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Can Near-Infrared Spectroscopy Identify the Severity of Shock in Trauma Patients?

Crookes, Bruce A. MD; Cohn, Stephen M. MD, FACS; Bloch, Scott BS; Amortegui, Jose MD; Manning, Ronald RN; Li, Pam RN; Proctor, Matthew S. BS; Hallal, Ali MD; Blackbourne, Lorne H. MD; Benjamin, Robert MD; Soffer, Dror MD; Habib, Fahim MD; Schulman, Carl I. MD; Duncan, Robert PhD; Proctor, Kenneth G. PhD

The Journal of Trauma: Injury, Infection, and Critical Care: April 2005 - Volume 58 - Issue 4 - p 806-816
doi: 10.1097/01.TA.0000158269.68409.1C
Original Articles
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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).

Conclusion: 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.

From the Division of Trauma, Burns and Critical Care, Department of Surgery, University of Vermont College of Medicine (B.A.C.), Burlington, Vermont, Department of Surgery, University of Texas Health Science Center (S.M.C.), San Antonio, Texas, and Divisions of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami School of Medicine (S.B., J.A., R.M., P.L., M.S.P., A.H., L.H.B., R.B., D.S., F.H., C.I.S., R.D., K.G.P.), Miami, Florida.

Submitted for publication April 29, 2004.

Accepted for publication January 13, 2005.

Supported by Office of Naval Research grants N000140210339 and N000140210035.

Presented at the 17th Annual Meeting of the Eastern Association for the Surgery of Trauma, Amelia Island, Florida, January 12–17, 2004; and at the 64th Annual Meeting of the Society of University Surgeons, Residents' Competition, February 12–14, 2003, Houston, Texas.

Address for reprints: Stephen M. Cohn, MD, FACS, Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900; email: cohn@uthscsa.edu.

© 2005 Lippincott Williams & Wilkins, Inc.