyana, Juan Carlos ; Moore, Ernest E. ; Beilman, Gregory J. ; McCarthy, Janet ; Jonas, Rachelle Babbitt ; Johnston, Joseph ; Lopez, Peter ; Nuxoll, Dian ; Tang, Huawei ; McKinley, Bruce A. ; Sangthong, Burapat ; Constantinou, Constantinos ; Polanco, Patricio ; Peitzman, Andrew B. ; Huls, Stephanie ; Johnson, Jeffrey L. ; Cothren, Catherine C. ; Thorson, Melissa ; Beal, Alan ; Nelson, Teresa ; Pearl, Ronald G. ; Gentilello, Larry M. ; Meyer, Anthony A. ; Anderson, LeAnn ; Gallea, Barbara ; Rupp, Diane ; Saar, Becky ; McGraw, Michelle ; Diaz, Virginia ; Carlson, Kristi ; Wheatley, Greg. / Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. In: Journal of Trauma. 2007 ; Vol. 62, No. 1. pp. 44-54.
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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 M

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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