David A Hampton1, Martin A Schreiber. 1. Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
Abstract
BACKGROUND: Pulse oximetry is routinely used to measure hemoglobin saturation and is currently the gold standard to assess oxygenation in patients. Due to attenuation of infrared light by skin, bone, and other organs, pulse oximetry cannot assess end-organ tissue oxygenation (StO(2)). Near infrared spectroscopy (NIS) penetrates a broad range of tissues and utilizes reflection rather than direct transmission between an emitter and receiver pair. NIS is able to measure StO(2) and assess end-organ perfusion in a variety of applications. STUDY DESIGN AND METHODS: A retrospective review of recent animal and human StO(2) studies was undertaken. StO(2) measurements and outcomes were assessed. RESULTS: StO(2) measurements identified visceral organ ischemia in animal hemorrhage models. These measurements were also able to guide optimization of resuscitation and end-organ oxygenation. Human studies demonstrated StO(2) changes preceded those seen in traditionally measured parameters such as blood pressure, heart rate, base deficit, serum lactate, and mental status. Additionally, StO(2) thresholds identified trauma patients who required massive transfusions, developed multiple organ dysfunction syndrome, or experienced lower extremity compartment syndrome. StO(2) measurements also demonstrated a benefit in selecting resuscitation fluids, assessing end-organ oxygenation during blood transfusion, and quantifying the oxygen-carrying deficit secondary to the blood storage lesion. CONCLUSION: StO(2) measurements have been used to guide resuscitation efforts in trauma patients. This technology and its applications continue to evolve and represent a novel change in patient care.
BACKGROUND: Pulse oximetry is routinely used to measure hemoglobin saturation and is currently the gold standard to assess oxygenation in patients. Due to attenuation of infrared light by skin, bone, and other organs, pulse oximetry cannot assess end-organ tissue oxygenation (StO(2)). Near infrared spectroscopy (NIS) penetrates a broad range of tissues and utilizes reflection rather than direct transmission between an emitter and receiver pair. NIS is able to measure StO(2) and assess end-organ perfusion in a variety of applications. STUDY DESIGN AND METHODS: A retrospective review of recent animal and human StO(2) studies was undertaken. StO(2) measurements and outcomes were assessed. RESULTS: StO(2) measurements identified visceral organ ischemia in animal hemorrhage models. These measurements were also able to guide optimization of resuscitation and end-organ oxygenation. Human studies demonstrated StO(2) changes preceded those seen in traditionally measured parameters such as blood pressure, heart rate, base deficit, serum lactate, and mental status. Additionally, StO(2) thresholds identified traumapatients who required massive transfusions, developed multiple organ dysfunction syndrome, or experienced lower extremity compartment syndrome. StO(2) measurements also demonstrated a benefit in selecting resuscitation fluids, assessing end-organ oxygenation during blood transfusion, and quantifying the oxygen-carrying deficit secondary to the blood storage lesion. CONCLUSION: StO(2) measurements have been used to guide resuscitation efforts in traumapatients. This technology and its applications continue to evolve and represent a novel change in patient care.
Authors: Laurence Weinberg; Irene Kearsey; Clarissa Tjoakarfa; George Matalanis; Sean Galvin; Scott Carson; Rinaldo Bellomo; Larry McNicol; Peter McCall Journal: World J Clin Cases Date: 2014-10-16 Impact factor: 1.337