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Tissue Oxygen Saturation Predicts the Development of Organ Dysfunction During Traumatic Shock Resuscitation

Cohn, Stephen M. MD; Nathens, Avery B. MD, PhD, MPH; Moore, Frederick A. MD; Rhee, Peter MD, MPH; Puyana, Juan Carlos MD; Moore, Ernest E. MD; Beilman, Gregory J. MD

The Journal of Trauma: Injury, Infection, and Critical Care: January 2007 - Volume 62 - Issue 1 - p 44-55
doi: 10.1097/TA.0b013e31802eb817
Original Articles
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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.

From the Department of Surgery, University of Texas Health Science Center, San Antonio, Texas (S.M.C.); Department of Surgery, University of Washington, Seattle, Washington (A.B.N.); Department of Surgery, University of Texas Health Science Center, Houston, Texas (F.A.M.); Department of Surgery, University of Southern California, Los Angeles, California (P.R.); Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (J.C.P.); Department of Surgery, University of Colorado, Denver, Colorado (E.E.M.); and Department of Surgery, University of Minnesota, Minneapolis, Minnesota (G.J.B.).

Submitted for publication October 16, 2006.

Accepted for publication November 10, 2006.

Presented at the 65th Annual Meeting of the American Association For the Surgery of Trauma, September 28–30, 2007, New Orleans, Louisiana.

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

© 2007 Lippincott Williams & Wilkins, Inc.