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European Journal of Trauma and Emergency Surgery

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Open Access 02-09-2022 | Shock | Original Article

Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock

Authors: Andrea Campos-Serra, Jaume Mesquida, Sandra Montmany-Vioque, Pere Rebasa-Cladera, Marta Barquero-Lopez, Ariadna Cidoncha-Secilla, Núria Llorach-Perucho, Marc Morales-Codina, Juan Carlos Puyana, Salvador Navarro-Soto

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2023

Abstract

Purpose

Persistent occult hypoperfusion after initial resuscitation is strongly associated with increased morbidity and mortality after severe trauma. The objective of this study was to analyze regional tissue oxygenation, along with other global markers, as potential detectors of occult shock in otherwise hemodynamically stable trauma patients.

Methods

Trauma patients undergoing active resuscitation were evaluated 8 h after hospital admission with the measurement of several global and local hemodynamic/metabolic parameters. Apparently hemodynamically stable (AHD) patients, defined as having SBP ≥ 90 mmHg, HR < 100 bpm and no vasopressor support, were followed for 48 h, and finally classified according to the need for further treatment for persistent bleeding (defined as requiring additional red blood cell transfusion), initiation of vasopressors and/or bleeding control with surgery and/or angioembolization. Patients were labeled as “Occult shock” (OS) if they required any intervention or “Truly hemodynamically stable” (THD) if they did not. Regional tissue oxygenation (rSO₂) was measured non-invasively by near-infrared spectroscopy (NIRS) on the forearm. A vascular occlusion test was performed, allowing a 3-min deoxygenation period and a reoxygenation period following occlusion release. Minimal rSO₂ (rSO₂min), Delta-down (rSO₂–rSO₂min), maximal rSO₂ following cuff-release (rSO₂max), and Delta-up (rSO₂max–rSO₂min) were computed. The NIRS response to the occlusion test was also measured in a control group of healthy volunteers.

Results

Sixty-six consecutive trauma patients were included. After 8 h, 17 patients were classified as AHD, of whom five were finally considered to have OS and 12 THD. No hemodynamic, metabolic or coagulopathic differences were observed between the two groups, while NIRS-derived parameters showed statistically significant differences in Delta-down, rSO₂min, and Delta-up.

Conclusions

After 8 h of care, NIRS evaluation with an occlusion test is helpful for identifying occult shock in apparently hemodynamically stable patients.

Level of evidence

IV, descriptive observational study.

Trial registration

ClinicalTrials.gov Registration Number: NCT02772653.

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Title: Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock
Authors: Andrea Campos-Serra
Jaume Mesquida
Sandra Montmany-Vioque
Pere Rebasa-Cladera
Marta Barquero-Lopez
Ariadna Cidoncha-Secilla
Núria Llorach-Perucho
Marc Morales-Codina
Juan Carlos Puyana
Salvador Navarro-Soto
Publication date: 02-09-2022
Publisher: Springer Berlin Heidelberg
Keywords: Shock
Shock
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02068-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Trial registration

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