Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation.
BACKGROUND
Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock.


METHODS
The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements.


RESULTS
Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death.


CONCLUSIONS
NIRS-derived muscle StO2 measurements perform similarly to BD in identifying poor perfusion and predicting the development of MODS or death after severe torso trauma, yet have the additional advantages of being continuous and noninvasive.
Cohn
Stephen M
SM
Department of Surgery, University of Texas Health Science Center, San Antonio, Texas 78229, USA. cohn@uthscsa.edu
Nathens
Avery B
AB
Moore
Frederick A
FA
Rhee
Peter
P
Puyana
Juan Carlos
JC
Moore
Ernest E
EE
Beilman
Gregory J
GJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D018482:Muscle, Skeletal / Q000378:metabolism*; D010100:Oxygen / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012151:Resuscitation; D012680:Sensitivity and Specificity; D012774:Shock, Traumatic / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D019265:Spectroscopy, Near-Infrared; D014481:United States / Q000453:epidemiology
D010100:Oxygen