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Thresholded area over the curve of spectrometric tissue oxygen saturation as an indicator of volume resuscitability in porcine hemorrhagic shock

Zenker, S and Polanco, PM and Kim, HK and Torres, A and Vodovotz, Y and Clermont, G and Pinsky, MR and Severyn, DA and Puyana, JC (2007) Thresholded area over the curve of spectrometric tissue oxygen saturation as an indicator of volume resuscitability in porcine hemorrhagic shock. Journal of Trauma, 63 (3). 573 - 580. ISSN 0022-5282

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Abstract

A rapid, reliable, and noninvasive functional measure of responsiveness to resuscitation in posttraumatic hemorrhagic shock could prove useful in guiding therapy, especially under circumstances such as the battlefield and civilian mass casualties. Tissue oxygen saturation (Sto2) is a promising c and idate for this application. We therefore explored the value of peripheral muscle Sto2 in predicting systemic responsiveness to colloid volume resuscitation in a porcine model of hemorrhagic shock. Fourteen isoflurane-anesthetized piglets were subjected to a st and ardized hemorrhage protocol that maintained mean arterial pressure (MAP) between 30 and 40 mm Hg. Asanguineous resuscitation with a volume of Hextend equal to the total volume bled was initiated when compensation was exhausted (MAP <30 mm Hg). We recorded continuous MAP and Sto2 values, and calculated the contiguous area over the Sto2 curve yet below a given threshold of Sto2 (TAOC) as a function of this threshold before the selected timepoint for timepoints up to 30 minutes before resuscitation. Hemorrhage resulted in significant fluctuations of MAP and high interindividual variability of disease dynamics and outcome: 4 nonsurvivors and 10 survivors at 2 hours postresuscitation. Sto2 measurements reflected hemodynamic conditions in most animals, with a pronounced drop preceding final decompensation in 7 of 14 animals. TAOC discriminated three of four nonresuscitable (nonsurvivor) animals from the survivors, with group differences reaching significance even for the earliest examined timepoint (30 minutes before resuscitation), depending on the choice of TAOC threshold. Sto2 may serve as a marker of decompensation, whereas TAOC, a physiologically motivated correlate of perfusion debt and cumulative hypoperfusion injury, may be a useful early indicator of responsiveness to volume resuscitation in hemorrhagic shock. © rofessor of Surgery and Critical Care, Director Applied Research, Innovative Medical and Information Technology Center, UPMC, F1265 Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213-2536; email: puyanajc@upmc.edu.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Zenker, S
Polanco, PM
Kim, HKhyk11@pitt.eduHYK11
Torres, A
Vodovotz, Y
Clermont, Gcler@pitt.eduCLER
Pinsky, MRpinsky@pitt.eduPINSKY
Severyn, DA
Puyana, JC
Date: 1 January 2007
Date Type: Publication
Journal or Publication Title: Journal of Trauma
Volume: 63
Number: 3
Page Range: 573 - 580
DOI or Unique Handle: 10.1097/ta.0b013e31812f6095
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0022-5282
PubMed ID: 18073603
Date Deposited: 05 Mar 2012 17:20
Last Modified: 02 Feb 2019 16:58
URI: http://d-scholarship.pitt.edu/id/eprint/11188

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