Department of Surgery, Universitat Autònoma de Barcelona, Parc Taulí Hospital Universitari, Parc del Taulí 1, 08208, Sabadell (Barcelona), Spain.
Critical Care Department, Parc Taulí Hospital Universitari, Sabadell, Spain.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):307-315. doi: 10.1007/s00068-022-02068-w. Epub 2022 Sep 2.
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.
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 (rSO) 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 rSO (rSOmin), Delta-down (rSO-rSOmin), maximal rSO following cuff-release (rSOmax), and Delta-up (rSOmax-rSOmin) were computed. The NIRS response to the occlusion test was also measured in a control group of healthy volunteers.
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, rSOmin, and Delta-up.
After 8 h of care, NIRS evaluation with an occlusion test is helpful for identifying occult shock in apparently hemodynamically stable patients.
IV, descriptive observational study.
ClinicalTrials.gov Registration Number: NCT02772653.
初始复苏后持续隐匿性低灌注与严重创伤后发病率和死亡率增加密切相关。本研究的目的是分析局部组织氧合以及其他全局标记物，作为隐匿性休克的潜在检测指标，用于其他血流动力学稳定的创伤患者。
对接受积极复苏的创伤患者在入院后 8 小时进行评估，测量多项全局和局部血流动力学/代谢参数。将明显血流动力学稳定（AHD）患者定义为收缩压≥90mmHg、心率<100bpm 且无血管加压药支持的患者，对其进行 48 小时随访，并最终根据持续出血（定义为需要额外输血）、开始使用血管加压药以及/或手术和/或血管栓塞控制出血的需要进行分类。如果需要任何干预，则将患者标记为“隐匿性休克”（OS），如果不需要干预，则标记为“真正血流动力学稳定”（THD）。通过近红外光谱（NIRS）在手前臂上进行非侵入性测量局部组织氧合（rSO）。进行血管闭塞试验，允许在闭塞释放后进行 3 分钟去氧和再氧合期。计算最小 rSO（rSOmin）、下降量（rSO-rSOmin）、闭塞释放后最大 rSO（rSOmax）和上升量（rSOmax-rSOmin）。还在一组健康志愿者的对照组中测量了 NIRS 对闭塞试验的反应。
共纳入 66 例连续创伤患者。在 8 小时后，17 例患者被归类为 AHD，其中 5 例最终被认为存在 OS，12 例为 THD。两组之间没有观察到血流动力学、代谢或凝血异常的差异，而 NIRS 衍生参数在下降量、rSOmin 和上升量方面存在统计学显著差异。
在 8 小时的护理后，通过闭塞试验进行 NIRS 评估有助于识别明显血流动力学稳定患者中的隐匿性休克。
IV，描述性观察研究。
ClinicalTrials.gov 注册号：NCT02772653。
