Cardiac troponin and skeletal muscle oxygenation in severe post-partum haemorrhage.
BACKGROUND
Cardiac troponin has been shown to be elevated in one-half of the parturients admitted for post-partum haemorrhage. The purpose of the study was to assess whether increased cardiac troponin was associated with a simultaneous alteration in haemoglobin tissue oxygen saturation in peripheral muscles in post-partum haemorrhage.


METHODS
Tissue haemoglobin oxygen saturation of thenar eminence muscle (StO2) was measured via near-infrared spectroscopy technology. Two sets of StO2 parameters (both isolated baseline and during forearm ischaemia-reperfusion tests) were collected at two time points: upon intensive care unit admission and prior to intensive care unit discharge. Comparisons were performed using Wilcoxon paired tests, and univariate associations were assessed using logistic regression model and Wald tests.


RESULTS
The 42 studied parturients, admitted for post-partum haemorrhage, had clinical and biological signs of severe blood loss. Initial cardiac troponin I was increased in 24/42 parturients (0.43 +/- 0.60 microrg/l). All measured parameters of muscular haemoglobin oxygen saturation, including Srecovery, were also altered at admission and improved together with improved haemodynamics, when bleeding was controlled. Multivariate analysis showed that muscular Srecovery <3%/second at admission was strongly associated with increased cardiac troponin.


CONCLUSIONS
Our study confirmed the high incidence of increased cardiac troponin, and demonstrated the simultaneous impairment in the reserve of oxygen delivery to peripheral muscles in parturients admitted for severe post-partum haemorrhage.
Heyer
Laurent
L
AP-HP, Department of Anesthesiology and Critical Care Medicine, University Paris 7, Hôpital Lariboisière, 2 Rue Ambroise Pare, 75010 Paris, France.
Mebazaa
Alexandre
A
Gayat
Etienne
E
Resche-Rigon
Matthieu
M
Rabuel
Christophe
C
Rezlan
Eva
E
Lukascewicz
Anne-Claire
AC
Madadaki
Catharina
C
Pirracchio
Romain
R
Schurando
Patrick
P
Morel
Olivier
O
Fargeaudou
Yann
Y
Payen
Didier
D
D000328:Adult; D005260:Female; D006801:Humans; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000378:metabolism*; D010101:Oxygen Consumption / Q000502:physiology*; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D019210:Troponin I / Q000097:blood*
D019210:Troponin I