Bazerbashi Hadil, Merriman Kelly W, Toale Katy M, Chaftari Patrick, Cruz Carreras Maria Teresa, Henderson Jerry D, Yeung Sai-Ching J, Rice Terry W
The University of Texas School of Public Health, Houston, TX; Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
J Crit Care. 2014 Oct;29(5):775-9. doi: 10.1016/j.jcrc.2014.05.006. Epub 2014 May 27.
Timely recognition of critical patients by emergency center triage is an ongoing challenge. Peripheral tissue oxygen saturation (StO2) measurement has been used to monitor shock patients' responses to resuscitation. Interest has developed in evaluating StO2 as a triage tool, but limited studies have addressed critically ill patients.
This is a single-center, retrospective study of 158 emergent cancer patients with hypotension and/or modified systemic inflammatory response syndrome who underwent StO2 spot measurement at triage.
Of the 57 patients with StO2 less than 70%, 17 went to the intensive care unit (ICU), whereas only 14 of the 101 patients with StO2 of 70% to 89% (P = .01) went to the ICU. There was no significant difference in non-ICU hospital admission or mortality between the 2 groups. The odds ratio of ICU admission for patients with StO2 less than 70% relative to those with StO2 of 70% to 89% was 2.64 (95% confidence interval, 1.18-5.87) and 2.87 (95% confidence interval, 1.23-6.66) when adjusted for mean arterial pressure, pulse, and temperature.
In this patient population, an StO2 less than 70% significantly increased the risk of ICU admission. Tissue oxygen saturation at triage identifies critical patients who may not be recognized by vital signs alone. Tissue oxygen saturation measurement could help providers make earlier decisions regarding hospital resource allocation.
急诊中心分诊时及时识别重症患者一直是一项挑战。外周组织氧饱和度（StO2）测量已用于监测休克患者对复苏的反应。人们对将StO2评估为一种分诊工具产生了兴趣，但针对重症患者的研究有限。
这是一项单中心回顾性研究，纳入了158例出现低血压和/或改良全身炎症反应综合征的急诊癌症患者，这些患者在分诊时接受了StO2即时测量。
在57例StO2低于70%的患者中，17例进入重症监护病房（ICU），而在101例StO2为70%至89%的患者中，只有14例进入ICU（P = 0.01）。两组在非ICU住院或死亡率方面无显著差异。在调整平均动脉压、脉搏和体温后，StO2低于70%的患者相对于StO2为70%至89%的患者进入ICU的比值比为2.64（95%置信区间，1.18 - 5.87）和2.87（95%置信区间，1.23 - 6.66）。
在该患者群体中，StO2低于70%显著增加了进入ICU的风险。分诊时的组织氧饱和度可识别出仅通过生命体征可能无法识别的重症患者。组织氧饱和度测量有助于医疗人员更早地做出关于医院资源分配的决策。
