Can near-infrared spectroscopy identify the severity of shock in trauma patients?
BACKGROUND
Our recent experimental study showed that peripheral muscle tissue oxygen saturation (StO2), determined noninvasively by near-infrared spectroscopy (NIRS), was more reliable than systemic hemodynamics or invasive oxygenation variables as an index of traumatic shock. The purpose of this study was to establish the normal range of thenar muscle StO2 in humans and the relationship between shock state and StO2 in trauma patients.


METHODS
This was a prospective, nonrandomized, observational, descriptive study in normal human volunteers (n = 707) and patients admitted to the resuscitation area of our Level I trauma center (n = 150). To establish a normal StO2 range, an NIRS probe was applied to the thenar eminence of volunteers (normals). Subsequently, in a group of trauma patients, an NIRS probe was applied to the thenar eminence and data were collected and stored for offline analysis. StO2 monitoring was performed continuously and noninvasively, and values were recorded at 2-minute intervals. Five moribund trauma patients were excluded. Members of our trauma faculty, blinded to StO2 values, classified each patient into one of four groups (no shock, mild shock, moderate shock, and severe shock) using conventional physiologic parameters.


RESULTS
Mean +/- SD thenar StO2 values for each group were as follows: normals, 87 +/- 6% (n = 707); no shock, 83 +/- 10% (n = 85); mild shock, 83 +/- 10% (n = 19); moderate shock, 80 +/- 12% (n = 14); and severe shock, 45 +/- 26% (n = 14). The thenar StO2 values clearly discriminated the normals or no shock patients and the patients with severe shock (p < 0.05).


CONCLUSIONS
Decreased thenar muscle tissue oxygen saturation reflects the presence of severe hypoperfusion and near-infrared spectroscopy may be a novel method for rapidly and noninvasively assessing changes in tissue dysoxia.
Crookes
Bruce A
BA
Division of Trauma, Burns and Critical Care, Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA.
Cohn
Stephen M
SM
Bloch
Scott
S
Amortegui
Jose
J
Manning
Ronald
R
Li
Pam
P
Proctor
Matthew S
MS
Hallal
Ali
A
Blackbourne
Lorne H
LH
Benjamin
Robert
R
Soffer
Dror
D
Habib
Fahim
F
Schulman
Carl I
CI
Duncan
Robert
R
Proctor
Kenneth G
KG
D000328:Adult; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D018482:Muscle, Skeletal / Q000378:metabolism*; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D012372:ROC Curve; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000378:metabolism*; D019265:Spectroscopy, Near-Infrared
D010100:Oxygen