Garcia Mancebo Julia, Sack Kristen, Romfh Padraic, Peng Yifeng, Kheir John
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
Pendar Technologies, Cambridge, Massachusetts, USA.
Trauma Surg Acute Care Open. 2024 Aug 24;9(1):e001480. doi: 10.1136/tsaco-2024-001480. eCollection 2024.
Mixed venous saturation (SvO2) is considered the gold standard to assess the adequacy of tissue oxygen delivery (DO2) in shock states. However, SvO2 monitoring is challenging as it requires an invasive catheter and frequent blood sampling. Non-invasive methods, including near-infrared spectroscopy, have demonstrated low sensitivity to tissue dysoxia.
We fabricated a new device that uses resonance Raman spectroscopy (RRS) to quantify oxyhemoglobin saturation (ShbO2) in the esophagus (eShbO2), tongue (tShbO2), and liver (hShbO2). In two rat models of hemorrhagic shock, we quantified (1) The correlation of RRS-measured ShbO2 to SvO2 during progressive hemorrhage (n=20) and (2) The value of these metrics to predict near-term mortality in fixed, severe hemorrhage (mean blood pressure =25 mm Hg; n=18).
In model 1, eShbO2 (r=0.705, p<0.0001) and tShbO2 (r=0.724, p<0.0001) correlated well with SvO2 and with serum lactic acid (eShbO2-lactate r=0.708, p<0.0001; tShbO2-lactate r=0.830, p<0.0001). hShbO2 correlated poorly with both SvO2 and lactic acid. Using time-matched ShbO2-SvO2 pairs, the performance of ShbO2 to detect severe tissue hypoxia (SvO2<20%) was excellent (AUC 0.843 for eShbO2, 0.879 for tShbO2). In model 2, eShbO2 showed a maximized threshold of 40% with 83% of animals dying within 45 minutes of this cut-off, demonstrating accuracy as a monitoring device. This was similar for tShbO2, with a threshold of 50%, predicting death within 45 minutes in 76% of animals. ShbO2 showed superior sensitivity to invasive monitoring parameters, including MABP<30 mm Hg (sensitivity 59%), pulse pressure<15 mm Hg (sensitivity 50%), and heart rate>220 bpm (sensitivity 39%, p=0.004).
eShbO2 represents a new paradigm to assess the adequacy of DO2 to a tissue. It constitutes a promising monitoring method to evaluate tissue oxygen saturation in real time and non-invasively, correlating with SvO2 and time to death.
Level III, therapeutic/care management.
混合静脉血氧饱和度（SvO2）被认为是评估休克状态下组织氧输送（DO2）充足性的金标准。然而，SvO2监测具有挑战性，因为它需要侵入性导管和频繁的血液采样。包括近红外光谱在内的非侵入性方法对组织缺氧的敏感性较低。
我们制造了一种新设备，该设备使用共振拉曼光谱（RRS）来量化食管（eShbO2）、舌头（tShbO2）和肝脏（hShbO2）中的氧合血红蛋白饱和度。在两种失血性休克大鼠模型中，我们量化了：（1）在渐进性出血期间，RRS测量的ShbO2与SvO2的相关性（n = 20）；（2）这些指标在预测固定严重出血（平均血压 = 25 mmHg；n = 18）近期死亡率方面的价值。
在模型1中，eShbO2（r = 0.705，p < 0.0001）和tShbO2（r = 0.724，p < 0.0001）与SvO2以及血清乳酸相关性良好（eShbO2与乳酸的相关性r = 0.708，p < 0.0001；tShbO2与乳酸的相关性r = 0.830，p < 0.0001）。hShbO2与SvO2和乳酸的相关性均较差。使用时间匹配的ShbO2 - SvO2对，ShbO2检测严重组织缺氧（SvO2 < 20%）的性能极佳（eShbO2的AUC为0.843，tShbO2的AUC为0.879）。在模型2中，eShbO2的最大阈值为40%，在此阈值下83%的动物在45分钟内死亡，表明其作为监测设备的准确性。tShbO2情况类似，阈值为50%，预测76%的动物在45分钟内死亡。ShbO2对侵入性监测参数表现出更高的敏感性，包括平均动脉压< 30 mmHg（敏感性59%）、脉压< 15 mmHg（敏感性50%）和心率> 220次/分钟（敏感性39%，p = 0.004）。
eShbO2代表了一种评估组织DO2充足性的新范式。它构成了一种有前景的监测方法，可实时、非侵入性地评估组织氧饱和度，与SvO2和死亡时间相关。
III级，治疗/护理管理
