Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Feb;49(1):307-315.
doi: 10.1007/s00068-022-02068-w. Epub 2022 Sep 2.

Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock

Andrea Campos-Serra  1 , Jaume Mesquida  2 , Sandra Montmany-Vioque  3 , Pere Rebasa-Cladera  3 , Marta Barquero-Lopez  4 , Ariadna Cidoncha-Secilla  3 , Núria Llorach-Perucho  3 , Marc Morales-Codina  5 , Juan Carlos Puyana  6 , Salvador Navarro-Soto  3
Affiliations
Observational Study

Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock

Andrea Campos-Serra et al. Eur J Trauma Emerg Surg. 2023 Feb.

Abstract

Purpose: 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.

Methods: 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 (rSO2) 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 rSO2 (rSO2min), Delta-down (rSO2-rSO2min), maximal rSO2 following cuff-release (rSO2max), and Delta-up (rSO2max-rSO2min) were computed. The NIRS response to the occlusion test was also measured in a control group of healthy volunteers.

Results: 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, rSO2min, and Delta-up.

Conclusions: After 8 h of care, NIRS evaluation with an occlusion test is helpful for identifying occult shock in apparently hemodynamically stable patients.

Level of evidence: IV, descriptive observational study.

Trial registration: ClinicalTrials.gov Registration Number: NCT02772653.

Keywords: Hemodynamics; Microcirculation; Occult shock; Resuscitation; Trauma.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that might have influenced this study.

Figures

Fig. 1
Fig. 1
Flow chart illustrating the study recruitment and the final categorization of apparently HD stable patients
See this image and copyright information in PMC

References

    1. World Health organization. Global Health Observatory. Top 10 causes of death in 2016. https://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/.
    1. O’Reilly D, Mahendran K, West A, Shirley P, Walsh M, Tai N. Opportunities for improvement in the management of patients who die from haemorrhage after trauma. Br J Surg. 2013;100(6):749–55. 10.1002/bjs.9096. - PubMed
    1. Pfeifer R, Tarkin IS, Rocos B, Pape HC. Patterns of mortality and causes of death in polytrauma patients-Has anything changed? Injury. 2009;40(9):907–11. 10.1016/j.injury.2009.05.006. - PubMed
    1. Tisherman SA, Barie P, Bokhari F, Bonadies J, Daley B, Diebel L, et al. Clinical practice guideline: endpoints of resuscitation. J Trauma. 2004;57(4):898–912. 10.1097/01.TA.0000133577.25793.E5. - PubMed
    1. Petrosoniak A, Hicks C. Resuscitation resequenced: a rational approach to patients with trauma in shock. Emerg Med Clin N Am. 2018;36(1):41–60. 10.1016/j.emc.2017.08.005. - PubMed

Publication types

Associated data