Nicks Bret A, Campons Kevin M, Bozeman William P
Department of Emergency Medicine, Wake Forest School of Medicine, 2nd Meads Hall, Medical Center Boulevard, Winston Salem, NC 27157, USA.
World J Emerg Med. 2015;6(2):105-10. doi: 10.5847/wjem.j.1920-8642.2015.02.004.
Near-infrared spectroscopy (NIRS) non-invasively monitors muscle tissue oxygen saturation (StO2). It may provide a continuous noninvasive measurement to identify occult hypoperfusion, guide resuscitation, and predict the development of multiple organ dysfunction (MOD) after severe trauma. We evaluated the correlation between initial StO2 and the development of MOD in multi-trauma patients.
Patients presenting to our urban, academic, Level I Trauma Center/Emergency Department and meeting standardized trauma-team activation criteria were enrolled in this prospective trial. NIRS monitoring was initiated immediately on arrival with collection of StO2 at the thenar eminence and continued up to 24 hours for those admitted to the Trauma Intensive Care Unit (TICU). Standardized resuscitation laboratory measures and clinical evaluation tools were collected. The primary outcome was the association between initial StO2 and the development of MOD within the first 24 hours based on a MOD score of 6 or greater. Descriptive statistical analyses were performed; numeric means, multivariate regression and rank sum comparisons were utilized. Clinicians were blinded from the StO2 values.
Over a 14 month period, 78 patients were enrolled. Mean age was 40.9 years (SD 18.2), 84.4% were male, 76.9% had a blunt trauma mechanism and mean injury severity score (ISS) was 18.5 (SD 12.9). Of the 78 patients, 26 (33.3%) developed MOD within the first 24 hours. The MOD patients had mean initial StO2 values of 53.3 (SD 10.3), significantly lower than those of non-MOD patients 61.1 (SD 10.0); P=0.002. The mean ISS among MOD patients was 29.9 (SD 11.5), significantly higher than that of non-MODS patients, 12.1 (SD 9.1) (P<0.0001). The mean shock index (SI) among MOD patients was 0.92 (SD 0.28), also significantly higher than that of non-MODS patients, 0.73 (SD 0.19) (P=0.0007). Lactate values were not significantly different between groups.
Non-invasive, continuous StO2 near-infrared spectroscopy values during initial trauma resuscitation correlate with the later development of multiple organ dysfunction in this patient population.
近红外光谱（NIRS）可无创监测肌肉组织氧饱和度（StO2）。它可能提供一种连续的无创测量方法，以识别隐匿性低灌注、指导复苏，并预测严重创伤后多器官功能障碍（MOD）的发生。我们评估了多发伤患者初始StO2与MOD发生之间的相关性。
本前瞻性试验纳入了就诊于我们城市的一级学术创伤中心/急诊科且符合标准化创伤团队启动标准的患者。患者到达后立即开始进行NIRS监测，在鱼际肌处采集StO2，并对入住创伤重症监护病房（TICU）的患者持续监测24小时。收集标准化的复苏实验室指标和临床评估工具。主要结局是基于MOD评分为6分或更高，评估初始StO2与24小时内MOD发生之间的关联。进行描述性统计分析；采用数值均值、多元回归和秩和比较。临床医生对StO2值不知情。
在14个月的时间里，共纳入78例患者。平均年龄为40.9岁（标准差18.2），84.4%为男性，76.9%为钝性创伤机制，平均损伤严重程度评分（ISS）为18.5（标准差12.9）。在这78例患者中，26例（33.3%）在最初24小时内发生了MOD。发生MOD的患者初始StO2值平均为53.3（标准差10.3），显著低于未发生MOD的患者61.1（标准差10.0）；P = 0.002。MOD患者的平均ISS为29.9（标准差11.5），显著高于未发生MOD的患者12.1（标准差9.1）（P < 0.0001）。MOD患者的平均休克指数（SI）为0.92（标准差0.28），也显著高于未发生MOD的患者0.73（标准差0.19）（P = 0.0007）。两组间乳酸值无显著差异。
在初始创伤复苏期间，无创、连续的近红外光谱StO2值与该患者群体中多器官功能障碍的后期发生相关。
