Naumann David N, Mellis Clare, Smith Iain M, Mamuza Jasna, Skene Imogen, Harris Tim, Midwinter Mark J, Hutchings Sam D
NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK.
University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
BMJ Open. 2016 Dec 21;6(12):e014162. doi: 10.1136/bmjopen-2016-014162.
Sublingual microcirculatory monitoring for traumatic haemorrhagic shock (THS) may predict clinical outcomes better than traditional blood pressure and cardiac output, but is not usually performed until the patient reaches the intensive care unit (ICU), missing earlier data of potential importance. This pilot study assessed for the first time the feasibility and safety of sublingual video-microscopy for THS in the emergency department (ED), and whether it yields useable data for analysis.
A safety and feasibility assessment was undertaken as part of the prospective observational MICROSHOCK study; sublingual video-microscopy was performed at the UK-led Role 3 medical facility at Camp Bastion, Afghanistan, and in the ED in 3 UK Major Trauma Centres.
There were 15 casualties (2 military, 13 civilian) who presented with traumatic haemorrhagic shock with a median injury severity score of 26. The median age was 41; the majority (n=12) were male. The most common injury mechanism was road traffic accident.
Safety and feasibility were the primary outcomes, as measured by lack of adverse events or clinical interruptions, and successful acquisition and storage of data. The secondary outcome was the quality of acquired video clips according to validated criteria, in order to determine whether useful data could be obtained in this emergency context.
Video-microscopy was successfully performed and stored for analysis for all patients, yielding 161 video clips. There were no adverse events or episodes where clinical management was affected or interrupted. There were 104 (64.6%) video clips from 14 patients of sufficient quality for analysis.
Early sublingual microcirculatory monitoring in the ED for patients with THS is safe and feasible, even in a deployed military setting, and yields videos of satisfactory quality in a high proportion of cases. Further investigations of early microcirculatory behaviour in this context are warranted.
NCT02111109.
对于创伤性失血性休克（THS），舌下微循环监测可能比传统的血压和心输出量更能预测临床结局，但通常要等到患者进入重症监护病房（ICU）才进行，从而错过一些可能具有重要意义的早期数据。这项初步研究首次评估了在急诊科（ED）对THS患者进行舌下视频显微镜检查的可行性和安全性，以及能否获取可用于分析的数据。
作为前瞻性观察性MICROSHOCK研究的一部分，进行了安全性和可行性评估；舌下视频显微镜检查在阿富汗巴斯蒂安营地由英国主导的3级医疗设施以及英国3个主要创伤中心的急诊科进行。
15名伤员（2名军人，13名平民），均表现为创伤性失血性休克，损伤严重程度评分中位数为26。年龄中位数为41岁；大多数（n = 12）为男性。最常见的致伤机制是道路交通事故。
安全性和可行性是主要结局指标，通过无不良事件或临床干扰以及成功采集和存储数据来衡量。次要结局指标是根据经过验证的标准评估采集到的视频片段的质量，以确定在这种紧急情况下能否获得有用的数据。
所有患者均成功进行了视频显微镜检查并存储用于分析，共获得161个视频片段。没有出现不良事件，也没有出现影响或中断临床管理的情况。14名患者的104个（64.6%）视频片段质量足以进行分析。
即使在部署的军事环境中，对THS患者在急诊科进行早期舌下微循环监测也是安全可行的，并且在很大比例的病例中能获得质量令人满意的视频。有必要在此背景下对早期微循环行为进行进一步研究。
NCT02111109。
