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Continuous Noninvasive Tissue Oximetry in the Early Evaluation of the Combat Casualty: A Prospective Study

Beekley, Alec C. MD; Martin, Matthew J. MD; Nelson, Teresa MS; Grathwohl, Kurt W. MD; Griffith, Matthew MD; Beilman, Gregory MD; Holcomb, John B. MD

The Journal of Trauma: Injury, Infection, and Critical Care: July 2010 - Volume 69 - Issue 1 - p S14-S25
doi: 10.1097/TA.0b013e3181e42326
Original Article

Background: We hypothesized that near-infrared spectroscopy (NIRS)-derived tissue oxygenation saturation (StO2) could assist in identifying shock in casualties arriving to a combat support hospital and predict the need for life-saving interventions (LSIs) and blood transfusions.

Methods: We performed a prospective observational trial at a single US Army combat support hospital in Iraq from August to December 2007. Arriving casualties had NIRS-derived StO2 recorded in the emergency department. Minimum (StO2 min) and initial 2-minute averaged StO2 and tissue hemoglobin index readings were used as end points. Outcomes measured were requirement for LSIs, any blood transfusion, massive transfusion (>10 units in 24 hours), and early mortality. The data were subjected to univariate and multivariate logistic regression modeling.

Results: Of the 147 combat casualties enrolled in the trial, 72 (49%) required an LSI, 42 (29%) required blood transfusion, and 10 (7%) required massive transfusion. On multivariate logistic regression analysis of the whole study group, systolic blood pressure (SBP), international normalized ratio, tissue hemoglobin index, and hematocrit predicted blood transfusion with an area under the curve of 0.90 (0.84–0.96), with a confidence interval of 95%. When just the group with an SBP >90 was analyzed, independent predictors of patients requiring blood transfusion on logistic regression analysis were StO2 min (odds ratio of 1.35) and hematocrit (odds ratio of 2.66) for an area under the curve of 0.84 (0.76–0.92).

Conclusions: NIRS-derived StO2 obtained on arrival predicts the need for blood transfusion in casualties who initially seem to be hemodynamically stable (SBP >90). Further study of this technology for use in the resuscitation of trauma patients is warranted.

From the Department of General Surgery (A.C.B., M.J.M.), Madigan Army Medical Center, Tacoma, Washington; Technomics Research, LLC (T.N.), Minneapolis, Minnesota; Departments of Anesthesiology/Critical Care Medicine (K.W.G.) and Infectious Disease (M.G.), Brooke Army Medical Center, San Antonio, Texas; Department of Surgical Critical Care (G.B.), University of Minnesota, Minneapolis, Minnesota; and Division of Acute Care Surgery (J.B.H.), University of Texas Health Science Center, Houston, Texas.

Submitted for publication March 12, 2010.

Accepted for publication April 21, 2010.

The opinions and assertions contained in this article are solely the authors' private ones and are not to be construed as official or reflecting the views of the US Army or the US Department of Defense. This article was prepared by US Government employees and, therefore, cannot be copyrighted and may be copied without restriction.

Podium presented at the Western Trauma Association 39th Annual Meeting, Crested Butte, CO, February 2009.

Address for reprints: Alec C. Beekley, MD, FACS, Department of General Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Road, Ft. Lewis, WA 98431-1100; email:

© 2010 Lippincott Williams & Wilkins, Inc.