Tissue Hemoglobin O2 Saturation during Resuscitation of Traumatic Shock Monitored Using Near Infrared Spectrometry

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Abstract
Near infrared (NIR) spectrometry offers a noninvasive monitor of tissue hemoglobin O2 saturation and has been developed to report a quantitative clinical variable, StO2 [= HbO2/(HbO2 + Hb)]. In this study, a prototype NIR oximeter was used to investigate the hypothesis that changes in systemic O2 delivery index (DO2I) would be reflected by changes in StO2 in skeletal muscle, subcutaneous tissue, or both, as reperfusion occurs during shock resuscitation. StO2 was also compared with other indices of severity of shock or adequacy of resuscitation, including arterial base deficit, lactate, gastric mucosal PCO2 (PgCO2), and mixed venous hemoglobin O2 saturation (SvO2). Skeletal muscle and subcutaneous tissue StO2 were monitored simultaneously in eight severely injured trauma patients (88% blunt mechanism; age, 42 ± 6 years; Injury Severity Score, 27 ± 3) during standardized shock resuscitation in the intensive care unit with the primary goal of DO2I ≥ 600 mL O2/min/m2 for 24 hours, and for an additional 12 hours during transition from resuscitation to standard intensive care unit care. Skeletal muscle StO2 increased significantly from 15 ± 2% (mean ± SEM) at the start of resuscitation to 49 ± 14% at 24 hours, and to ∼55% from 25 to 36 hours. Subcutaneous tissue StO2 ∼ 82% and was significantly greater than skeletal muscle StO2 throughout. DO2I increased significantly from 372 ± 54 to 718 ± 47 mL O2/min/m2 during resuscitation. Over 36 hours, mean DO2I and skeletal muscle StO2 were highly correlated (r = 0.95). Neither DO2I-PgCO2 nor DO2I-SvO2 were significantly correlated; neither SvO2 nor subcutaneous tissue StO2 changed significantly. Hemoglobin O2 saturation was monitored noninvasively and simultaneously in skeletal muscle and subcutaneous tissues as StO2 (%) by using a prototype NIR oximeter. Skeletal muscle StO2 tracked systemic O2 delivery during and after resuscitation. As a rapidly deployable, noninvasive monitor of peripheral tissue oxygenation and O2 delivery, skeletal muscle StO2 obtained using NIR spectrometry would be useful to guide resuscitation in the intensive care unit, to monitor resuscitation status in the operating room, and, potentially, in combination with indicators such as base deficit and lactate, to detect shock during initial assessment of the severe trauma patient in the emergency department.