Handheld Tissue Oximetry for the Prehospital Detection of Shock and Need for Lifesaving Interventions: Technology in Search of an Indication?

Autor: Radowsky JS; R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD., DuBose JJ; Center for Sustainment for Trauma and Readiness Skills, Baltimore, MD., Scalea TM; R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD., Miller C; Air Force Research Laboratories, Baltimore, MD., Floccare DJ; Maryland Institute for Emergency Medical Services Systems, Baltimore, MD., Sikorski RA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., MacKenzie CF; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD., Hu P; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD., Rock P; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD., Galvagno SM; R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD. Electronic address: sgalvagno@som.umaryland.edu.
Jazyk: angličtina
Zdroj: Air medical journal [Air Med J] 2019 Jul - Aug; Vol. 38 (4), pp. 276-280. Date of Electronic Publication: 2019 Apr 25.
DOI: 10.1016/j.amj.2019.03.014
Abstrakt: Improved prehospital methods for assessing the need for lifesaving interventions (LSIs) are needed to gain critical lead time in the care of the injured. We hypothesized that threshold values using prehospital handheld tissue oximetry would detect occult shock and predict LSI requirements. This was a prospective observational study of adult trauma patients emergently transported by helicopter. Patients were monitored with a handheld tissue oximeter (InSpectra Spot Check; Hutchinson Technology Inc, Hutchinson, MN), continuous vital signs, and 21 laboratory measurements obtained both in the field with a portable analyzer and at the time of admission. Shock was defined as base excess ≥ 4 or lactate > 3 mmol/L. Eighty-eight patients were enrolled with a median Injury Severity Score of 16 (interquartile range, 5-29). The median hemoglobin saturation in the capillaries, venules, and arterioles (StO 2 ) value for all patients was 82% (interquartile range, 76%-87%; range, 42%-98%). StO 2 was abnormal (< 75%) in 18 patients (20%). Eight were hypotensive (9%) and had laboratory-confirmed evidence of occult shock. StO 2 correlated poorly with shock threshold laboratory values (r = -0.17; 95% confidence interval, -0.33 to 1.0; P = .94). The area under the receiver operating curve was 0.51 (95% confidence interval, 0.39-0.63) for StO 2 < 75% and laboratory-confirmed shock. StO 2 was not associated with LSI need on admission when adjusted for multiple covariates, nor was it independently associated with death. Handheld tissue oximetry was not sensitive or specific for identifying patients with prehospital occult shock. These results do not support prehospital StO 2 monitoring despite its inclusion in several published guidelines.
(Copyright © 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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