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Published in:

01-08-2014

Low Tissue Oxygen Saturation Is Associated with Requirements for Transfusion in the Rural Trauma Population

Authors: Mohammad A. Khasawneh, Martin D. Zielinski, Donald H. Jenkins, Scott P. Zietlow, Henry J. Schiller, Mariela Rivera

Published in: World Journal of Surgery | Issue 8/2014

Abstract

Background

Tissue O₂ saturation (StO₂) is a measure of tissue perfusion and should decrease during active hemorrhage. An initial StO₂ value upon trauma center arrival measured concurrently with or prior to vitals, may predict hemorrhagic shock, requiring early blood product transfusion. Our aim was to identify the early StO₂ threshold associated with a greater volume of packed red blood cell (PRBC) transfusion 24 h after injury.

Methods

All highest tier triage trauma patients from January 2011 to July 2012 were included in this study. The initial StO₂ value upon arrival was used for comparison.

Results

A total of 632 patients were considered, 74 % of them male with a mean age of 46 years. Initial StO₂ values were available for 325 patients. An StO₂ value of 65 % was determined as the cutoff due to the marked increase in PRBC consumption in 24 h. There were 23 patients (7 %) with an StO₂ reading <65 % compared to 302 patients with values ≥65 %. Both groups had similar systolic blood pressure (118 vs. 126) and heart rate (99 vs. 95) in the trauma bay. In addition, there was no difference in the initial hemoglobin, pH, or base deficit. An early StO₂ value <65 % also led to a greater number of PRBC transfused in 24 h (6.4 vs. 1.7). Regression analysis demonstrated that an StO₂ <65 % was the only variable associated with a higher PRBC transfusion volume in 24 h (p = 0.01).

Conclusions

An StO₂ value <65 % correlates with greater requirement for PRBC transfusion 24 h after injury. This suggests that StO₂ can be used as an early marker of hemorrhage which may be superior to traditional vital signs in the trauma population.

Sauaia A, Moore FA, Moore EE et al (1995) Epidemiology of trauma deaths: a reassessment. J Trauma 38:185–193PubMedCrossRef

MacLeod JB, Cohn SM, Johnson EW et al (2007) Trauma deaths in the first hour: are they all unsalvageable injuries? Am J Surg 193:195–199PubMedCrossRef

Acosta JA, Yang JC, Winchell RJ et al (1998) Lethal injuries and time to death in a level I trauma center. J Am Coll Surg 186:528–533PubMedCrossRef

Cocchi MN, Kimlin E, Walsh M et al (2007) Identification and resuscitation of the trauma patient in shock. Emerg Med Clin North Am 25:623PubMedCrossRef

Parks JK, Elliott AC, Gentilello LM et al (2006) Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample. Am J Surg 192:727–730PubMedCrossRef

Sasser SM, Hunt RC, Faul M et al (2012) Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep 61(RR–1):1–20PubMed

McKinley BA, Marvin RG, Cocanour CS et al (2000) Tissue hemoglobin O₂ saturation during resuscitation of traumatic shock monitored using near infrared spectrometry. J Trauma 48:637–642PubMedCrossRef

Yokose N, Sakatani K, Murata Y et al (2010) Bedside assessment of cerebral vasospasms after subarachnoid hemorrhage by near infrared time-resolved spectroscopy. Adv Exp Med Biol 662:505–511PubMedCrossRef

Hargroves DR, Tallis RC, Pomeroy VM et al (2004) Near-infrared spectroscopy in stroke: from research to clinical practice. Stroke 35:2430 (author reply 2430–2431)PubMedCrossRef

10.

Terborg C, Groschel K, Petrovitch A et al (2009) Noninvasive assessment of cerebral perfusion and oxygenation in acute ischemic stroke by near-infrared spectroscopy. Eur Neurol 62:338–343PubMedCrossRef

11.

Comerota AJ, Throm RC, Kelly P et al (2003) Tissue (muscle) oxygen saturation (StO₂): a new measure of symptomatic lower-extremity arterial disease. J Vasc Surg 38:724–729PubMedCrossRef

12.

Harrison DK (2002) Optical measurement of tissue oxygen saturation. Int J Low Extrem Wounds 1:191–201PubMedCrossRef

13.

Lima A, van Bommel J, Jansen TC et al (2009) Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients. Crit Care 13(Suppl 5):S13PubMedCentralPubMedCrossRef

14.

Mesquida J, Espinal C, Gruartmoner G et al (2012) Prognostic implications of tissue oxygen saturation in human septic shock. Intensive Care Med 38:592–597PubMedCrossRef

15.

Vorwerk C, Coats TJ (2012) The prognostic value of tissue oxygen saturation in emergency department patients with severe sepsis or septic shock. Emerg Med J 29:699–703PubMedCrossRef

16.

Santora RJ, Moore FA (2009) Monitoring trauma and intensive care unit resuscitation with tissue hemoglobin oxygen saturation. Crit Care 13(Suppl 5):S10PubMedCentralPubMedCrossRef

17.

Cohn SM, Nathens AB, Moore FA et al (2007) Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma 62:44–54 (discussion 54–45)PubMedCrossRef

18.

Smith J, Bricker S, Putnam B (2008) Tissue oxygen saturation predicts the need for early blood transfusion in trauma patients. Am Surg 74:1006–1011PubMed

19.

Beilman GJ, Blondet JJ (2009) Near-infrared spectroscopy-derived tissue oxygen saturation in battlefield injuries: a case series report. World J Emerg Surg 4:25PubMedCentralPubMedCrossRef

20.

Chalmers JP, Korner PI, White SW (1967) Effects of haemorrhage on the distribution of the peripheral blood flow in the rabbit. J Physiol 192:561–574PubMedCentralPubMed

21.

Krumrei NJ, Park MS, Cotton BA et al (2012) Comparison of massive blood transfusion predictive models in the rural setting. J Trauma Acute Care Surg 72:211–215PubMed

22.

Vandromme MJ, Griffin RL, Weinberg JA et al (2010) Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage? J Am Coll Surg 210(861–867):867–869

23.

Sagraves SG, Newell MA, Bard MR et al (2009) Tissue oxygenation monitoring in the field: a new EMS vital sign. J Trauma 67:441–443 (discussion 443–444)PubMedCrossRef

24.

Nunez TC, Voskresensky IV, Dossett LA et al (2009) Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J Trauma 66:346–352PubMedCrossRef

Title: Low Tissue Oxygen Saturation Is Associated with Requirements for Transfusion in the Rural Trauma Population
Authors: Mohammad A. Khasawneh
Martin D. Zielinski
Donald H. Jenkins
Scott P. Zietlow
Henry J. Schiller
Mariela Rivera
Publication date: 01-08-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 8/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2505-3

At a glance: The STEP trials

Springer Medicine

Low Tissue Oxygen Saturation Is Associated with Requirements for Transfusion in the Rural Trauma Population

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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